American Journal of Audiology最新文献

Background: Hearing loss is a highly prevalent sensory disability in older adults and has been increasingly linked to adverse mental health outcomes. However, longitudinal evidence on its association with depression, particularly in low- and middle-income countries, remains limited.

Objective: The objective of this study was to examine the prospective association between baseline self-perceived hearing loss and the onset of depression in older Chinese adults and to explore whether this association varies across demographic and clinical subgroups.

Method: In this prospective cohort study, we analyzed data from 2,324 community-dwelling adults aged ≥ 65 years who participated in the Chinese Longitudinal Healthy Longevity Survey. Self-perceived hearing status and depressive symptoms were assessed at baseline and during follow-up. The primary outcome was time to depression onset. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident depression. Models were progressively adjusted for sociodemographic, lifestyle, and health-related covariates. Stratified and interaction analyses were performed to examine potential effect modifiers.

Results: Baseline self-perceived hearing loss was significantly associated with an increased risk of incident depression (adjusted HR > 1.00, p < .001). This association remained statistically significant after adjusting for measured sociodemographic, lifestyle, and health-related covariates, although residual confounding from unmeasured factors cannot be excluded. Stratified Cox models showed consistent effects across subgroups defined by age, sex, and other clinical characteristics. No statistically significant interactions were detected. Participants with hearing loss had shorter depression-free survival than those with normal hearing.

Conclusions: This study demonstrates that self-perceived hearing loss is independently associated with an increased risk of depression after adjusting for measured covariates. These findings highlight the importance of considering hearing health in care for older adults, though interpretations should account for the subjective nature of the hearing measure used.

Supplemental material: https://doi.org/10.23641/asha.31580260.

Purpose: Musical ear syndrome (MES), or musical hallucinations, is a rare auditory phenomenon involving the perception of music in the absence of external stimuli. This case report presents an idiopathic occurrence of MES in a young female with normal hearing, highlighting the potential efficacy of structured auditory therapy in reducing symptom distress.

Method: A 19-year-old female reported vivid, complex musical hallucinations persisting for 2 years, without any psychiatric, neurological, or audiological abnormalities. Comprehensive audiological and neuropsychological assessments were conducted, including pure-tone audiometry, tympanometry, otoacoustic emissions, imaging, and standardized questionnaires (Tinnitus Handicap Inventory [THI]). A 12-session intervention involving psychoeducation, sound enrichment, and auditory retraining using patient-selected stimuli was implemented.

Results: Audiological and neurological evaluations were normal. The patient demonstrated progressive improvement with intervention: Her THI score reduced from 54 (moderate handicap) to 12 (slight handicap) over 3 months. Qualitative reports also indicated reduced intensity of hallucinations, improved emotional coping, and enhanced social engagement.

Conclusions: This case underscores the potential for nonpharmacological auditory interventions to alleviate MES-related distress, even in idiopathic cases with normal hearing. The findings challenge traditional assumptions linking MES strictly to hearing loss and support expanding diagnostic and therapeutic frameworks for younger populations.

Purpose: An Adult Cochlear Implant Aural Rehabilitation Special Interest Group was formed in 2023. Members represent interdisciplinary collaborators, including audiologists, speech-language pathologists, surgeons, nonclinical administrators, manufacturer/industry representatives, and researchers. Current perspectives of adult cochlear implant (CI) recipients regarding aural rehabilitation (AR) remain unknown and understudied. The aim of this study is to survey adult CI recipients to determine their perspectives on the AR process.

Method: A web-based national survey was sent to adult CI recipients through multiple channels. The survey asked recipients about their demographics, state of residence, hearing loss history, and device configuration. Questions probed recipients' experiences of learning about AR options, services used, definitions of AR, and perceived value of services received. Questions were also asked about barriers to AR services, preoperative counseling, and satisfaction with their decision to pursue a CI.

Results: A total of 115 CI recipients responded to the survey. Results revealed a relative lack of information provided to many CI recipients regarding AR services. Many CI recipients reported wishing they had received additional resources in the areas of music training and equipment troubleshooting. Most participants reported that both one-on-one clinician-guided AR and independent listening practice were effective methods of AR.

Conclusions: Findings shed light on current gaps in providing the most effective AR services, which will need to be addressed to optimize hearing health care and outcomes for adult CI recipients. Future work should include outreach to a broader representation of CI users to expand our understanding of AR resources, education, and limitations.

Purpose: The study compared spatial hearing in individuals with misophonia, by examining interaural time difference (ITD) and interaural level difference (ILD) thresholds, Virtual Acoustic Spatial Identification (VASI) scores, and potential correlations between these thresholds and the Amsterdam Misophonia Questionnaire (A-MISO-S).

Method: Standard group comparison consisting of 40 individuals with normal hearing was conducted. Participants were divided into two groups: 20 individuals with misophonia and 20 without misophonia (controls). Misophonia was diagnosed based on A-MISO-S scores. Behavioral assessments included ITD and ILD, and VASI tests (identification of eight virtual locations), which were carried out in a closed field environment (under headphones).

Results: Multivariate analysis of variance results showed that the misophonic group demonstrated significantly higher ITD thresholds and significantly lower overall VASI accuracy scores. This effect was also reflected in location-specific performance on VASI test, with markedly poorer scores at the R45 and L45 positions, compared to the nonmisophonic group. Correlational analysis showed significant negative correlation between A-MISO-S scores and VASI accuracy scores, in a misophonic group. Furthermore, Fisher discriminant analysis revealed that ITD and VASI are effective predictors of group segregation based on spatial hearing performance, with an overall classification accuracy of 95%.

Conclusions: The findings suggest that misophonia may be associated with reduced performance on binaural hearing tasks involving temporal cues (ITD) and spatial identification tasks (VASI). This may be secondary to limited cognitive resources in complex spatial tasks and altered binaural temporal processing in misophonics.

Background: Hearing aid verification ensures that appropriate audibility and access to the speech signal are provided to the hearing aid user. Best practice guidelines recommend evidence-based verification measures (on-ear real-ear aided response [REAR] and simulated REAR) to match the hearing aid output with prescribed targets. Skill development for measuring and interpreting REAR involves six stages: novice, advanced, beginner, competent, proficient, and expert. At the competent stage, trainees can perform entrustable professional activities independently, demonstrating sufficient competence for unsupervised practice.

Purpose: The purpose of this study was to obtain consensus on key competency criteria expected for audiologists performing hearing aid verification across the lifespan to ensure effective real-ear performance evaluation.

Method: A modified e-Delphi technique was used. In the preparatory stage, 54 preselected competency items were categorized into seven domains. In the first round of the survey, expert audiologists rated their level of agreement on a 7-point Likert scale ranging from strongly disagree to strongly agree for each competency. An a priori threshold of 70% was required for consensus.

Results: Twenty-nine expert audiologists completed the first survey round. Consensus was achieved for 52 out of the 54 competency items. Competencies related to calibration, equipment setup, and interpretation of REAR had over 90% agreement. Items not reaching initial consensus were revised for Round 2 based on expert feedback.

Conclusions: Results from Round 1 and the new consolidated items will be shared in Round 2. This study identifies key competencies for audiologists to perform on-ear and simulated REAR, forming the basis for knowledge, training, and improved clinical outcomes.

Purpose: Access to hearing health care remains a major issue for people with hearing and balance disorders across the lifespan. University audiology clinics are in a unique position to address these disparities in access, as they serve as training programs for future clinicians and health care centers. This study examined the accessibility of university audiology clinics in various domains including financial barriers, LGBTQ+-inclusive facilities, physical access, scheduling, transportation, financial assistance, and communication.

Method: Data on accessibility domains were collected via structured phone calls with clinic reception staff at university audiology clinics and websites. Distances between the nearest bus stop or rail station and the university audiology clinic were calculated and categorized based on the frequency of service. Responses and public transportation data were analyzed using descriptive statistics.

Results: University audiology clinics had a range of accessibility features, including ways to schedule an appointment, services for patients with limited English proficiency, financial assistance, disability accommodations, availability of gender-neutral restrooms, and extended clinic hours. Most offered standard scheduling by phone, written visit summaries, and accessible physical facilities, but fewer clinics provided services for extended hours, disability accommodations, or language support. Gaps identified include gender-inclusive restrooms, bilingual staffing, and financial assistance options for patients. The mean distance from the university clinic to the nearest bus stop was 0.206 mi, and the mean distance from the university clinic to the nearest rail station was 0.488 mi. Clinics are located in slightly more socially disadvantaged areas compared to the national average.

Conclusions: The findings provide data on the accessibility of university audiology clinics for patients from various backgrounds with differing needs (e.g., financial assistance, language support). Gaps in hearing health care access and areas for improvement of accessibility across areas such as language services, physical facilities, scheduling, and transportation for university audiology clinics are identified and discussed. Recommendations include asking about transportation options, scheduling considerations around transit schedules, installing clear signage, providing staff training, and offering tele-audiology appointments.

Supplemental material: https://doi.org/10.23641/asha.31235929.

Purpose: This study examined the extent to which spectral degradation and speaking style (child-directed vs. adult-directed speech) affect emotion recognition from prosodic cues and how these effects are modulated by concurrent tasks involving nonauditory sensory input.

Method: Adults with normal hearing completed an emotion recognition task under three conditions: alone (auditory single-task), concurrently with a low-load visual memory task (four identical images), and with a high-load visual memory task (four different images). Stimuli consisted of semantically neutral sentences spoken in five emotions (angry, happy, neutral, sad, and scared) and two speaking styles (child-directed and adult-directed). All sentences were vocoded to simulate spectral degradation. Emotion recognition was assessed using a single-interval, five-alternative, forced-choice paradigm, in which the participants were asked to indicate which of five emotions was associated with each heard sentence.

Results: Emotion recognition was significantly reduced for vocoded stimuli, as indicated by lower sensitivity (d') and prolonged reaction times (RTs). Child-directed speech led to better performance than adult-directed speech, although its facilitative effect was reduced under vocoded conditions. Dual-tasking impaired performance, with lower d' values in both dual-task conditions and slower RTs under high-load dual-task conditions. Crucially, dual-task effects did not significantly vary with spectral degradation or speaking style.

Conclusions: Top-down cognitive demands from cross-modal dual-tasking and bottom-up stimulus factors, such as spectral degradation and speaking style, independently influence emotion recognition from prosodic cues. These findings provide insight into how cochlear implant users perceive emotional speech in complex, multimodal environments.

Purpose: Digital and remote technologies are commonly used in audiology, which require digital literacy skills. The study objectives were to (a) assess digital literacy in adults with hearing loss attending an audiology clinic in Australia and (b) establish the relationship of digital literacy with demographic factors.

Method: A single-center, cross-sectional survey on self-report of skill and confidence with mobile technologies using two measures (a) the validated Mobile Device Proficiency Questionnaire-16 items (MDPQ-16), and (b) the short two-item Digital Literacy-2Q (DL-2Q) for clinical use asking about Mobile Skill and Mobile Confidence. The study sample was adults with primarily mild-moderate hearing loss (n = 110), aged 52-96 years (M = 73.9).

Results: Age was negatively associated with MDPQ-16 scores, r(108) = -0.454, p < .001. However, in the mid-age range 65-85 years, more than twice as many participants (69.7%) had good mobile proficiency compared to those who had poorer mobile proficiency (30.3%). For the DL-2Q, the 92% who rated themselves as competent, and the 58.3% and 41.0% who rated themselves as confident or depends on task, respectively, had good MDPQ-16 scores. However, in 25% there was a mismatch between ratings of competent and confident. No other demographic factors were significantly associated with digital literacy.

Conclusions: Although age overall was a factor in digital literacy, there were many older adults attending audiology appointments who were shown to have good digital literacy, irrespective of their age. The DL-2Q is a quick and easy measure to assess digital literacy in audiology clinics. This can help to ensure that age is not barrier to remote hearing health technologies, which should be accessible to all those who would benefit.

Supplemental material: https://doi.org/10.23641/asha.30853604.

Purpose: Controlled clinical trials demonstrate the safety and efficacy of new treatments, but real-world outcomes may vary due to patient diversity and treatment variations. Tinnitus, affecting 10%-15% of the population, is a major health concern. Lenire, a bimodal neuromodulation treatment combining sound and tongue stimulations, has shown safety and effectiveness in clinical trials. This study presents the first real-world evidence (RWE) from a U.S. cohort that investigates tinnitus subgroup severities, providing further assessment of Lenire's use in clinical practice.

Method: A single-site, single-arm chart review of 140 patients treated between May 1, 2023, and January 19, 2024, was conducted. Patients were prescribed Lenire for up to 60 min daily and attended follow-ups at 6 and 12 weeks.

Results: This is the first study in a U.S. cohort to show results consistent with the U.S. Food and Drug Administration (FDA) labeling of Lenire, where positive therapeutic outcomes were achieved in patients with moderate or worse tinnitus severity as measured by the Tinnitus Handicap Inventory (THI). In this bothered tinnitus group, 81.8% (95% CI [70.9%, 89.3%]) achieved a clinically significant response (THI improvement ≥ 7 points) to treatment, with a mean reduction of -23.8 ± 2.3 points after only 12 weeks of treatment. In contrast, when providing Lenire treatment to tinnitus patients with less bothersome tinnitus (i.e., slight and mild categories), nearly zero change in score, on average, was observed after treatment. Additionally, responder rates based on an alternative threshold of at least an 11-point reduction in THI score show a high response to treatment even with this stricter minimal clinically important difference criterion, with 71.2% (95% CI [59.4%, 80.7%]) of the participants meeting or exceeding the threshold. Similar results were observed when using an alternative threshold based on an intrasubject percent improvement, defined as a reduction of at least 15% from each participant's THI score at the initial assessment.

Conclusions: Real-world data support Lenire's clinical benefits for patients with moderate or more severe tinnitus and demonstrate consistency with clinical trial results that led to FDA approval. These findings further confirm its successful integration into standard audiology care. Ongoing RWE collection will help identify the most responsive patients and guide tailored treatments.

Supplemental material: https://doi.org/10.23641/asha.31028449.

Purpose: Limited access to qualified professionals prevents children and adults with hearing loss from receiving timely care needed to mitigate the insidious impacts of hearing loss. Previous studies note the U.S. audiology workforce (~14,400 in 2022) is insufficient for meeting the growing hearing health care needs of the American population. The objective of the present study is to characterize the geographic dispersion of audiologists in Texas and to compare sufficiency using various benchmarks for identifying hearing health care shortage areas in the state.

Method: For each of the 254 Texas counties, geographic hearing health accessibility was assessed as a binary outcome (sufficient, insufficient) using three published provider-to-population ratio benchmarks (1:3,500 [primary care physicians]; 1:5,000 [dentists]; and 1:10,000 [educational audiologists]). Workforce sufficiency of licensed audiologists was then compared across Texas public health service regions (PHSRs), rurality categories, and U.S.-Mexico border designations.

Results: Results indicated that the audiologist workforce in Texas is insufficient to meet the hearing health care needs of the population in 96% of counties (244 of the 254). Most PHSRs were understaffed, with the exception of select counties in the Dallas metro area. Access to licensed audiologists was consistently limited, regardless of rurality or proximity to the U.S.-Mexico border.

Conclusions: The audiology workforce in Texas is insufficient to meet the hearing health care needs of the population. State-level public health, regulatory, and educational policies should prioritize addressing workforce shortages and audiology "deserts." Provision of audiology services via telehealth also represents a promising strategy for improving access in areas where no provider is present.

Supplemental material: https://doi.org/10.23641/asha.30781130.