American Journal of Audiology最新文献

Purpose: This study provides the first independent evaluation of the Apple Over-the-Counter Hearing Aid Feature (OTC-HAF), examining its usability and laboratory performance among adults with self-perceived mild-to-moderate hearing loss.

Method: A cross-sectional evaluation was conducted at a university audiology clinic. Digitally literate iPhone users (n = 25, ages 20-72 years) independently used AirPods Pro 2 to complete the Apple Hearing Test Feature and activate the OTC-HAF. The sample size aligns with usability model recommendations for moderately complex systems. Outcomes were assessed immediately after setup.

Results: Usability was high, with a mean mHealth App Usability Questionnaire score of 6.7/7 (SD = 0.3) and a mean Hearing Aid Skills and Knowledge Inventory-Clinical score of 93.4% (SD = 9.0%). Study-specific questionnaire responses showed high satisfaction, good sound quality, and ease of use. Qualitative feedback highlighted affordability, convenience, and dual-purpose design, with some noting occlusion and difficulty locating settings. Some participants reported they would only use the device situationally. The audiogram import feature showed limited accuracy: 71% of thresholds were within 5 dB of the reference when both ears were scanned together and 73% when each ear was scanned separately, with 12% and 8% of thresholds missing for these methods, respectively. Objective performance measures showed nonsignificant speech-in-noise benefit (Quick Speech-in-Noise Test mean benefit of 0.1 dB SNR, SD = 1.9), and real-ear measurements showed gain levels generally below National Acoustic Laboratories-Non-Linear 2 targets.

Conclusions: The Apple OTC-HAF showed high usability and satisfaction among digitally literate iPhone users, but nonsignificant speech-in-noise benefit and gain levels generally lower than prescriptive targets. Further research should explore broader applicability, long-term outcomes, and strategies to support uptake and consistent use.

Supplemental material: https://doi.org/10.23641/asha.31366123.

Purpose: Cochlear synaptopathy, the loss of the synapses between the inner hair cells and their auditory nerve fiber targets, is expected to be a common type of auditory deficit resulting from noise exposure or aging. Unfortunately, there is currently no means for diagnosing cochlear synaptopathy or other forms of cochlear deafferentation. Wideband middle ear muscle reflexes (MEMRs) have been proposed as a potential diagnostic indicator of cochlear deafferentation, but we lack normative ranges for MEMR magnitude. The objective of this study was to develop normative ranges for wideband MEMR magnitude that can be used to identify patients with abnormally weak MEMRs.

Method: Normative ranges were generated for ipsilateral and contralateral wideband MEMR magnitude in a population at low risk for cochlear synaptopathy due to young age, normal hearing thresholds, and minimal noise exposure history. The normative ranges were statistically adjusted for average distortion product otoacoustic emission (DPOAE) levels to account for possible impacts of outer hair cell dysfunction. To evaluate the ability of the normative ranges to differentiate between populations at low versus high risk of synaptopathy, measurements were also collected from military Veterans with normal hearing thresholds who reported at least one of the auditory complaints predicted to result from synaptopathy-tinnitus, speech perception in noise difficulty, or decreased sound tolerance.

Results: For individuals with poorer DPOAEs, it is not possible to fall below the lower bounds of the wideband MEMR normative ranges. For individuals with more robust DPOAEs, the lower bounds are very close to an MEMR magnitude indicating an absent reflex. Few individuals from the high-risk sample fell below the normative ranges, suggesting that these normative ranges do not identify significant cochlear deafferentation as expected.

Conclusion: Wideband MEMR magnitude normative ranges will not be effective as a stand-alone indicator of cochlear deafferentation.

Purpose: This commentary discusses the evolving role of boothless audiometry in hearing conservation programs. It addresses space and access limitations of traditional booth-based testing and explores how boothless solutions offer alternatives for maintaining and boosting service delivery.

Method: We present a conceptual discussion on the utility of boothless audiometry for hearing conservation monitoring, followed by a real-world implementation example from Department of Defense (DOD) hearing conservation clinics.

Results: DOD hearing conservation programs completed over 40,000 boothless hearing tests between 2021 and May 2025, showing progressive year-over-year adoption. Patient satisfaction surveys from over 800 service members revealed positive ratings for boothless compared to traditional booth-based testing. Implementation feedback emphasized the importance of quiet testing environments and comprehensive staff training.

Conclusions: Boothless audiometry represents a viable, and often underutilized, model for conducting audiometric monitoring for hearing conservation programs. Its portability, scalability, and adaptability make it particularly suited to outreach settings, resource-limited clinics, or as a contingency during facility disruptions. This commentary encourages audiologists to explore boothless approaches as complementary, not alternative, methods for increasing access to high-quality care.

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.