American Journal of Audiology最新文献

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.

Purpose: The purpose of this study was to evaluate the benefit of the Apple AirPods Pro 2 Live Listen feature on speech recognition and recall in noise among older adults in a controlled laboratory setting.

Method: Twenty adults aged 60-90+ years completed a modified speech-in-noise task with and without AirPods using the Live Listen feature. A Quick Speech-in-Noise Test-derived task measured recognition and recall under both conditions. Participants also completed audiometric screening, working memory assessment, and signal-to-noise ratio (SNR) loss estimation. Paired t tests and multiple regression analyses were used to assess performance differences and predictors.

Results: Participants demonstrated significantly higher speech recognition (p < .00001) and recall (p = .00023) when using Live Listen. Recognition improvements were predicted by age, SNR loss, and sex, while recall improvements showed no significant predictors.

Conclusions: The Live Listen feature of the Apple AirPods Pro 2 significantly improved speech-in-noise performance in older adults. These preliminary findings support its potential as an affordable assistive tool in noisy environments, such as hospitals, where traditional hearing aids may be unavailable.

Purpose: Outcomes from an interprofessional preschool hearing health education curriculum, Love My Ears (LME), are presented. LME was developed by an audiologist, speech-language pathologist, and early childhood educator and was presented previously. The importance and efficacy of early hearing health education are discussed.

Method: LME was delivered as a 5-week pull-out program for three separate groups of six children each (total = 18) in a preschool educational setting. Three broad concept areas were taught: sound/hearing, volume/sound safety, and steps for hearing protection. Postprogram assessments were conducted and reported for 15 children (M_age = 4.9 years). The assessment evaluated knowledge of 12 concepts within the three broad concept areas. Descriptive statistics were used to evaluate the efficacy of the LME program. The number and percentage of children that correctly identified each of the concept items were tallied. A correct overall response of 80% or greater was considered indicative of the successful achievement of a concept item.

Results: Outcomes revealed the greatest accuracy (≥ 80%) in descriptive concepts related to sound/hearing (2/4), volume/sound safety (2/4), and hearing protection (4/4), supporting the efficacy of preschool hearing health education. Topic-specific vocabulary was less well learned.

Conclusion: These outcomes revealed that hearing health education using a specifically designed interprofessional curriculum such as LME is effective in a preschool population.

Purpose: Narrowband (NB) chirps have recently been of great interest in audiology for the electrophysiological assessment of hearing in infants, but clinicians have little information about these new stimuli and how they compare to more standard stimuli, such as 2-1-2-cycle tones. The current study examined the frequency specificity of NB chirps by comparing the spectral characteristics of 500-, 1000-, 2000-, and 4000-Hz NB CE-Chirp LS ("level-specific" version) stimuli with those of the 2-1-2 tones.

Method: Spectral characteristics, including center frequency (CF), bandwidth, and stimulus energy changes after stopband filtering, were compared. Bandwidth was computed as the difference between the upper and lower frequencies at the -20 and -3 dB cutoff points of the main lobe; CF was determined as the geometric mean of the upper and lower frequencies at the -20 and -3 dB cutoff points.

Results: At 100 dB peSPL, the bandwidths of the 500-, 1000-, and 2000-Hz NB CE-Chirp LS acoustic spectra were 1.8-1.9 times wider than those of the acoustic spectra for the 2-1-2 tones; the 4000-Hz NB CE-Chirp LS bandwidths were 1.4-1.5 times wider than those of the 2-1-2 tones. The energy of the NB CE-Chirp LS stimuli was concentrated within ±0.75 octave of the CF, compared to ±0.5 octave for 2-1-2 tones. These spectral characteristics did not change with stimulus intensity.

Conclusions: The NB CE-Chirp LS stimuli demonstrated poorer frequency specificity compared with that of the 2-1-2 tones. NB-chirp thresholds may therefore underestimate true thresholds, especially in steeply sloping hearing loss. Further studies are needed to investigate the cochlear place specificity of auditory brainstem responses to the NB CE-Chirp LS stimuli before recommending them for clinical use.

Purpose: The main objective of this study was to examine the effect of a classifier-based noise management algorithm (AutoSense Sky OS 3.0) on speech perception in noise in pediatric cochlear implant (CI) recipients and to compare the speech perception outcomes with typically hearing peers.

Method: This prospective observational study included nine children (ages 9-15 years) with bilateral CIs and nine age-matched, typically hearing peers. Speech perception outcomes were measured in noise using Pediatric AzBio sentences to compare performance in the omnidirectional microphone mode with the classifier-based automatic noise management mode at four signal-to-noise ratios. Ratings of listening ease and speech clarity were recorded to obtain subjective measures of benefit. Results from the bilateral CI recipients were compared to a group of typically hearing children. Paired t tests were used to evaluate outcomes.

Results: Classifier-based noise management improved speech perception in noise compared to listening in the omnidirectional microphone mode. CI group averages revealed a 21.4 percentage point and 47.1 percentage point improvement in speech perception when using the Sky OS 3.0 algorithm at 0 and -5 dB SNR, respectively. Listening ease and speech clarity were improved when using the classifier-based noise management algorithm.

Conclusions: Pediatric CI recipients can benefit from classifier-based noise management. Given the difficult listening environments children face, especially in typical classroom settings while listening for learning, audiologists should consider activating classifier-based noise management in this population.

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: Our study aimed to compare the new M&RIE (Microphone & Receiver-In-Ear) hearing aid directionality technology with the traditional omnidirectional mode in terms of speech intelligibility (SI) skills in noise.

Method: Twenty-four participants (12 women and 12 men) with bilateral symmetrical sensorineural hearing loss and no hearing aid experience, aged 28-65 years, were included in our study. Audiologic evaluations were performed, and eligible participants were fitted with hearing aids set to M&RIE and omnidirectional modes. Free-field hearing assessments and Turkish Matrix Tests under different signal/noise conditions were conducted.

Results: Significant differences were found between M&RIE and omnidirectional mode for both speech reception threshold and SI in noise when the signal was from the front and noise from the back (p < .01), as well as for SI when both signal and noise were presented from the front (p < .01).

Conclusions: In our study, M&RIE outperformed the omnidirectional mode in speech understanding tests under quiet and different noise conditions. Since placing the microphone in the ear canal is the most natural place for sound collection, M&RIE could potentially benefit any hearing aid user within the gain range of the device.

Purpose: Audiologic assessment is crucial for managing hearing loss across the lifespan. Routine evaluations typically include pure-tone audiometry and word recognition in quiet (WRQ), the clinical standard for over 60 years. More recently, speech-in-noise tests such as the Quick Speech-in-Noise Test (QuickSIN) have been adopted. This study investigated the effects of age, sex, and hearing sensitivity on WRQ and QuickSIN performance in a large clinical cohort.

Method: Data from 9,042 patients (17,414 ears; aged 18-90 years) who underwent audiometric assessment at the Stanford Ear Institute were analyzed. All completed pure-tone audiometry, WRQ, and monaural QuickSIN. Analyses focused on individuals with hearing loss (9,373 ears) and those with normal hearing (4,277 ears), using stepwise linear regression. In a subset of normal-hearing individuals (1,095 ears), perceived auditory disability was also assessed using the 12-item Speech, Spatial, and Qualities of Hearing Scale (SSQ12).

Results: In the hearing-loss cohort, high-frequency pure-tone average (HFPTA) predicted both WRQ and QuickSIN performance. Sex also contributed, with females performing better on QuickSIN but worse on WRQ. After adjusting for HFPTA and sex, age affected QuickSIN but not WRQ. In the normal-hearing group, hearing sensitivity had no effect on WRQ, but thresholds at 2000 and 4000 Hz influenced QuickSIN. Sex predicted QuickSIN performance, with males performing better. After accounting for thresholds, age was associated with both WRQ and QuickSIN. QuickSIN, but not WRQ, predicted perceived auditory disability on the SSQ12.

Conclusions: After accounting for hearing sensitivity, age showed minimal effects on speech performance in normal-hearing and hearing-loss groups, explaining less than 1% of WRQ variance and < 0.5 dB on QuickSIN. These findings suggest age has limited impact on speech recognition once hearing thresholds are considered. Small but consistent sex effects aligned with prior work. For WRQ, ceiling effects may mask age-related changes, while for QuickSIN, the small effect may be driven by additional peripheral or central auditory factors.

Purpose: The aim of this scoping review was to examine key elements of school-based hearing conservation programs (HCPs) for children and adolescents, with a focus on intervention program components, delivery strategies, outcome measures, and reported results. This review serves as a preliminary step in developing an HCP for children and adolescents.

Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, four bibliographic databases were searched to identify relevant articles. After screening titles, abstracts, and full texts against the eligibility criteria, seven studies were included in the review.

Results: The included studies addressed a range of themes, several of which were informed by health behavior theories. Most interventions were conducted in classroom settings by members of the research team. These interventions typically comprised one or two sessions of less than 60 min, using various delivery methods. Outcomes were assessed primarily through questionnaires, with study designs commonly following a pretest-intervention-posttest format; some studies also incorporated short-term follow-up assessments. Findings revealed that older students showed more resistance to behavior change.

Conclusions: Program effectiveness was strongly associated with multiple, repeated intervention sessions; various delivery modalities; and long-term follow-up. Moreover, early intervention is particularly important, as younger children demonstrate better long-term retention than adolescents.