American Journal of Audiology recent issues

Building on AJA's Legacy as a Pioneer [From the Editor]

Humes, L. E. — 2012-05-24T10:18:04-07:00

Providing Audiological Services to Individuals With Aphasia: Considerations, Preliminary Recommendations, and a Call for Research [Clinical Focus]

Silkes, J. P. — 2012-05-24T10:18:05-07:00

Purpose

The populations most susceptible to hearing loss and to aphasia overlap substantially, creating a high likelihood that audiologists will be called on to assess and treat individuals with aphasia. There is, however, scarce research available to guide best practices for serving this population.

Method

The available relevant literature is reviewed to summarize what is already known, providing basic information about aphasia and its potential impact on audiological diagnostic and intervention processes.

Conclusion

Suggestions for managing aphasia in the clinical audiology setting are provided, and areas of needed research are identified so that services for individuals with aphasia can be optimized.

A Comparison Between the First-Fit Settings of Two Multichannel Digital Signal-Processing Strategies: Music Quality Ratings and Speech-in-Noise Scores [Research Article]

Higgins, P., Searchfield, G., Coad, G. — 2012-05-24T10:18:05-07:00

Purpose

The aim of this study was to determine which level-dependent hearing aid digital signal-processing strategy (DSP) participants preferred when listening to music and/or performing a speech-in-noise task.

Method

Two receiver-in-the-ear hearing aids were compared: one using 32-channel adaptive dynamic range optimization (ADRO) and the other wide dynamic range compression (WDRC) incorporating dual fast (4 channel) and slow (15 channel) processing. The manufacturers' first-fit settings based on participants' audiograms were used in both cases. Results were obtained from 18 participants on a quick speech-in-noise (QuickSIN; Killion, Niquette, Gudmundsen, Revit, & Banerjee, 2004) task and for 3 music listening conditions (classical, jazz, and rock).

Results

Participants preferred the quality of music and performed better at the QuickSIN task using the hearing aids with ADRO processing. A potential reason for the better performance of the ADRO hearing aids was less fluctuation in output with change in sound dynamics.

Conclusion

ADRO processing has advantages for both music quality and speech recognition in noise over the multichannel WDRC processing that was used in the study. Further evaluations of which DSP aspects contribute to listener preference are required.

Effect of Rate-Alteration on Speech Perception in Noise in Older Adults With Normal Hearing and Hearing Impairment [Research Article]

Adams, E. M., Gordon-Hickey, S., Morlas, H., Moore, R. — 2012-05-24T10:18:05-07:00

Purpose

The purpose of this study was to evaluate the effect of using slow and fast speaking rates in competing noise on older adults with normal hearing (NH) and those with hearing impairment (HI).

Method

Thirty-four older adults (56–85 years) were grouped based on hearing ability—NH (N = 15) and HI (N = 19). Rate-altered Quick Speech-in-Noise Test (QuickSIN; Etymotic Research, 2001) stimuli were presented at 3 speech rates (slow, average, and fast), and the signal-to-noise ratio (SNR) loss was calculated for each.

Results

The older participants with HI had significantly higher SNR loss than the NH participants at all 3 speech rates. The NH participants showed improved speech perception in noise when a slow rate of speech was used. This benefit was not observed for the participants with HI. Both groups performed poorly with the fastest speech rate.

Conclusion

Results suggest that older adults with HI who are not wearing hearing aids are not able to take advantage of additional processing time afforded by the use of slow speaking rates when speech (70–75 dB HL) is presented in competing noise. Additionally, the use of a fast speaking rate significantly reduces an individual's ability to perceive speech in noise, regardless of hearing status. Decreasing from a fast speaking rate to an average rate is beneficial and should be recommended by audiologists to increase the likelihood of older adults understanding speech in noise.

Association Between Cardiorespiratory Fitness and Hearing Sensitivity [Research Article]

Loprinzi, P. D., Cardinal, B. J., Gilham, B. — 2012-05-24T10:18:05-07:00

Purpose

As a follow-up to previous smaller scale studies, the purpose of the present study was to examine the link between cardiorespiratory fitness and hearing sensitivity using a nationally representative U.S. sample of adults.

Method

Data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES; U.S. Centers for Disease Control and Prevention [CDC], 2011) were used in the analyses. After exclusions, the final sample included 1,082 NHANES participants ages 20–49 years. Maximum oxygen uptake (VO_2max) was obtained from an established nonexercise prediction equation and through heart-rate extrapolation during a treadmill-based submaximal test. Audiometry data were objectively measured to obtain estimates of low (LPTA) and high (HPTA) pure-tone frequency average.

Results

VO_2max was not associated with hearing sensitivity when using the heart-rate extrapolation method but was significantly associated with hearing sensitivity (for women) when applying the nonexercise prediction equation for both LPTA and HPTA (p < .01). Women with higher predicted cardiorespiratory fitness were 6% more likely than women with lower predicted cardio-respiratory fitness to have good hearing compared to worse hearing.

Conclusion

Cardiorespiratory fitness was associated with hearing sensitivity when using the nonexercise prediction equation to measure VO_2max. Further studies are needed to confirm these findings. Findings suggest a potentially auditory-protective effect of cardiorespiratory fitness.

The Awareness of the Profession of Audiology Among Entering College Students [Research Article]

Emanuel, D. C., Donai, J. J., Araj, C. F. — 2012-05-24T10:18:05-07:00

Purpose

The purpose of this study was to develop and pilot test a survey of entering college students' awareness of the profession of audiology and to report the preliminary results of the survey.

Method

A survey was developed and administered in 2003 at the California University of Pennsylvania. A modified survey was administered in 2009. Survey questions asked students to identify what audiologists do and the education requirements to become an audiologist.

Results

Seventeen percent of the students self-reported that they knew what an audiologist did and were able to accurately describe the profession. Approximately 30% of the students learned about audiology from family/friends. Students reported selecting their major based on interest in a specific field and not on market-driven forces such as job opportunities and salary.

Conclusion

Future surveys should be conducted to confirm the extent of the lack of visibility of audiology as a profession and to serve as a metric for the efficacy of future marketing efforts in the profession.

Assessing the Development of Binaural Integration Ability With the French Dichotic Digit Test: Ecoute Dichotique de Chiffres [Research Article]

Jutras, B., Mayer, D., Joannette, E., Carrier, M.-E., Chenard, G. — 2012-05-24T10:18:05-07:00

Purpose

Binaural integration is assessed by dichotic listening tests. This study aimed to assess the development of binaural integration ability using a newly developed dichotic digit test in French.

Method

Twenty-eight children with normal hearing sensitivity and binaural integration capacity, assessed with a dichotic listening word test, participated in the study. The children were divided into 3 groups: nine 6-year-olds, nine 9-year-olds, and ten 12-year-olds. They completed 4 subtests with earphones at normal conversational level. Three subtests consisted of 1, 2, and 3 different digit pairs, respectively, between 1 and 9 that were sent dichotically to the ears. The fourth subtest consisted of 4 digits, but only the 2 middle digits were sent dichotically.

Results

Performance improved significantly as a function of age and decreased with increasing number of digits to be repeated. All groups performed significantly better on digits presented in the right ear than the left ear, and on the digit rather than the word test.

Conclusion

The new French dichotic digit test would be useful in assessing binaural integration in children. The 4 subtests make it suitable for inclusion in a test battery to assess central auditory processing in children and are an alternative, especially the fourth subtest, to the French version of the Staggered Spondaic Word Test (Rudmin & Normandin, 1983).

Survey of Audiological Immittance Practices [Research Article]

Emanuel, D. C., Henson, O. E. C., Knapp, R. R. — 2012-05-24T10:18:05-07:00

Purpose

The purpose of this study was to examine current immittance practices and trends over time, reasons why multifrequency (MF) and multicomponent (MC) tympanometry have been underused, and the prevalence of negative patient reactions to acoustic reflex (AR) testing.

Method

Two audiological practice surveys were conducted regarding tympanometry (2008, n = 156) and AR (2009, n = 90).

Results

Most respondents conduct tympanometry and AR threshold (ART) testing. MF and MC tympanometry were rarely reported, generally due to a lack of equipment and training. ART testing was reported most often using both ipsilateral and contralateral presentation. Contralateral testing has decreased over time. Patient complaints of discomfort following AR testing were common. Complaints of tinnitus or hearing loss were present, although rare.

Conclusion

Tympanometry and ART tests have remained popular for the past 30 years, whereas acoustic reflex decay (ARD) testing has decreased in popularity. MF and MC tympanometry are conducted infrequently. AR is frequently associated with discomfort but rarely associated with other symptoms. However, one respondent reported that AR testing had caused permanent tinnitus and hearing loss.

Development and Evaluation of an English Language Measure of Detection of Word-Final Plurality Markers: The University of Western Ontario Plurals Test [Research Article]

Glista, D., Scollie, S. — 2012-05-24T10:18:05-07:00

Purpose

This article describes the development and evaluation of The University of Western Ontario (UWO) Plurals Test, which is an English language measure of detection of the word-final fricative cue for plurality.

Method

Normative data are provided for 26 listeners with normal hearing and 24 listeners with hearing impairment (children and adults), as are evaluations of the acoustical properties of the stimuli, the test's test–retest reliability, and the test's sensitivity to changes in hearing aid signal processing (e.g., nonlinear frequency compression).

Results

Results indicate reliable, repeated outcome measurement at the level of the individual. When compared to a global measure of real-world listening preference, the UWO Plurals Test was found to be somewhat sensitive to the effects of changes in hearing aid signal processing.

Conclusion

Findings suggest potential use of the UWO Plurals Test to evaluate aided and unaided ability of listeners between the ages of 6 and 81 years to detect the word-final fricatives /s/ and /z/ as they occur in English plural nouns.

Hearing Aid Processing Changes Tone Burst Onset: Effect on Cortical Auditory Evoked Potentials in Individuals With Normal Audiometric Thresholds [Research Article]

Easwar, V., Glista, D., Purcell, D. W., Scollie, S. D. — 2012-05-24T10:18:05-07:00

Purpose

The validity of using the cortical auditory evoked potential (CAEP) as an objective measure of hearing aid outcome has been questioned in the literature due to stimulus modifications caused by hearing aid processing. This study aimed to investigate the effects of hearing aid processing on the CAEP elicited with tone bursts that may have altered onsets.

Method

CAEPs to unprocessed and hearing aid–processed tone bursts were obtained from 16 individuals with normal audiometric thresholds when the onset time, level, and signal-to-noise ratio (SNR) were matched between the 2 conditions. Tone bursts processed by the hearing aid were recorded in an anechoic box and were presented through insert receivers. Unprocessed tone bursts were superimposed with hearing aid noise floor to match the SNR of the hearing aid–processed tone bursts.

Results

Shortening of rise time and overshoot at the onset of the tone burst were evident in the hearing aid–processed stimuli. Statistical analysis of data showed no significant effects of hearing aid processing on the latency or amplitude of CAEP peaks (p > .05).

Conclusion

The changes in rise time occurring in the tone bursts due to hearing aid processing may not confound CAEP measures that are used to validate hearing aid fitting.

Early Hearing Detection and Intervention: Parent Experiences With the Diagnostic Hearing Assessment [Research Article]

Larsen, R., Munoz, K., DesGeorges, J., Nelson, L., Kennedy, S. — 2012-05-24T10:18:05-07:00

Purpose

The aim of this study was to investigate parent experiences with the infant diagnostic hearing evaluation process.

Method

This study used a cross-sectional survey design. Surveys were distributed via parent support organizations in December 2009 to parents of children with hearing loss. A total of 416 completed surveys were received from 43 states.

Results

The median age of diagnosis of hearing loss has decreased over time from 11 months of age to 2 months. For babies born between 2006 and 2009, the most frequently reported challenge to obtaining a diagnostic hearing evaluation by 3 months of age was a delay in appointment availability (36%). Just >1/4 (27%) of parents reported that they did not feel comfortable in knowing what they needed to do next after talking with the audiologist at the time their child was diagnosed with hearing loss.

Conclusion

Significant progress has been made over the past 2 decades in reducing the age of hearing loss identification. However, many parents in this study experienced challenges that resulted in delays that exceeded Joint Committee on Infant Hearing (2007) recommendations of diagnosis by 3 months of age. The parent-reported experiences provide valuable information about areas that need further investigation to improve the early hearing detection and intervention process for children with hearing loss.

The Practical Hearing Aids Skills Test--Revised [Research Note]

Doherty, K. A., Desjardins, J. L. — 2012-05-24T10:18:05-07:00

Purpose

The purpose of the present study was to revise the Practical Hearing Aid Skills Test (PHAST; Desjardins & Doherty, 2009) for clinical use.

Method

The original PHAST 5-point rating scale was revised to a 3-point rating scale, and the battery and hearing aid cleaning skill tasks were revised to include additional actions necessary to perform these tasks. The revised version of the PHAST is referred to as the Practical Hearing Aid Skills Test—Revised (PHAST–R). The data obtained in the Desjardins and Doherty (2009) study with the original PHAST 5-point rating scale were re-analyzed in the present study using the PHAST–R 3-point rating scale. Also, the PHAST–R was piloted on 15 experienced hearing aid users in a clinical setting.

Results

The secondary data analysis of the original PHAST scores showed no significant difference between participants' percentage correct scores using the original PHAST 5-point rating scale and the PHAST–R 3-point rating scale. PHAST–R scores for the group of 15 experienced hearing aid users ranged from 61.29% to 100% (M = 88.48, SD = 12.6).

Conclusion

Clinicians were able to use the PHAST–R to quickly and objectively identify hearing aid orientation problems for which clients needed counseling and reinstruction.

The Challenge of Detecting Minimal Hearing Loss in Audiometric Surveys [Tutorial]

Schlauch, R. S., Carney, E. — 2012-05-24T10:18:05-07:00

Purpose

This tutorial provides framework and context for understanding the complex interaction of hearing measurement methodology and cohort social factors, as well as their relation to approaches to data interpretation and identification of minimal hearing loss (HL) in audiometric surveys.

Method

Pertinent archival studies were reviewed, and an original analysis on U.S. Centers for Disease Control and Prevention (CDC) audiometric survey data from children (ages 6–19) was performed.

Conclusion

The definition of an otologically normal individual, the pass–fail criterion representing the upper limit of the range of normal hearing, and the quality of the audiometry affect the percentage of persons who are falsely identified as having a minimal HL. An upper limit of normal hearing of 15 dB HL yields an unacceptably high false-positive rate, particularly when the more variable higher audiometric frequencies are examined. When air-conduction thresholds are assessed in isolation to estimate potential noise damage, the failure to exclude persons who have possible middle and external ear problems, including earwax, results in high false-positive rates. When these factors and other limitations are considered, audiograms from teens from a recent CDC survey do not show evidence consistent with widespread noise-induced HL. Suggestions are made to improve the effectiveness of pure-tone audiometry and the identification of minimal HL.

In Appreciation [From the Editor]

Pratt, S. R. — 2011-12-07T13:51:07-08:00

Survey of Audiologic Service Provision to Older Adults With Cochlear Implants [Clinical Focus]

Rossi-Katz, J., Arehart, K. H. — 2011-12-07T13:51:07-08:00

Purpose

This study examined whether audiologists modify practice patterns in their provision of cochlear implant (CI) services to older adults and, if so, whether the nature of such modifications is consistent across clinical sites.

Method

An online survey was sent to audiologists at CI centers across the United States. Questions addressed demographics, candidacy, programming, outcomes assessment, rehabilitation, and professional development.

Results

Responses were obtained from 47 audiologists who provided CI services to older adults. The majority of these audiologists did not report modifying CI practice patterns on the basis of age. Counseling appeared to be an exception: Audiologists reported that both the content and delivery of information were modified for older adults. Specific to CI candidacy with older adults, under half of the respondents indicated that assessing an older adult's cognitive status was part of their clinical protocol.

Conclusion

The audiologists who responded to the survey acknowledged issues related to aging when providing CI services to older adults. Despite this acknowledgment, the results of the survey suggest a gap in how age-related issues are incorporated into CI service provision. Continued discussion as to how CI services can be optimized for older adults is needed.

Is Measured Hearing Aid Benefit Affected by Seeing Baseline Outcome Questionnaire Responses? [Research Article]

Silverman, S., Cates, M., Saunders, G. — 2011-12-07T13:51:07-08:00

Purpose

To determine whether hearing aid outcome measured by the Hearing Handicap Inventory (HHI) for the Elderly/Adults (Newman, Weinstein, Jacobson, & Hug, 1990; Ventry & Weinstein, 1982) is differentially affected by informed vs. blind administration of the postfitting questionnaire.

Method

Participants completed the HHI at their hearing aid evaluation and again at their hearing aid follow-up visit. At follow-up, half received a clean HHI form (blind administration), whereas the remainder responded on their original form (informed administration) and could thus base their follow-up responses on those they gave at the hearing aid evaluation.

Results

The data show that for the population examined here, informed administration of the follow-up HHI did not yield a different outcome to blind administration of the follow-up HHI. This was not influenced by past hearing aid use, age of the participant, or the duration of time between baseline questionnaire completion and follow-up completion.

Conclusion

These data suggest that completion of follow-up questionnaires in either informed or blind format will have little impact on HHI responses, most likely because of the many other factors that combined to influence hearing aid outcome.

Development of the Screening Test for Hearing Problems [Research Article]

Demorest, M. E., Wark, D. J., Erdman, S. A. — 2011-12-07T13:51:07-08:00

Purpose

The goal of this study was to develop a brief self-assessment instrument to screen for communication problems and psychosocial adjustment to hearing impairment as part of a rehabilitative needs assessment.

Method

A pseudorandom sample of 1,000 cases was drawn from a large, heterogeneous clinical database containing audiometric data and responses to the Communication Profile for the Hearing Impaired (CPHI; Erdman & Demorest, 1998a). Item response theory was used to derive item-characteristic curves, and item selection was based primarily on item discrimination. Internal consistency, factor structure, sensitivity, and specificity of 2 scales, Communication and Adjustment, were evaluated in a holdout sample of 319 cases from the same database.

Results

A 9-item Communication scale and an 11-item Adjustment scale both showed satisfactory internal consistency, and the 20-item test presented a clear 2-factor structure. Sensitivity and specificity functions and positive and negative predictive values indicated that the 2 scales could be used to identify the bottom 2 quartiles of the clinical population, as defined by factor scores on the CPHI.

Conclusion

The 2 scales of the Screening Test for Hearing Problems can be used to screen for communication and adjustment problems that warrant a comprehensive rehabilitative assessment.

Ear Asymmetries and Asymmetric Directional Microphone Hearing Aid Fittings [Research Article]

Cord, M. T., Surr, R. K., Walden, B. E., Dittberner, A. B. — 2011-12-07T13:51:07-08:00

Purpose

To determine whether an asymmetry between ears for speech understanding in noise was related to performance with, or preference for, 1 of 2 asymmetric microphone fittings in which omnidirectional processing was provided to 1 ear and directional processing to the other.

Method

Twenty-eight adults with symmetric sensorineural hearing impairment were recruited from the clinic population. Sixteen individuals had symmetric hearing-in-noise ability between their right and left ears, and 12 participants had an asymmetry for speech understanding in noise between ears. A repeated measures design was used. Interactions between various microphone fittings and speech signal locations in noise were assessed in the laboratory. In addition, the listeners with asymmetry between ears for hearing in noise completed a field trial comparing the 2 fittings in everyday listening situations.

Results

Laboratory testing resulted in different patterns of performance for the 2 groups. Field trial results revealed that participants generally noticed little difference between the 2 fittings in everyday life and did not express a strong preference for 1 fitting over the other.

Conclusion

An asymmetry between ears for speech understanding in noise did not result in preference for 1 asymmetric fitting over the other in everyday listening situations.

Early Hearing Detection and Intervention: Diagnostic Hearing Assessment Practices [Research Article]

Munoz, K., Nelson, L., Goldgewicht, N., Odell, D. — 2011-12-07T13:51:07-08:00

Purpose

To gain an understanding of practice patterns for infant diagnostic hearing services at pediatric audiology facilities.

Method

The authors used a cross-sectional survey design. From August to November of 2009, surveys were mailed to 1,091 facilities in 28 states and the District of Columbia. One survey was completed per facility, and responses were anonymous.

Results

The return rate was 33% (356 surveys). The results revealed that the comprehensiveness of the test batteries used varied among facilities. Over half of the respondents, 146 (55%), reported using a limited test battery, 94 facilities reported using a comprehensive test battery but lacked at least 1 component recommended by the Joint Committee on Infant Hearing, and 25 facilities reported using a test battery that met Joint Committee on Infant Hearing recommendations. The wait time for an appointment varied between facilities (range = 3 days–5 months) and was affected by the test condition (i.e., natural sleep, sedation, or operating room).

Conclusions

The results suggest that it is difficult for stakeholders to identify pediatric audiology facilities that serve infants less than 6 months of age and that there is variability among facilities in test batteries and wait times for an appointment. Implications exist for diagnostic accuracy and timeliness of diagnosis.

Impact of Co-Occurring Birth Defects on the Timing of Newborn Hearing Screening and Diagnosis [Research Article]

2011-12-07T13:51:07-08:00

Purpose

Early detection of hearing loss in all newborns and timely intervention are critical to children's cognitive, verbal, behavioral, and social development. The initiation of appropriate early intervention services before 6 months of age can prevent or reduce negative developmental consequences. The purpose of this study was to assess, using large, population-based registries, the effect of co-occurring birth defects (CBDs) on the timing and overall rate of hearing screening and diagnosis.

Method

The authors linked statewide data from newborn hearing screenings, a birth defects registry, and birth certificates to assess the timeliness of newborn hearing screening and diagnosis of hearing loss (HL) for infants with and without CBDs in 485 children with confirmed HL.

Results

Nearly one third (31.5%) of children with HL had 1 or more CBDs. The presence of CBDs prolonged the time of the initial infant hearing screening, which contributed to further delays in the subsequent diagnosis of HL.

Conclusions

Better coordination of HL assessment into treatment plans for children with CBDs may enable earlier diagnosis of HL and provide opportunities for intervention that will affect long-term developmental outcomes for these children.

Effects of Transient Noise Reduction Algorithms on Speech Intelligibility and Ratings of Hearing Aid Users [Research Article]

DiGiovanni, J. J., Davlin, E. A., Nagaraj, N. K. — 2011-12-07T13:51:07-08:00

Purpose

The goal of this study was to assess the functional utility of transient noise reduction (TNR) algorithms available in hearing aids via speech intelligibility and user preferences.

Method

Two pairs of hearing aids, 1 pair each from Siemens and Unitron, were programmed for 17 hearing impaired individuals after a hearing evaluation. Intelligibility was measured for each participant for sentences presented in quiet, with 2 types of transient noise, multitalker babble, and in a combination of each type of transient noise and multitalker babble. Each condition was tested with TNR activated and TNR deactivated in a counterbalanced, single-blinded format. Subjective ratings of overall speech understanding, comfort, and sound quality were obtained for each condition.

Results

A significant improvement in speech intelligibility was measured with the TNR activated when speech was presented in multitalker babble, in the presence of chair clang transient noises, and when combining these noises. Activation of the TNR algorithm did not result in significant improvements for any of the subjective ratings.

Conclusions

While improvements were limited to certain conditions, specifically those with the chair clang transient and/or multitalker babble, TNR appears to offer an incremental step in improving the listening experience for hearing aid users.

Gabapentin for Tinnitus: A Systematic Review [Review]

Aazh, H., El Refaie, A., Humphriss, R. — 2011-12-07T13:51:07-08:00

Purpose

The main aim of this study was to assess the effect of gabapentin on tinnitus via a systematic review.

Method

An electronic search of literature as well as a hand search were conducted. Only double-blind randomized controlled trials (RCTs) that met all of the inclusion criteria were included in this review. The Cochrane Collaboration tool for risk of bias assessment was used to investigate the validity of the included studies. Meta-analysis was not appropriate due to inadequate details in reporting the data in the included studies. Hence, qualitative synthesis and interpretation of the data were carried out.

Results

Two studies that met the inclusion criteria were included in the review. Fourteen studies were excluded. There were substantive within-study clinical heterogeneities with regard to the baseline tinnitus handicap scores, duration of tinnitus, and severity of hearing loss in the included double-blind RCTs.

Conclusion

The authors of both studies reported that gabapentin was not superior to placebo in their primary outcomes. However, following the assessment of risk of bias and within-study clinical heterogeneities, this review concludes that there is insufficient evidence regarding the effect of gabapentin on tinnitus.

Audiologic Management of Auditory Neuropathy Spectrum Disorder in Children: A Systematic Review of the Literature [Review]

Roush, P., Frymark, T., Venediktov, R., Wang, B. — 2011-12-07T13:51:07-08:00

Purpose

This review summarizes current evidence related to the audiologic management of children with auditory neuropathy spectrum disorder (ANSD).

Method

A systematic search of the literature was conducted in 25 electronic databases (e.g., PubMed, CINAHL, and ERIC) using key words such as auditory neuropathy, auditory neuropathy spectrum disorder, auditory neuropathy/dyssynchrony, and hearing loss. Eighteen studies met the inclusion criteria by addressing 1 or more of 8 clinical questions. Studies were evaluated for methodological quality, and data regarding participant, intervention, and outcome variables are reported.

Results

Fifteen of the 18 studies addressed the use of cochlear implantation, and 4 addressed conventional acoustic amplification. All participants demonstrated improved auditory performance; however, all 18 studies were considered exploratory, and many had methodological limitations.

Conclusion

The clinical evidence related to intervention for ANSD is at a very preliminary stage. Additional research is needed to address the efficacy of acoustic amplification and cochlear implantation in children with ANSD and the impact of this disorder on developmental outcomes.

Cortical High-Gamma Responses in Auditory Processing [Tutorial]

Cervenka, M. C., Nagle, S., Boatman-Reich, D. — 2011-12-07T13:51:07-08:00

Purpose

This tutorial provides an introduction to cortical auditory spectral responses, focusing on event-related activity in the high-gamma frequencies (60–150 Hz), their recent emergence in neuroscience research, and potential clinical applications.

Method

Auditory high-gamma responses are described and compared with traditional cortical evoked responses, including the auditory evoked N1 response. Methods for acquiring and analyzing spectral responses, including time-frequency analyses, are discussed and contrasted with more familiar time-domain averaging approaches. Four cases are presented illustrating high-gamma response patterns associated with normal and impaired auditory processing.

Conclusions

Cortical auditory high-gamma responses may provide a useful clinical measure of auditory processing.

Including Service Learning in the Undergraduate Communication Sciences and Disorders Curriculum: Benefits, Challenges, and Strategies for Success [Using Service Learning to Enhance Undergraduate and Graduate Education in Audiology and Aural Rehabilitation]

Peters, K. A. — 2011-12-07T13:51:07-08:00

Purpose

To describe some of the benefits of service learning (SL), considerations in course development and construction, and implementation and outcomes of an SL course in the undergraduate communication sciences and disorders (CSD) program at a small, public university in northwest Washington.

Method

A review of the literature on SL and a description of the author's experience in course development are provided on the basis of a computerized database search, library search, and discussions with the Western Washington University Center for Service Learning.

Conclusions

Teaching an SL course can present challenges to both faculty and students; nonetheless, incorporating SL into the undergraduate CSD curriculum is an excellent way of enriching the academic experience and improving critical-thinking skills of young students. SL provides hands-on opportunities for students to apply what they are learning in their CSD classes to real-world contexts, gain a better understanding of course content through engagement in real situations, and integrate information from a variety of courses in and outside of their major.

Communication Connections: Service Learning and American Sign Language [Using Service Learning to Enhance Undergraduate and Graduate Education in Audiology and Aural Rehabilitation]

Reading, S., Padgett, R. J. — 2011-12-07T13:51:07-08:00

Purpose

This article describes a connection between service learning and American Sign Language (ASL) instruction. The Deaf community served as communication partners for university students, enabling them to use language skills in a natural setting.

Method

The rationale and implementation of pairing ASL with service learning are presented. A review of one study provides information about student perceptions of service learning, and a second study presents evidence about the development of ASL skills through a service learning experience.

Results

Service learning proved to be a valuable teaching method for ASL instruction, facilitating an increase in cultural awareness and ASL skills. Students' anecdotal evidence about service learning experiences indicated that they gained insights beyond just the improvement in language skills.

Conclusions

The connection between service learning and ASL instruction is advantageous because students gained cultural understanding as well as language skills. This course design could be used at other institutions where a Deaf community is accessible.

Addressing Qualified Personnel Shortages for Children Who Are Deaf or Hard of Hearing With an Interdisciplinary Service Learning Program [Using Service Learning to Enhance Undergraduate and Graduate Education in Audiology and Aural Rehabilitation]

Pakulski, L. A. — 2011-12-07T13:51:07-08:00

Purpose

To describe the student training benefits for speech-language pathology graduate students involved in an interdisciplinary, community-based intervention program at a Midwestern university for families of preschool children who were deaf or hard of hearing (DHH) and auditory-based spoken language users.

Method

The Auditory and Language Enriched Program was developed to provide graduate students with a clinically relevant service learning opportunity that also met some unique community needs of families in the community. Specifically, students learned to provide families with imaginative ways to expose their children who were DHH to language and literacy and nurture their natural curiosity and zest for learning.

Results

Statistically significant improvement was noted between pre- and postintervention questionnaires of knowledge and skill related to intervention for this population by a single group of students.

Conclusions

An interdisciplinary service learning approach to intervention might provide opportunities for university graduate programs to address the immediate and long-term needs of families who have chosen a spoken language outcome for their young children who are DHH while simultaneously providing invaluable experience with low-incidence populations for their preservice graduate students.

The Promise of Service Learning in a Pediatric Audiology Course on Clinical Training With the Pediatric Population [Using Service Learning to Enhance Undergraduate and Graduate Education in Audiology and Aural Rehabilitation]

Kaf, W. A., Strong, E. C. — 2011-12-07T13:51:07-08:00

Purpose

This study investigated the effectiveness of service learning (SL) and its impact on students' clinical competency, interest in pediatric audiology as a career, and levels of community engagement, as well as its impact on the community.

Method

Forty-eight students enrolled in an SL pediatric audiology course providing hearing and middle ear testing to 292 children, ages 6 months to 5 years. Another 10 non-SL students served as a control group. SL surveys were administered to students before and after the SL experience and post hoc to the non-SL group to assess their perceived readiness for evaluating children and their interest in pediatric audiology. Parents and community partner staff members completed another survey to provide feedback about their experience with the SL activity.

Results

The students' ratings were higher post-SL than pre-SL, and their learning gain was positively ranked post-SL compared with the non-SL group. Also, 71% of the SL students expressed positive interest in pediatric audiology post-SL compared with 37% of the non-SL group. Responses from community partners were also positive.

Conclusions

Embedding SL into a pediatric audiology course increased student interest in pediatric audiology as a career and enhanced readiness to evaluate young children.

Service Learning in Auditory Rehabilitation Courses: The University of Texas at Dallas [Using Service Learning to Enhance Undergraduate and Graduate Education in Audiology and Aural Rehabilitation]

Cokely, C. G., Thibodeau, L. M. — 2011-12-07T13:51:07-08:00

Purpose

The aim of this work was to review service learning (SL) principles and its implementation into the auditory rehabilitation (AR) curriculum at the University of Texas at Dallas and to evaluate the courses to determine whether potential benefits of SL are worth the substantial time commitment and course restructuring.

Method

Via retrospective review, student outcomes for 25 students from 3 cohorts who completed the adult AR course prior to implementation of SL curriculum (pre-SL) were compared with those of 28 students from 3 SL cohorts. Data included final examination grades, ratings for overall course content, amount learned, clarity of responsibility, workload, relevance, and course comments. Student journals from the SL group and mentor surveys also were reviewed.

Results

The majority of student outcomes were comparable for pre-SL and SL cohorts. Clarity of responsibility and workload were rated lower for SL courses than for pre-SL classes, with medium and small to medium effect sizes, respectively. Mentors rated the projects and process of high value and benefit, and several projects remain in use beyond the end of the course.

Conclusion

Continued use of an SL approach is supported, but additional guidance for students is needed for reflection and project analysis.

Effect of Interdisciplinary Service Learning Experience for Audiology and Speech-Language Pathology Students Working With Adults With Dementia [Using Service Learning to Enhance Undergraduate and Graduate Education in Audiology and Aural Rehabilitation]

Kaf, W. A., Barboa, L. S., Fisher, B. J., Snavely, L. A. — 2011-12-07T13:51:07-08:00

Purpose

An interdisciplinary service learning (SL) experience with audiology and speech-language pathology students was designed to examine changes in students' attitudes toward adults with dementia following an SL experience in which they socialized with nursing home residents who had dementia.

Method

Nineteen audiology and 24 speech-language pathology students completed an SL course, and 14 audiology and 18 speech-language pathology students did not participate in the SL course. The students interacted with 24 nursing home residents with dementia; specifically, the audiology students conducted 2 hearing evaluations with the residents, and the speech-language pathology students socialized with the residents during 15 visits. The students' attitudes toward older adults with dementia were assessed using Kogan's Attitudes Toward Old People Scale (Kogan, 1961) and qualitative analysis of their journal entries. The results were compared across groups over time.

Results

The SL groups showed more positive attitudes than the non-SL students, and their later journal entries were more positive than earlier entries.

Conclusions

This SL experience provided clinical opportunities for audiology and speech-language pathology students to work with adults with dementia. Direct contact with the residents resulted in more positive attitudes toward older adults in residential facilities.

War Injuries [From the Editor]

Pratt, S. R. — 2011-06-01T09:01:06-07:00

Computerized Administration and Scoring of the Dichotic Nonsense Syllable Test [Clinical Focus]

Lundeen, C. — 2011-06-01T09:01:06-07:00

Purpose

A user-friendly computer program was designed to administer the dichotic nonsense syllable test (DNST). Computer automation makes it easier for listeners to perform the response task appropriately and for audiologists to administer and accurately score the test.

Method

The program presents test stimuli in a user-controlled, self-paced sequence; provides an easy-to-use client interface to collect listener responses; verifies that appropriate responses are recorded before proceeding with the test; scores responses automatically; and stores the information in an electronic format that is easy to analyze and archive.

Results

The automated DNST protocol is described. Verification tests confirm the accuracy of stimulus sequencing, response recording, and test scoring.

Conclusions

Computer automation makes administering the DNST easier, ensures the accuracy of test scoring, and simplifies the analysis and archiving of results. These refinements may make the DNST more useful to clinicians. Further research is required to establish normative data for this version of the DNST.

Services for Children With Central Auditory Processing Disorder in the Republic of Ireland: Current and Future Service Provision [Clinical Focus]

Logue-Kennedy, M., Lyons, R., Carroll, C., Byrne, M., Dignan, E., O'Hagan, L. — 2011-06-01T09:01:06-07:00

Purpose

An interdisciplinary research group was established to investigate current and future service provision for children with central auditory processing disorder ([C]APD) in the Republic of Ireland. The aim of Phase 1 was to identify current awareness and knowledge of (C)APD among the relevant professionals in Ireland, including level of service provision, if any, available for children with (C)APD. The aim of Phase 2 was to explore the initial steps required to develop an integrated service for children presenting with (C)APD.

Method

A quantitative design was used in Phase 1, and 520 surveys were distributed to speech and language therapists, audiologic scientists, and educational psychologists. A qualitative participative design was used in Phase 2.

Results

There was a 53% response rate to the survey. The main findings from Phase 1 were that all professional groups considered themselves to be inadequately informed and lacking in skills for (C)APD assessment or intervention. In Phase 2, 98 participants with backgrounds in speech and language therapy, audiologic science, educational psychology, and occupational therapy engaged in interdisciplinary discussions to identify the first steps required to develop a (C)APD service.

Conclusion

All professional groups considered that they were inadequately informed about (C)APD, and the first steps required to develop services in Ireland include the promotion and development of interdisciplinary teamwork and education, a need for additional resources, a clearer understanding of the definition of (C)APD, and evidence-based assessment and management of this condition.

How "Proficient" Is Proficient? Subjective Proficiency as a Predictor of Bilingual Listeners' Recognition of English Words [Research Article]

Shi, L.-F. — 2011-06-01T09:01:06-07:00

Purpose

English proficiency must be considered when a bilingual individual is to be evaluated clinically with English speech material. This study describes the minimum level of self-reported English proficiency that identifies bilingual individuals who may perform on par with monolingual listeners on an English word recognition test.

Method

A total of 125 normal hearing bilingual listeners rated their English proficiency in listening, speaking, and reading on an 11-point scale. Other related linguistic variables were also obtained. A randomly selected Northwestern University Auditory Test No. 6 (NU-6) list (50 English monosyllabic words) was presented to all participants at 45 dB HL in quiet.

Results

Over 90% of the listeners self-rated to have at least "good" proficiency in English listening, speaking, or reading. Of these participants, more than 30% did not achieve a monolingual normative level in English as delimited by binomial distribution. Composite proficiency ratings across language domains better predicted word recognition performance than self-ratings for listening proficiency only. Combining language dominance and age of English acquisition with proficiency ratings further improved prediction specificity.

Conclusions

Self-rated English proficiency can predict bilingual listeners' performance on the NU-6 test. For desirable sensitivity and specificity in predicting monolingual-like performance, a minimum rating of 8 out of 10 across all language domains is recommended.

Noise-Induced Hearing Injury and Comorbidities Among Postdeployment U.S. Army Soldiers: April 2003-June 2009 [Research Article]

Helfer, T. M., Jordan, N. N., Lee, R. B., Pietrusiak, P., Cave, K., Schairer, K. — 2011-06-01T09:01:06-07:00

Purpose

To evaluate noise-induced hearing injury (NIHI) and blast-related comorbidities among U.S. Army soldiers in an effort to understand the morbidity burden and future health service requirements for wounded war fighters returning from the Central Command Area of Responsibility, predominantly from Iraq and Afghanistan deployments.

Method

Inpatient and outpatient records with diagnosed NIHI or blast-related comorbidities (e.g., significant threshold shift [STS], noise-induced hearing loss, tinnitus, sensorineural hearing loss, eardrum perforations, mild traumatic brain injury, and posttraumatic stress disorder) were extracted for active duty soldiers returning from combat deployments. Records were limited to those within 6 months of the soldier's return date from April 2003 through June 2009. To account for changes in STS coding practice, STS rates observed after October 1, 2006, were used to extrapolate prior probable postdeployment STS.

Results

Statistically significant increases were observed for tinnitus, dizziness, eardrum perforations, and speech-language disorders. The combination of observed and extrapolated STS yielded a conservative estimate of 27,427 cases.

Conclusions

Estimates can be used to forecast resource requirements for hearing services among veterans. This article could serve as a guide for resourcing and innovating prevention measures and treatment in this population. Data provided may also serve as a baseline for evaluating prevention measures.

Comparing Pure-, Pulsed, and Warbled Tone Thresholds in Adults at 3000 and 6000 Hz [Research Article]

Franklin, C. A., Franklin, T. C., Franklin, J. L. — 2011-06-01T09:01:06-07:00

Purpose

Pulsed and warbled tones are suitable substitutions for pure tones in hearing threshold measurement according to the 2005 American Speech-Language-Hearing Association guidelines. These guidelines also recommend measuring thresholds at 3000 and 6000 Hz. To date, there is no research directly supporting substitution of pulsed or warbled tones for pure tones at 3000 and 6000 Hz for listeners with normal hearing or with hearing loss. This study compared pure-, pulsed, and warbled tone thresholds at 3000 and 6000 Hz.

Method

Forty-seven adults with normal hearing and 16 adults with sensorineural hearing loss participated in this study. Air-conduction thresholds were elicited with pure tones at octave intervals from 250 to 8000 Hz and with pure-, pulsed, and warbled tone stimuli at 3000 and 6000 Hz.

Results

Small mean differences in thresholds were obtained using each of the 3 stimulus types for both listeners with normal hearing and hearing loss. Some of the mean differences tested were found to be statistically significant. The differences were nevertheless small and in all cases within the clinically accepted 5-dB step size.

Conclusion

Although substitutions did not violate the 5-dB step size, the slope of a listener's hearing loss may be a factor in the inaccuracy of measurement during the substitution of warbled tones for pure tones.

Survey of the Diagnosis and Management of Auditory Processing Disorder [Research Article]

Emanuel, D. C., Ficca, K. N., Korczak, P. — 2011-06-01T09:01:06-07:00

Purpose

A survey of audiologists' diagnosis and intervention protocols for auditory processing disorder (APD) was conducted to determine current protocols and compare results with published recommendations.

Method

A survey was distributed by mail to 515 American Speech-Language-Hearing Association audiology members who listed APD as an area of expertise and via e-mail to Educational Audiology Association members. The survey was completed by 195 audiologists.

Results

The majority of respondents reported using auditory processing (AP) test batteries selected based on clinical experience, review of the literature, and attendance at professional conferences. The most popular tests were dichotic, monaural low-redundancy speech, and temporal processing tests. Treatment and management recommendations were usually customized for each patient based on deficits found in behavioral AP testing. The majority of respondents indicated that audiologists are responsible for APD diagnosis (97%) and recommendation of treatment/management (81%); in contrast, only 40% of respondents indicated audiologists were responsible for providing treatment/management.

Conclusions

Audiologists are selecting AP test batteries based on the age and case history of the patient, which is in accordance with recent national guidelines. Audiologists are primarily responsible for APD diagnosis and recommending treatment/management. APD treatment is provided by speech-language pathologists, educators, and audiologists.

The Influence of Receiver Size on Magnitude of Acoustic and Perceived Measures of Occlusion [Article]

Vasil-Dilaj, K. A., Cienkowski, K. M. — 2011-06-01T09:01:06-07:00

Purpose

The current study examined measured and perceived occlusion for a receiver-in-the-canal (RIC) hearing aid with different-sized receivers. The relationship between these measures and ear canal volume was also investigated.

Method

Thirty adult participants were fitted with an RIC hearing aid and tested with 5 receiver size conditions. Measured occlusion effect was calculated from aided and unaided real-ear responses obtained while subjects vocalized /i/. Perceived occlusion measures were acquired using an occlusion effect scale.

Results

Measured occlusion was greatest for the largest receiver. The most common perceived occlusion ratings were none to mild occlusion for all receiver sizes. Perceived ratings were weakly correlated to acoustic measures. There was little to no correlation between receiver size and estimated ear canal volume.

Conclusions

Measured and perceived occlusion was minor in all receiver conditions. Occlusion was not correlated to ear canal volume, suggesting that RIC hearing aids most often result in negligible amounts of measured and perceived occlusion effect, regardless of ear canal size. Because no significant relationship existed between the occlusion measures, clinicians may need to consider that self-rating of occlusion may not match measured occlusion results.

Targeting Hearing Health Messages for Users of Personal Listening Devices [Review]

Punch, J. L., Elfenbein, J. L., James, R. R. — 2011-06-01T09:01:06-07:00

Purpose

To summarize the literature on patterns and risks of personal listening device (PLD) use, which is ubiquitous among teenagers and young adults. The review emphasizes risk awareness, health concerns of PLD users, inclination to take actions to prevent hearing loss from exposure to loud music, and specific instructional messages that are likely to motivate such preventive actions.

Method

We conducted a systematic, critical review of the English-language scholarly literature on the topic of PLDs and their potential effects on human hearing. We used popular database search engines to locate relevant professional journals, books, recent conference papers, and other reference sources.

Conclusions

Adolescents and young adults appear to have somewhat different perspectives on risks to hearing posed by PLD use. Messages designed to suggest actions they might take in avoiding or reducing these risks, therefore, need to be targeted to achieve optimal outcomes. We offer specific recommendations regarding the framing and content of educational messages that are most likely to be effective in reducing the potentially harmful effects of loud music on hearing in these populations, and we note future research needs.