American Journal of Audiology最新文献

Purpose: For many people with bothersome tinnitus, accessing in-person intervention is difficult. We developed a remote counseling program, Tinnitus Activities Treatment-Online (TAT-Online), to provide for patients' tinnitus education and coping strategies. We aimed to test the effectiveness and acceptability of the remote counseling program in adults with tinnitus.

Method: We included adults with chronic tinnitus who had access to a smartphone, tablet, or computer. In total, 59 adult participants completed all study procedures out of 243 adults who were initially enrolled. Participants completed weekly modules that included viewing narrated videos, practicing strategies using homework, and completing quizzes at the end of each session to assess learning. Participants completed the sessions in a self-paced manner over 6 weeks: Week 1: Questionnaires and Introduction; Week 2: Thoughts and Emotions; Week 3: Sleep; Week 4: Hearing; Week 5: Concentration; and Week 6: Relaxation Techniques and Sound Therapy. Participants completed four outcome measures before the remote counseling began in Week 1 and after the remote counseling concluded in Week 6. Statistical analysis was conducted using a doubly multivariate analysis of variance approach. Acceptability of TAT-Online was determined based on an exit survey and compliance in completing the activities.

Results: Comparing pre- to posttest scores, there was a significant improvement on all tinnitus measures and significantly lower ratings of tinnitus loudness and annoyance. There was no significant change in Meaning of Life ratings. Mean ratings of effectiveness for the TAT-Online videos were rated at 9 out of 10. The self-paced format of TAT-Online was acceptable and easy to follow and effective for patients' learning to cope with tinnitus.

Conclusions: Self-paced remote tinnitus counseling, which included asynchronous educational videos, reflection exercises, and helpful strategies, was effective for learning how to cope with tinnitus. In future studies, we plan to conduct a randomized control trial to further investigate the effectiveness of TAT-Online in combination with hearing or tinnitus devices.

Purpose: Sentences are encoded with sematic context, which facilitates audiologic ability to navigate background noise, or speech-in-noise (SIN), conditions. To examine how semantic context contributes to performance on one commonly used SIN test, the Quick Speech-in-Noise Test (QuickSIN) by Etymotic Research, Inc. (henceforth "QuickSIN"), we use a novel experimental paradigm that isolates semantic information.

Method: Ten college-aged monolingual participants with typical hearing listened to 72 sentences delivered in 0, 5, 10, 15, 20, or 25 dB SNR followed by a choice between two visual words. One word was related to the overall sentence meaning, and the other word was unrelated. The reaction time (RT) to correctly select related targets was measured to index usage of semantic information.

Results: Participant's RTs to select a correct response were compared across different signal-to-noise ratios (SNRs). We found that less favorable noise conditions (0, +5 dB SNR) elicited a greater usage of semantic information than more favorable noise conditions (20, 25 dB SNR). Transformed RT data were analyzed with nonparametric tests that assessed the homogeneity of variance within responses to each SNR condition. Results indicated that participants' RTs were consistently varied within each SNR condition, except to sentences in +20 dB SNR, indicating an imbalance in the degree of semantic context used in the sentences in that SNR level.

Conclusions: Respondents to the QuickSIN use semantic context to facilitate processing especially at less favorable SNR levels, which is consistent with research supporting a greater role of semantic information during suboptimal listening conditions. Differences in context use across noise conditions means test performance also reflects language processing and should be considered for updated tests of speech-in-noise performance. Critically, responses to sentences at the +20 dB SNR used in the QuickSIN are so inconsistently varied in their degree of semantic usage as to prohibit a clinical interpretation alongside the other conditions. These findings warrant the development of a quick-to-administer SIN test with stimuli that are balanced for semantic expectancy to avoid language effects.

Purpose: This study aimed to identify individual factors associated with older adults' ability to manage commercially available over-the-counter (OTC) hearing aids (HAs).

Method: Participants completed an OTC HA skills assessment, scored on a 4-point Likert scale (3 = independent with no difficulty, 0 = unable to complete). Steps included downloading the application (app), inserting the HAs, and cleaning them with a brush. Scores were averaged to calculate an overall mean; higher scores indicated better OTC HA skills. Each independent variable was analyzed in separate linear regression models, and geometric mean ratios (GMRs) were calculated for significant factors. OTC HA skills were also examined dichotomously, with unsuccessful performance defined as any unresolved error.

Results: Eighty-two adults participated in the study, 66% (n = 54) of whom were new HA users. After adjusting for covariates, education remained a strong predictor of OTC HA skills: Individuals with less than a college degree demonstrated 45% lower performance compared to those with a master's degree or higher (GMR = 0.55, 95% confidence interval [0.34, 0.89]). Overall, 68% (n = 56) of participants were unsuccessful in completing the OTC HA assessment. The most challenging tasks across all participants were manually adjusting the volume, pairing the HAs with a smartphone, and replacing the wax guard. New HA users performed significantly worse than experienced users on the task of putting the HAs on, t(52) = -2.58, p = .013, with a moderate effect size (Cohen's d = -0.44).

Conclusions: Education emerged as a strong predictor of OTC HA skills, underscoring the need to address disparities in device usability. These findings highlight the importance of developing tailored devices and educational materials to support users with lower educational attainment. Such efforts may help promote more equitable access and prevent the exacerbation of existing hearing health disparities in the era of OTC HAs.

Supplemental material: https://doi.org/10.23641/asha.29847827.

Purpose: Numerous individuals in the United States are bothered enough by tinnitus that it affects normal daily activities, including sleep and concentration. There is a high prevalence of self-reported bothersome tinnitus in the U.S. military, and therefore, it is important to assess the impact of tinnitus on functional performance. The primary aim of this study was to examine the effects of tinnitus on a range of subjective, objective, auditory, and cognitive measures. A secondary aim was to determine which factors best predict whether individuals ever self-reported tinnitus. A prospective study was conducted to address the primary aim, and an exploratory machine learning approach was used to address the second.

Method: The study included 463 active duty U.S. Service members being seen for annual hearing surveillance. Participants completed several auditory and cognitive tests, along with questionnaires regarding tinnitus, depression, anxiety, and sleep difficulty.

Results: The primary aim found no significant performance differences on tasks of selective attention, short-term memory, or speech in noise between the tinnitus groups. However, there were significant group differences in extended high-frequency hearing. A machine learning algorithm was used to predict whether an individual self-reported experiencing tinnitus. The model had approximately 80% accuracy, excellent sensitivity, and modest specificity.

Conclusions: Study findings corroborated other evidence that extended high-frequency thresholds are poorer in those who reported ever experiencing tinnitus, regardless of tinnitus bother. Our results suggest that combining results from audiometric testing, high-frequency hearing, and subjective assessment of sleep achieved 80% accuracy in predicting tinnitus presence.

Purpose: The Minimum Speech Test Battery-Version 3 for adults (MSTB-3) was released in 2024 as an evidence-based, streamlined test battery for pre-operative determination of candidacy and postoperative assessment of adult cochlear implant (CI) performance. A survey was dispersed to examine clinicians' understanding and adoption of the new protocol and gain clinical insights on its implementation.

Method: A link to a 32-question survey was distributed to audiologists via e-mail and social media platforms, collecting responses from 307 participants practicing in various settings. The survey assessed respondents' understanding of MSTB-3 materials, participation in training sessions, and integration of MSTB-3 recommendations into clinical care. Descriptive statistics were used to analyze data and identify trends.

Results: Results indicated that 89% of audiologists were familiar with the MSTB-3, with 60% having participated in one or more training sessions. Of the respondents, 85% reported incorporating parts or all of the MSTB-3 recommendations into their practices and 75% believed it improved standardization of CI evaluations. Clinicians reported using Consonant-Nucleus-Consonant (CNC) word scores for CI candidacy decisions, consistent with MSTB-3 recommendations, but varied in the score criteria used to determine candidacy. Results show a trend toward more streamlined and efficient patient care delivery recommendations.

Conclusions: The MSTB-3 has facilitated greater consistency in CI evaluation and follow-up care, addressing historical variability in clinical practices. Its evidence-based approach, including streamlined test protocols and user-friendly tools, offers a framework for improved CI access and standardization. Further training and dissemination efforts are recommended to enhance clinicians' understanding and to address implementation challenges, ultimately advancing the quality of CI services and reducing disparities in care.

Purpose: This study aimed to explore the integrated digit-in-noise test (iDIN) as a tool for assessing speech recognition in noise among older hearing aid (HA) users, including those who cannot be tested using conventional sentence-in-noise tests.

Method: The study involved 81 older HA users with moderate-to-severe hearing loss. Participants underwent the iDIN, along with two sentence-in-noise tests (Mandarin Hearing in Noise Test [MHINT] and Mandarin Chinese Matrix Sentence Test [CMNmatrix]) and two working memory (WM) tests (reading span test and digit span test). Correlation analysis and hierarchical multiple regression were employed to relate iDIN outcomes to conventional sentence-in-noise test results.

Results: Among 56 participants who completed all tests, high correlations (ranging from .66 to .73) were observed between speech recognition thresholds (SRTs) measured using sentence-in-noise tests and SRTs measured with two-, three-, four-, and five-digit sequences on the iDIN. Reading span and two-digit SRT were significant predictors for SRTs measured using the CMNmatrix test. The two-digit SRT and the difference between five-digit and two-digit SRTs accounted for 57.9% and 61.3% of the variance in MHINT and CMNmatrix SRTs, respectively. When using 0.5 as the cutoffs for the two-digit SRT, among the 81 participants, the two-digit SRT (sensitivity: 0.818; specificity: 0.895) effectively differentiated those who could successfully complete sentence-in-noise tests.

Conclusions: The findings highlight the potential of the iDIN as a simple, quick, and reliable tool for measuring speech recognition that correlates well with performance on conventional sentence-in-noise tests and for those who could not be tested using these conventional measures. While results on short digit sequences primarily reflect auditory function, longer digit sequences involve the contribution of WM function, providing additional information regarding an individual's ability to understand speech in noise.

Purpose: The aim of the study was to investigate genotype-phenotype correlations in Usher syndrome (USH).

Method: Thirty-five USH patients were included, categorized into three genetic-based groups: USH1 (n = 11), USH2 (n = 22), and USH4 (n = 2). The functional and emotional impact of dizziness and equilibrium was assessed using the Dizziness Handicap Inventory (DHI), the Hospital Anxiety and Depression Scale (HADS), and the Activities-Specific Balance Confidence (ABC) Scale. Participants underwent pure-tone threshold testing, bithermal caloric testing, rotary chair testing (RCT), video head impulse test (vHIT), ocular (oVEMP) and cervical (cVEMP) vestibular evoked myogenic potentials, and posturography. Genotype-phenotype associations were analyzed.

Results: Total DHI could only distinguish USH1 (25.71 ± 21.04) from USH2 (50.13 ± 22.54, p = .024) but not between the three groups (p = .084). ABC and HADS could not also distinguish between the three USH subgroups (p = .286 and .180). Hearing loss in USH1 was significantly greater than in USH2 and USH4 (p < .001). USH1 showed greater caloric weakness than USH2 and USH4 (p < .004). RCT was not completed in USH4 but could distinguish between USH1 and USH2 (sinus 0.16 Hz, p = .033; sinus 0.32 Hz, p = .011; and sinus 0.64 Hz, p = .003). vHIT in USH1 demonstrated lower overall gain than in USH2 and USH4 (p < .001). USH1 showed higher number of absent cVEMP responses in the right and/or left ear when compared to USH2/USH4 (p < .001). USH1 showed a higher number of absent oVEMP responses in the right and/or left ear when compared to USH2 and USH4 (right ear, p < .007; left ear, p < .023). In posturography, no relevant differences were found between the three USH groups.

Conclusions: Contemporary hearing and vestibular assessment successfully differentiated between distinct USH groups. However, varying degrees of vestibular dysfunction were observed across all groups.

Purpose: The Connected Speech Test (CST) assesses an individual's ability to understand everyday contextualized running speech amidst competing background babble. To minimize accent effects on speech perception scores and reduce the noise floor of the original recordings, an updated version was developed by Saleh et al. (2020). The updated recordings feature a speaker with a General American accent to replace the Southern U.S. accent in the original test, and modern recording equipment was used to achieve a lower noise floor. The aim of this study was to collect normative data, characterizing performance on the updated CST. Self-reported speech intelligibility and listening effort ratings were collected to examine how subjective perceptions of the task vary across test conditions.

Method: To evaluate normative performance on this updated test, 40 native English-speaking adults (36 females and four males) with normal hearing were recruited from The University of Western Ontario. Multitalker babble was presented at a fixed level, and speech was presented at fixed signal-to-babble ratios (SBRs) to participants in both co-located and separated loudspeaker conditions. At each SBR, participants were scored based on key words correctly identified. Subjective speech intelligibility and listening effort were evaluated using self-report scales. For each measure, data were fitted with transfer functions to characterize performance on the task.

Results: Participants demonstrated significantly better performance in the separated loudspeaker condition, indicating a spatial release from masking. For both conditions, increased SBR was associated with increased performance and subjective speech intelligibility, and decreased listening effort.

Conclusion: The study provides normative data to characterize expected performance for the updated version of the CST.

Purpose: The aim of this study was to describe psychological inflexibility for hearing difficulty for a sample of adults seeking hearing help and explore associations with demographic and audiological characteristics.

Method: Archival data from 226 clinical electronic medical records at one university clinic were analyzed for this retrospective exploratory study. Audiometric test findings and results from the Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) were extracted for adult patients seen between June 1, 2022, and February 29, 2024.

Results: The majority had a bilateral hearing loss (64%), 10% had a unilateral hearing loss, and 26% had bilateral pure-tone averages better than 25 dB HL. The AAQ-AHL total scores ranged from 0 to 51, and 8% had a high likelihood of distress from internal struggles related to their difficulty hearing. On individual items, up to one third of the sample expressed internal challenges. The AAQ-AHL total scores were moderately correlated with word recognition in noise, weakly correlated with better ear pure-tone average and word recognition in quiet, and were not correlated with age.

Conclusions: The current study adds to the previous research describing psychosocial challenges that can be experienced by people with hearing difficulties. Our research demonstrates that psychological inflexibility for hearing loss can be experienced by individuals of all ages and hearing status. Based on the present findings, we recommend that audiologists intentionally assess for psychosocial challenges for people seeking hearing help.

Purpose: Audiologists play an essential role in hearing health care. It has been predicted that the supply of audiologists may fail to meet future market demand. One way to improve the number of available audiologists is to improve retention. The purpose of this study was an exploration of audiologist attrition as a first step toward creating strategies to improve retention.

Method: A survey completed by 47 former audiologists included questions about demographics, why participants entered and exited the audiology profession, and job satisfaction.

Results: Participants cited lack of reward as the most common reason for leaving the profession. About a third disliked the for-profit hearing aid dispensing aspect of the profession, and a few would return to the profession for an audiology job that did not involve hearing aid dispensing. About a quarter left audiology to pursue other opportunities (e.g., selling a private practice), and about a quarter reported poor psychosocial work environment.

Conclusion: Findings highlight the need for national efforts focused on (a) improving audiology awareness so students have a greater understanding of audiology as they are exploring career choices, (b) advocating for improved compensation overall and compensation models that de-emphasize sales-based financial incentives, and (c) creating strategies to help improve audiologists' work environment and opportunities for leadership roles.

Supplemental material: https://doi.org/10.23641/asha.28599341.