A preliminary investigation into hearing aid fitting based on automated real-ear measurements integrated in the fitting software: test–retest reliability,matching accuracy and perceptual outcomes

Objective: The recent integration of automated real-ear measurements (REM) in the fitting software facilitates the hearing aid fitting process. Such a fitting strategy, TargetMatch (TM), was evaluated. Test–retest reliability and matching accuracy were quantified, and compared to a REM-based fitting with manual adjustment. Also, it was investigated whether TM leads to better perceptual outcomes compared to a FirstFit (FF) approach, using software predictions only.

Design and study sample: Ten hearing impaired participants were enrolled in a counterbalanced single-blinded cross-over study comparing TM and FF. Aided audibility, speech intelligibility and real-life benefits were assessed. Repeated measurements of both TM and REMs with manual adjustment were performed.

Results: Compared to a REM-based fitting with manual adjustment, TM had higher test–retest reliability. Also, TM outperformed the other fitting strategies in terms of matching accuracy. Compared to a FF, improved aided audibility and real-life benefits were found. Speech intelligibility did not improve.

Conclusions: Preliminary data suggest that automated REMs increase the likelihood of meeting amplification targets compared with a FF. REMs integrated in the fitting software provide additional reliability and accuracy compared to traditional REMs. Findings need to be verified in a larger and more varied sample.     

Tone-induced stereocilia lesions as a function of exposure level and duration in the hamster cochlea

The present study presents an atlas of the effects of 10 kHz tone exposures of different levels and durations on cochlear hair cells and their stereocilia in the Syrian golden hamster. Animals were sound exposed while under anesthesia. The exposure conditions were varied over an intensity range of 90–129 dB SPL; at the highest levels (126–129 dB SPL) the exposure periods were varied over a range of 30 min to 4 h. In animals with mild damage the lesions were commonly restricted to either the inner hair cells and/or the first row of outer hair cells; the order of damage susceptibility was IHC, OHC1, OHC2, OHC3. Damage to the second and third rows of outer hair cells were found only in animals with the severest lesions. Possible mechanisms underlying the row-specific distributions of these lesions and relative susceptibilities of the 4 rows of hair cells are discussed.     

MarkeTrak 2022: Insights into the Evolving Hearing Market: Hearing Health Outcomes as a Function of Age,Gender, and Diversity

The United States does not ensure equitable access to hearing health care for all age groups, largely because these services are costly and even unobtainable in some places. Barriers to care are discussed within a context of the social determinants of health, under-representativeness of hearing-care professionals from historically marginalized communities, older adults and age-related hearing loss, and associated health conditions. The MarkeTrak 2022 study generated a sample of 15,138 respondents with information on 43,597 individuals. Data analysis revealed that self-reported hearing difficulty appears to increase with age with a rate of 12.4% for adults 18 years of age and older. A substantial proportion of individuals with hearing difficulty assumed that their problem was age-related, followed by exposure to loud sound and noise. Individuals with hearing difficulty were nearly three to four times more likely to have tinnitus, cognitive problems, and issues with balance and falling than those with no hearing problems. Self-reported hearing difficulty was lower for historically marginalized groups (7%) than for the White population (12%). Recommendations are presented to reduce the burden of hearing difficulty and hearing aid deserts for rural and urban populations.     

Modelling the speech reception threshold in non-stationary noise in hearing-impaired listeners as a function of level

Abstract

The extended speech intelligibility index (ESII) model () forms an upgrade to the conventional speech intelligibility index model. For normal-hearing listeners the ESII model is able to predict the speech reception threshold (SRT) in both stationary and non-stationary noise maskers. In this paper, a first attempt is made to evaluate the ESII with SRT data obtained by , and of hearing-impaired listeners in stationary, 10-Hz interrupted, and non-stationary speech-shaped noise measured at different noise levels. The results show that the ESII model is able to describe the SRT in different non-stationary noises for normal-hearing listeners at different noise levels reasonably well. However, the ESII model is less successful in the case of predicting the SRT in non-stationary noise for hearing-impaired subjects. As long as the present audibility models cannot describe the auditory processing in a listener with cochlear hearing loss accurately, it is difficult to distinguish between raised SRTs due to supra-threshold deficits or factors such as cognition, age, and language skills.

Sumario

El modelo del Índice extendido de inteligibilidad del lenguaje (ESII) () constituye una actualización del modelo de índice convencional de inteligibilidad del lenguaje. Para oyentes con audición normal, el modelo del ESII es capaz de predecir el umbral de recepción del lenguaje (SRT) tanto ante enmascaradores de ruido estacionario y como no estacionario. En este trabajo, se realiza un primer intento para evaluar el ESII con datos del SRT obtenidos por Laat y Plomp (1983) y a partir de sujetos con hipoacusia, en ruido estacionario, con interrupciones de 10-Hz, y en ruido no estacionario con conformación de lenguaje, medido a diferentes niveles de intensidad. Los resultados muestran que el modelo ESII es capaz de describir el SRT razonablemente bien, para diferentes ruidos no estacionarios en sujetos normo-oyentes, a diferentes niveles de intensidad. Sin embargo, el modelo ESII es menos exitoso para predecir el SRT en ruido no estacionario con sujetos hipoacúsicos. En tanto que los modelos presentes de audibilidad no puedan describir el procesamiento auditivo en un sujeto con pérdida auditiva coclear en forma exacta, es difícil distinguir entre un SRT elevado debido a una deficiencia supra-umbral o a factores tales como cognición, edad o habilidad para el lenguaje.     

The binaural masking level difference as a function of frequency, masker level and masking bandwidth in normal-hearing and hearing-impaired listeners

Binaural masking level differences (MLDs) were measured for 10 normal-hearing and 10 cochlear-impaired listeners, at 500 and 2 000 Hz. Maskers were either wide-band (approximately 2 000 Hz), or narrow-band (50 Hz). For wide-band maskers the noise pressure spectrum level was 50 dB/Hz, and for the narrow-band maskers the noise levels were 50 and 60 dB/Hz. At 500 Hz the hearing-impaired listeners show abnormally low MLDs in wide-band noise, but not in narrow-band noise. At 2 000 Hz, the hearing-impaired subjects show abnormally low MLDs only in narrow-band noise at the 50 dB/Hz level. The clinical implications of the results are considered.     

Barriers to Cochlear Implant Access: Acknowledging the Challenges,Changing the Future: Functional Assessment of Hearing Aid Benefit: Incorporating Verification and Aided Speech Recognition Testing into Routine Practice

Potential cochlear implant (CI) candidates arrive to the clinic with a variety of hearing loss configurations, hearing aid history, and aided capabilities. CI candidacy is primarily determined based on aided speech recognition capability, which relies on benefit derived from use of hearing aids. Therefore, contemporary evaluation for CI candidacy should incorporate a battery of testing to determine abilities and limitations and must be predicated on appropriate verification of the hearing aid fitting. However, recent reports, including a retrospective chart review of patients presenting to Cleveland Clinic for CI evaluation, suggest that a significant subset of patients may be using inappropriately fit or programmed amplification. Thus, a combination of simulated real-ear measurements and aided speech recognition testing is essential for fully assessing the effect of amplification and ultimately determination of CI candidacy. Furthermore, waiting to incorporate these tools until CI candidacy is suspected may delay timely identification of problems or need to change technology. Utilization of evidence-based decision drivers ultimately leads clinicians to timely patient-specific interventions which may include surgical intervention or other amplification options. As audiology moves into a healthcare era in which payers consider the benefit of our services to overall health and well-being, demonstrating timely, optimal outcomes using thorough, multifactorial evaluation is essential.     

Choice of a tone-pip envelope for frequency-specific threshold evaluations by means of the middle-latency response: normally hearing subjects and slope of sensorineural hearing loss

The effects of stimulus rise-fall and plateau times on the middle-latency response (MLR) waveform (Na-Pa amplitude and Pa latency) were investigated in 14 normally hearing subjects and an objective MLR threshold was evaluated at low and middle frequencies in ten normally hearing subjects and ten patients with slope of sensorineural hearing loss, using a selected stimulus-envelope time. After analyzing the effects of envelope times on the MLR waveform and the spectra of tone-pips, it was found that a rise-fall time of 4 ms with a plateau of 2 ms (4–2–4) is an acceptable compromise between a synchronous discharge and frequency specificity for estimating the MLR threshold. The MLR threshold produced by 4–2–4 tone-pips approximated the psychoacoustic threshold at low and middle frequencies in the normal and hearing impaired subjects. This demonstrates the clinical usefulness of the MLR in estimating low- and middle-frequency thresholds.     

Computed tomography evaluation of the inner ear as a diagnostic,counselling and management strategy in patients with congenital sensorineural hearing impairment

The value of computed tomography (CT) of the petrous bone in the investigation of congenital sensorineural hearing impairment has been questioned. We have conducted a study to establish the usefulness of CT of the temporal bone in the evaluation and management of a consecutive series of unselected adolescent patients with congenital sensorineural hearing impairment of greater than 50 dB HL. Seventy-one patients (142 ears) were identified and images reviewed to establish the incidence of inner ear malformations. Fifteen ears were found to be abnormal in eight patients (seven bilateral and one unilateral abnormality). Three patients had Mondini abnormalities and one of these also had dilatation of the lateral semicircular canals. There were five patients with dilatation of the vestibular aqueduct. One patient had a unilateral dysplasia of the middle and external ear. A variety of incidental intracranial abnormalities were also discovered. We conclude that CT does have a valuable role in the management of SNHI.     

Response properties of the human frequency-following response (FFR) to speech and non-speech sounds: level dependence,adaptation and phase-locking limits

Abstract

Objective: The frequency-following response (FFR) is a neurophonic potential used to assess auditory neural encoding at subcortical stages. Despite the FFR’s empirical and clinical utility, basic response properties of this evoked potential remain undefined.

Design: We measured FFRs to speech and nonspeech (pure tone, chirp sweeps) stimuli to quantify three key properties of this potential: level-dependence (I/O functions), adaptation and the upper limit of neural phase-locking.

Study sample: n?=?13 normal-hearing listeners.

Results: I/O functions showed FFR amplitude increased with increasing stimulus presentation level between 25 and 80?dB SPL; FFR growth was steeper for tones than speech when measured at the same frequency. FFR latency decreased 4–5?ms with decreasing presentation level from 25 and 80?dB SPL but responses were ～2?ms earlier for speech than tones. FFR amplitudes showed a 50% reduction over 6?min of recording with the strongest adaptation in the first 60?s (250 trials). Estimates of neural synchronisation revealed FFRs contained measurable phase-locking up to ～1200–1300?Hz, slightly higher than the single neuron limit reported in animal models.

Conclusions: Findings detail fundamental response properties that will be important for using FFRs in clinical and empirical applications.     

Rhinitis,sinusitis and the yellow nail syndrome: a review of symptoms and response to treatment in 17 patients

A total of 17 patients with yellow nail syndrome are described. Their symptoms, age of onset and severity are examined with particular reference to the presence of rhinosinusitis. Fourteen of the patients (83%) suffered severe rhinosinusitis, which pre-dated nail changes in four, coincided with yellow nails in six, and occurred later in the remaining patients. In general, patients responded poorly to conventional medical and surgical treatment, with the exception of functional endoscopic sinus surgery (FESS) which may be of value in these patients. The frequent association of rhinosinusitis with yellow nails may warrant its recognition as part of the syndrome. Careful inspection of the fingernails in all patients presenting with severe rhinosinusitis is warranted.     

A comparison of the speech recognition and pitch ranking abilities of children using a unilateral cochlear implant, bimodal stimulation or bilateral hearing aids

Objective

The present study compared the speech recognition and pitch ranking abilities of normally hearing children (n = 15) to children using a cochlear implant (CI) alone (n = 8), bilateral hearing aids (HAs) (n = 6), or bimodal stimulation (BMS) (n = 9). It was hypothesised that users of BMS would score higher on tasks of speech and pitch perception than children using a CI alone, but not children using HAs.

Methods

Participants were assessed on tasks of monosyllabic word recognition in quiet, sentence recognition in quiet and noise (10 dB signal-to-noise ratio), and a pitch ranking task using pairs of sung vowels one, half, and a quarter of an octave apart.

Results

There were no significant differences between the mean percentage-correct scores of the four participant groups for either words in quiet or sentences in quiet and noise. However, the proportion of bimodal users who scored >80% correct (80%) was significantly greater than the proportion of high-scoring unilateral CI (25%) or bilateral HA users (17%). Contrary to expectations, there was also no significant difference between the pitch ranking scores of users of BMS and users of a CI alone for all three interval sizes (p < 0.05, RM-ANOVA). However participants using only acoustic hearing (i.e. the NH and HA groups) scored significantly higher than participants using electrical stimulation (i.e. the CI and BMS groups) on the pitch ranking task (p < 0.05; RM-ANOVA).

Conclusions

Contrary to findings in postlingually deafened adults, we found no significant bimodal advantage for pitch perception in prelingually deafened children. However, the performance of children using electrical stimulation was significantly poorer than children using only acoustic stimulation. Further research is required to investigate the contribution of the non-implanted ears of users of BMS to pitch perception, and the effect of hearing loss on the development of pitch perception in children.