American Journal of Audiology最新文献

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.

Purpose: Cognitive decline may affect how older listeners tolerate noise. Our purpose was to determine which cognitive variables are associated with older adults' acceptance of background noise, as measured by the acceptable noise level (ANL).

Method: Fifteen adults with hearing within normal limits, aged 50-72 years, were administered the following tests: the ANL, the digit span and letter-number sequencing subtests of the Wechsler Adult Intelligence Scale-Fourth Edition, the auditory attention subtest from the Woodcock-Johnson Tests of Cognitive Abilities, the Hearing in Noise Test (HINT), and the operation span test. We then compared data from the older adults with an earlier data set obtained from younger adults with normal hearing, aged 20-29 years.

Results: Older adults had significantly larger ANL values (were less tolerant of noise) than younger adults, and older adults scored significantly lower on auditory attention than the younger adults. There was no significant relation between scores on the HINT test and the ANL scores.

Conclusions: Older adults' reduced attention control may make them less tolerant of noise than younger adults. Older adults who are not yet hearing aid candidates may still be more adversely affected by noise and may benefit from auditory rehabilitation-related tools to address noise.

Purpose: Telemedicine can increase access to services, reduce wait time, and decrease patient travel. The COVID-19 pandemic revolutionized telemedicine with the rapid removal of barriers that have historically challenged the implementation and adoption of telemedicine. Yet, despite this evidence, telemedicine utilization is declining postpandemic, and barriers have been reinstated, such as lack of payment parity and more stringent regulation. Alaska is dependent on telemedicine services to provide care with the majority of the state's population living in remote communities. Innovation in the early 2000s resulted in a cutting-edge customized telemedicine solution that created a network of specialty care access across the Tribal Health System in Alaska and was one of the largest telemedicine programs in the world. A shift in focus away from telemedicine to electronic health records stalled innovation, and reduced investment in funding, equipment, and research. This created a lack of clarity around system integration and functionality that eroded the utilization and effectiveness of telemedicine solutions. Today, there is much we can learn from renewed research efforts in innovative applications of telemedicine that can be used to inform policymakers and drive adoption.

Conclusions: If hearing health care professionals are to address the public health crisis of a lack of access to care for the majority of the one in five individuals with hearing loss today, technology solutions such as telemedicine will need to be leveraged. This will require provider training and education; implementation of integrated telemedicine services; continued generation of evidence; and advocacy for regulatory, reimbursement, and payment reform.

Purpose: This study investigated the effects of a soft speech enhancement algorithm on distant speech perception for adults with severe-to-profound hearing loss (SPHL), examining speech intelligibility, listening effort, and sound quality.

Method: Participants were 16 Mandarin-speaking adults (13 men, 3 women; M_age = 58 years) with symmetrical severe-to-profound sensorineural hearing loss. They had at least 1 year of hearing aid experience. A within-subject experimental design compared two hearing aid conditions: with the Speech Enhancer algorithm activated and deactivated. Speech intelligibility was assessed using the Mandarin Chinese matrix sentence test at individual speech reception thresholds. Subjective listening effort was measured using a categorical rating scale for speech presented at three distances (2, 4, and 8 m). Sound quality ratings were collected for loudness, speech understanding, and overall impression using a visual analog scale.

Results: Activation of the speech enhancement algorithm led to a notable increase in speech intelligibility from 45% to 67%. Subjective listening effort decreased significantly with the algorithm activated at all distances, with greater benefits observed at farther distances. Similarly, sound quality ratings were significantly higher with the algorithm on for all attributes across all distances, with the largest improvements in overall impression ratings at greater distances.

Conclusions: The soft speech enhancement algorithm significantly improved speech intelligibility, reduced listening effort, and enhanced sound quality for distant speech perception in Mandarin-speaking adults with SPHL. These findings suggest that targeted signal processing for soft speech can provide substantial benefits for individuals with SPHL, including speakers of tonal languages, potentially improving communication in challenging listening situations.

Purpose: Tinnitus may be an early indication of cochleovestibular pathology in individuals with normal hearing. The present study characterizes the Head Impulse Paradigm (HIMP) and the Suppression Head Impulse Paradigm (SHIMP) among normal-hearing individuals with tinnitus.

Method: Forty-five normal-hearing individuals with unilateral tinnitus and 45 normal-hearing individuals without tinnitus underwent both the HIMP and the SHIMP. The vestibulo-ocular reflex (VOR) gains in the HIMP and SHIMP, interaural VOR gain asymmetry, and the presence/absence of compensatory saccades in the HIMP and anticompensatory saccades in the SHIMP were measured for all participants.

Results: Significant reductions in both HIMP and SHIMP VOR gains were recorded among the normal-hearing individuals with tinnitus, exclusively in the ears presenting with tinnitus compared with their nontinnitus ears (p < .05) and their healthy counterparts (p < .05). The interaural gain asymmetry in both the HIMP and the SHIMP was significantly higher among the normal-hearing individuals with tinnitus (p < .05). Moreover, individuals with tinnitus exhibited various patterns of anticompensatory saccades that were distinct from those of healthy individuals. The study also found a negative correlation between the duration of tinnitus and the VOR gain values in both the HIMP and the SHIMP (p < .05).

Conclusions: The findings indicate that the VOR and its suppression mechanism are affected among normal-hearing individuals with tinnitus. Reduced VOR gains and altered saccadic patterns on the HIMP and SHIMP suggest subtle peripheral vestibular involvement in these individuals. The results of the study highlight the potential utility of video head impulse test paradigms in identifying subclinical vestibular deficits in normal-hearing individuals with tinnitus.

Objectives: The purpose of this study was to determine if the pattern of an adult cochlear implant (CI) participant's band importance function (BIF) was associated with speech perception performance using standard assessments (i.e., consonant-nucleus-consonant [CNC] words, Arizona Biomedical [AzBio] sentences).

Design: A total of seven adults (nine ears) with CIs participated, along with nine adults with normal hearing (NH) as a control group. Each participant completed speech recognition measures (CNC word recognition and AzBio sentence recognition) in addition to BIF testing for six 1-octave-wide bands centered on frequencies between 256 and 8487 Hz using filtered monosyllabic words.

Results: The BIFs of NH and CI participants showed highest importance for mid-frequency bands. The BIFs for NH participants were uniform across participants with peak importance for the band with a center frequency around 2 kHz. BIFs for CI participants were variable, although, on average, they placed greater weight on the 2-kHz band. Additionally, the band with a center frequency of around 8 kHz carried the least importance for both groups. Higher speech perception outcomes were not obviously associated with a specific pattern of BIF among CI participants.

Conclusion: Results of this study suggest that adults with CIs have more variable BIFs compared to adults with NH and that higher speech recognition outcomes are not associated with specific patterns of BIFs.

Purpose: This study aims to determine the most common management strategies for vestibular neuritis and labyrinthitis (VNL) by ear, nose, and throat (ENT) providers and identify sociodemographic variations in vestibular rehabilitation therapy (VRT) referral rates and VNL patient performance on baseline VRT assessments.

Method: A retrospective study of all adult patients with a single diagnosis of VNL who visited a multiprovider tertiary ENT clinic (n = 168) was conducted. Demographic information, treatment recommendations, and baseline vestibular rehabilitation performance information were extracted from ENT clinical notes and initial VRT notes. Chi-square and Fisher's exact tests were performed to evaluate sociodemographic differences, and p ≤ .003 was considered statistically significant.

Results: VRT was the most popular treatment recommendation made by ENT providers, and VRT referral rates did not vary according to sociodemographic factors. 68.8% of referred patients initiated VRT. The number of patients with abnormal baseline VRT assessments did not differ by sex or race. More public insurance holders had abnormal Dynamic Gait Index assessment scores (p = .001) and gait speeds than did private insurance holders (p < .001).

Conclusions: VRT was the most frequent clinical management strategy recommended to VNL patients by ENT providers, and referral rates did not vary by sex, race, or insurance status. Most VRT patients had vestibular dysfunction on baseline assessments, suggesting appropriate referral of VRT by ENT. VNL patients' baseline vestibular function did not vary by sex or race but did vary by insurance status. Further work is needed to investigate study generalizability and elucidate the impact of insurance type on fall risk.

Supplemental material: https://doi.org/10.23641/asha.30053206.

Purpose: This study investigated the effects of age-related hearing decline on functional networks using resting-state functional magnetic resonance imaging (rs-fMRI). The main objective of the present study was to examine resting-state functional connectivity (RSFC) and graph theory-based network efficiency metrics in 49 adults categorized by age and hearing thresholds to identify the neural mechanisms of age-related hearing decline.

Method: Forty-nine adults with self-reported normal hearing underwent pure-tone audiometry and rs-fMRI. RSFC within key brain networks and auditory-related brain regions, including the default mode network, salience network, dorsal attention network, and primary auditory cortices, was assessed using region-of-interest-based and graph theory approaches. Functional metrics, such as RSFC strength and global and local efficiency, were compared across age groups (middle age vs. older age) and hearing profile groups (negative screening vs. positive screening and negative high-frequency [HF] screening vs. positive HF screening).

Results: Older adults demonstrated significantly weaker RSFC between the left primary auditory cortex and the left rostrolateral prefrontal cortex/anterior cingulate cortex within the salience network than middle-aged adults. Participants without age-related hearing decline exhibited weaker internetwork connectivity within the dorsal attention network and bilateral auditory regions, highlighting the impact of hearing sensitivity on network functionality. Graph theory metrics indicated greater local efficiency in nodes within the salience network among individuals without age-related hearing decline, suggesting preserved cognitive control and attentional processing.

Conclusions: Age and hearing thresholds significantly affected the functional connectivity and network efficiency of the brain. These results emphasize the importance of neuroimaging techniques like rs-fMRI in studying neural mechanisms of age-related hearing loss.

Supplemental material: https://doi.org/10.23641/asha.29945021.

Purpose: In the United States, final-year externs in clinical audiology play an important role in clinical practices, yet many are unpaid for their work. This article evaluates cross-discipline research to place the high prevalence of unpaid externships in a larger trend toward precarious work arrangements that shift risk from employers to workers. Concerns about the cost of paying externs are understandable, and this article discusses how the benefits outweigh the challenges. Audiology program directors and precepting audiologists have a responsibility to challenge this status quo that undervalues audiology externs and advocate for paid externships. Compelling reasons to compensate externs include attracting higher quality trainees, reducing medical errors, improving extern learning outcomes and health, and addressing the shortage of audiologists to meet rising demands for audiologic services. Establishing paid externships as the expected standard will require changes at both the organizational and individual practice levels. Precepting audiologists are ideally positioned to model equitable labor practices and invest in the future of the profession.

Conclusions: This article argues that fair monetary compensation for the work that externs perform is essential for the well-being of trainees and for the quality of the clinical services they provide. By fairly compensating externs for their important work, audiologists can create a fairer, more equitable pipeline of diverse audiologists to meet rising hearing health care needs. It is time to recognize the value of audiology externs' work and commit to providing them the compensation they deserve.

Purpose: The objective of this study was to evaluate anxiety, depression, dizziness disability, sleep, and quality of life in individuals diagnosed with Ménière's disease (MD) and vestibular migraine (VM). Additionally, the study sought to examine the impact of anxiety and depression levels, as well as dizziness disability, on sleep and quality of life.

Method: The present study included a total of 51 individuals, with 25 subjects in the MD group and 26 subjects in the VM group. The Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), the Dizziness Handicap Inventory (DHI), the 36-Item Short Form Health Survey (SF-36) for quality of life, and the Pittsburgh Sleep Quality Index (PSQI) were administered face-to-face to all subjects.

Results: A statistically significant difference was not observed between the two groups in terms of BDI, BAI, DHI total, and subcategories (Emotional, Physical, and Functional; p > .05). Among the subdimensions of SF-36, only Vitality and Mental Health scores were found to be statistically significantly higher in the MD group compared to the VM group (p = .039 and p = .030, respectively). Conversely, the PSQI score exhibited a statistically significant difference, with higher values observed in the VM group compared to the MD group (p = .023).

Conclusions: VM and MD significantly impact psychological and physiological outcomes, including anxiety, depression, dizziness, quality of life, and sleep. Psychiatric comorbidities and reduced quality of life profoundly affect daily life. Therefore, a multidisciplinary approach, including psychiatric support, is essential for effective management.