Journal of the American Academy of Audiology最新文献

Background:  We describe a 42-year-old patient with reported "shaking" vision referred due to concerns of possible vestibular system dysfunction. The patient has known history of Usher syndrome type I, bilateral cochlear implants, and severe vision impairment.

Purpose:  This case describes an unusual nystagmus previously only reported in individuals with central demyelinating disorders, significant light deprivation, or in congenital/early-onset visual pathway impairment.

Research design:  Case study.

Data collection and analysis:  Retrospective chart review of vestibular function.

Results:  Vestibular function was likely absent in this case. There was no evidence of vestibular (jerk) nystagmus for sinusoidal harmonic acceleration stimuli or repeatable responses for cervical vestibular evoked myogenic potentials. Significant pendular low-amplitude high-frequency oscillations of approximately 6 Hz were present for horizontal and vertical tracings throughout testing.

Conclusion:  Nystagmus may not always be associated with vestibular system impairment. In this case, the patient's reported "shaking" vision was attributed to pendular low-amplitude high-frequency nystagmus and hypothesized to relate to long-standing significant vision impairment. This presentation is unusual in adults and has historically been associated with individuals with significant central pathology or in those with long duration light deprivation.

Background:  Simultaneous multifrequency (SiMFy) is a time-saving and reliable stimulus to determine the frequency tuning of ocular vestibular-evoked myogenic potential (oVEMP); however, the absence of 4000 Hz in SiMFy potentially makes it a less potent tool for the diagnosis of superior semicircular canal dehiscence, a pathology with an ever-increasing prevalence. Further, SiMFy was validated using only the infraorbital (IO) electrode montage. However, the recordings obtained using the IO montage might be susceptible to reference contamination introduced by a small separation between the recording electrodes and also susceptible to reflex impurity due to the spatially displaced reference electrode from the inferior oblique muscle, rendering it vulnerable to picking up responses from other muscles. Nonetheless, little is known about the similarities/differences between the SiMFy-induced oVEMPs using alternate montages (belly-tendon [BT], chin-reference [CR], and sternum-reference [SR]) and the nonsimultaneous multifrequency oVEMPs (NSM-oVEMPs) using the IO montage.

Purpose of the study:  To develop a modified SiMFy stimulus and investigate its effects on frequency tuning of oVEMP using various electrode montages.

Research design:  Within-subject experimental design.

Study sample:  Thirty-three healthy adults aged 20 to 30 years.

Data collection and analysis:  Tone bursts of octave and mid-octave frequencies from 250 to 4000 Hz were generated and concatenated to create the modified SiMFy stimulus. All participants underwent NSM oVEMPs and modified SiMFy oVEMPs using BT, CR, SR, and IO montages simultaneously. The response rate, peak-to-peak amplitude, and frequency tuning were compared between NSM-oVEMP and modified SiMFy oVEMP and also between the electrode montages.

Results:  BT montage recorded the largest amplitude among the montages in NSM stimulation and modified SiMFy stimulation. Although the response rates were comparable, the modified SiMFy produced significantly lower oVEMP amplitudes than the NSM stimulation within each electrode montage (p < 0.05). A moderate-to-strong agreement on frequency tuning existed between the NSM stimuli and modified SiMFy stimulus for all the montages, except for the SR montage.

Conclusions:  Although the modified SiMFy produces smaller amplitude oVEMPs than the NSM stimulation for the respective montages, its use in combination with the BT montage yields higher response rates and larger peak-to-peak amplitudes than the NSM recording using IO montage.

Background:  Hearing loss significantly affects an individual's well-being, communication, social interaction, and quality of life. Cochlear implants serve as a viable management option. Given the variability in the impact of impairment, self-report measures are crucial for evaluating the perceived benefits of management options.

Purpose:  The study aims to assess the reliability of the International Outcome Inventory for Cochlear Implants (IOI-CI) and establish evaluative cutoffs. This questionnaire evaluates patient's satisfaction with cochlear implants and contributes to the understanding of their experiences, addressing the increasing interest among cochlear implant clinicians.

Research design:  The design relies on electronic medical databases within the Veterans Affairs and Department of Defense systems. After identification of eligibility, recruitment was based on participants responding to mailed study documents. This research adopts a descriptive approach of the analysis of questionnaire responses as well as quantitatively evaluating the reliability.

Study sample:  Forty-nine service members, Veterans, and their dependents, including 32 men and 17 women, participated in the study. The participants had a mean age of 68.0 years, with cochlear implants ranging from 6 months to 2 years postinitial stimulation. The majority had a unilateral cochlear implant with a hearing aid on the contralateral ear.

Data collection and analysis:  Data collected involved mailing baseline study packets, including the IOI-CI questionnaire, to potential participants identified through medical databases. Participants indicated consent by returning the study packet. Follow-up packets were sent at a later time. Intraclass correlation coefficients were utilized for test-retest reliability and generalized linear models (GLM) for exploring the impact of clinical and demographic factors. Data were analyzed using R.

Results:  The ICC revealed a good level of agreement (ICC = 0.84) between baseline and follow-up assessments for the IOI-CI total score. The GLM did not identify significant factors influencing IOI-CI scores. Evaluative values were established, indicating total scores between 18 and 35 as within the range of general satisfaction with a cochlear implant for this questionnaire.

Conclusion:  The study contributes valuable insights into the reliability of the IOI-CI and establishes evaluative cutoffs, aiding clinicians in assessing cochlear implant users' experiences and satisfaction.

Objective:  To determine the readability and quality of both English and Spanish Web sites for the topic of hearing aids.

Study design:  Cross-sectional Web site analysis.

Setting:  Various online search engines.

Methods:  The term "hearing aid" was queried across four popular search engines. The first resulted 75 English Web sites and first resulted 75 Spanish Web sites were extracted for data collection. Web sites that met the inclusion criteria were stratified by the presence of a Health on the Net Code (HONCode) certificate. Articles were then compiled to be independently reviewed by experts on hearing aids, using the DISCERN criteria, which allowed assessment of the quality of the Web sites. Readability was assessed by calculating the Flesch Reading Ease Score in English and the Fernandez Huerta Formula in Spanish. Readability and quality were both analyzed, comparing scores to their respective language and cross-comparing.

Results:  There were 37 English Web sites and 30 Spanish Web sites that met inclusion criteria. When analyzing readability, English Web sites were determined to be significantly more difficult to read (average = 55.37, standard deviation [SD] = 7.73, 95% confidence interval [CI] = 52.9-57.9) than the Spanish Web site counterparts (average = 58.64, SD = 5.26, 95% CI = 56.8-60.5, p = 0.035). For quality, Spanish Web sites (average = 38, SD = 9.7, 95% CI = 34.5-41.5) were determined to be of significantly higher quality than English Web sites (average = 32.16, SD = 10.60, 95% CI = 29.7-34.6). Additionally, there was a significant difference between the non-HONCode English Web sites versus the non-HONCode Spanish Web sites (p = 0.0081), signifying that Spanish non-HONCode certified Web sites were less reliable than non-HONCode certified English Web sites.

Discussion:  The present study highlights the importance and necessity of providing quality, readable materials to patients seeking information regarding hearing aids. This study shows that both English and Spanish Web sites are written at a level that is much higher than the American Medical Association (AMA)-recommended sixth-grade reading level, and no Web site included in this study fell at or below the AMA-recommended sixth-grade reading level. English and Spanish Web sites also lacked consistency and quality, as evidenced by their wide variability in DISCERN scores. Specifically, Hispanic patients are more likely to suffer long-term consequences of their health care due to low levels of health literacy. It is important to bridge this gap by providing adequate reading materials. It is especially important to provide evidence-based claims that are directly supported by experts in the field.

Background:  Music-induced hearing loss (MIHL) is a critical public health issue. During music instruction, students and teachers are at risk of developing hearing loss due to exposure to loud and unsafe sound levels that can exceed 100 dBA. Prevention of MIHL in music students must be a desired action of all music educators.

Purpose:  To promote deliberate changes in music instruction and encourage more moderate sound creation and exposure during music education, it is essential to equip the instructors with live dynamic tools to monitor the overall sound intensities during music instruction. Equally important data to convey to the instructors are information regarding the intensity and duration of sounds at specific frequency regions in the music they are generating. Unfortunately, there are no feasible techniques to track cumulative live music exposures at various frequencies nor are there any guidelines for safe music exposure.

Research design:  We created a visually appealing, user-friendly dashboard prototype system to display the accumulated time and intensity of sound exposure during live classes/rehearsals categorized into three frequency ranges. These visuals can be easily understood at a glance allowing musicians and instructors to make informed decisions about how to play music safely.

Experimental approach and results:  The dashboard included a collection of circular dial graphs that displayed in real time the accumulated sound exposure in the instructor's selected frequency range and showed the percentage of the maximum daily sound exposure based on the National Institute for Occupational Safety and Health Standards (NIOSH, 1998). Although NIOSH standards are not widely applied for music exposure, we propose that these standards can be used to provide initial guidelines to develop critical levels of music exposure. Additionally, the dashboard included a color-coded equalizer that displayed the instantaneous frequency distribution of sounds to indicate if sound levels at specific frequencies were too high even for short-term exposure.

Conclusion:  Less expensive than existing technology and more convenient to use, this dashboard will enable music instructors to make informed decisions on how to best adapt their teaching approaches to protect the hearing health of their students.

Background:  While cardiovascular and neurological diseases induced by obstructive sleep apnea syndrome (OSAS) hypoxia are well established, the association between neuro-otological diseases and OSAS is not entirely understood. Vestibular and audiological tests have been used to evaluate the degeneration of neurons in the brainstem caused by recurrent hypoxia.

Purpose:  Evaluation of the vestibular-evoked myogenic potential (VEMP) test findings applied to detect the possible influence on the vestibular reflex arc due to hypoxia in patients diagnosed with OSAS using Activity-Specific Balance Confidence (ABC) and Berg Balance Scale (BBS) scales determination of scores.

Research design:  This was a cross-sectional study.

Study sample:  Participants aged 18 to 60 who underwent polysomnography due to snoring/sleep apnea were divided into an OSAS, and a control group of subjects were also included. Each group consisted of 20 participants.

Data collection and analysis:  All participants were evaluated with cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests. The groups were compared regarding variables such as the rate of oVEMP and cVEMP waves obtained, the interval between the waves, and the latency and amplitude. Also, BBS and ABC scales were applied to all participants.

Results:  The cVEMP (50%) and oVEMP (45%) response rates and amplitudes were significantly lower in the OSAS group. No significant difference was found between the groups when comparing other VEMP parameters. However, a statistically significant decrease was observed in the ABC and BBS scores in the OSAS group.

Conclusion:  The identification of VEMP alterations in the OSAS group is a clear indication that the vestibular reflex pathways may be adversely affected by hypoxia. Personal rehabilitation programs can be created by evaluating activities of daily living with the ABC and static and dynamic balances with BBS in patients with OSAS.

Objective: This study investigates the potential correlation between in vitro fertilization (IVF) and hearing impairment in twins compared to naturally conceived twins.

Method: Analyzing data from 2416 twin infants born between 2019 and 2021. Analyze the pregnancy conditions and complications of mothers, the birth conditions of newborns, perinatal diseases, initial hearing screening results, and subsequent follow-up conditions.

Results: Our findings reveal that the incidence of hearing impairment in IVF-conceived twins is comparable to that in naturally conceived twins. Significant differences in low birth weight, preterm birth, respiratory distress syndrome, and hyperbilirubinemia were observed between infants who passed and referred the hearing screening (P ＜ 0.05). The IVF group exhibited a lower incidence of low birth weight (P < 0.05) and older maternal age (P < 0.05), while showing higher rates of placental abnormalities and placental abruption (P < 0.05). Notably, these distinctions did not translate into a significant impact on hearing impairment. Regardless of the method of conception, the following key factors contributing to hearing impairment in twins were identified: low birth weight, preterm birth, respiratory distress syndrome, and hyperbilirubinemia.

Conclusion: IVF technology does not exert specific effects on hearing impairment in twins, with perinatal complications being the primary influencing factors.

Background:  Cervical vestibular-evoked myogenic potentials (cVEMPs) are predominantly ipsilateral, myogenic responses originating from saccular activation. Some individuals have contralateral-crossed cVEMP responses with monaural air-conducted stimulation (ACS) which can contaminate cVEMP responses with bilateral stimulation. While the origin of the contralateral-crossed response is under debate, its presence has implications for cVEMP testing with midline bone conduction vibration (BCV).

Purpose:  The purpose of this study was to determine the origin of the contralateral-crossed cVEMP response. It was hypothesized that the crossed response is due to electrode contamination and would disappear with a modified electrode montage.

Research design:  This is a cross-sectional research study.

Study sample:  Fifteen healthy participants (30 ears; mean age: 27.4 19-39; 10 females).

Data collection and analysis:  Participants completed cVEMP testing using three stimulation methods (monoaural ACS, binaural ACS, and midline BCV) and two electrode montages (sternum reference and Fp reference).

Results:  In the monoaural ACS with sternum reference condition, 53.3% ears had contralateral-crossed cVEMP responses that were in-phase with the ipsilateral response for all but three ears. Whereas in the monoaural ACS with Fp reference condition, 3% had a contralateral-crossed cVEMP response. ACS and BCV cVEMP corrected amplitudes were significantly larger in the sternum reference conditions, which is attributed to artificial enhancement from the in-phase contralateral-crossed responses.

Conclusions:  The significant reduction of contralateral-crossed responses in the Fp reference condition suggests that the contralateral-crossed cVEMP response is due to reference electrode contamination and may be a more appropriate reference placement when completing cVEMPs with midline BCV.

Background:  Clinicians are increasingly interested in self-reported hearing-specific quality of life (HQoL) for cochlear implant (CI) recipients, including pediatric CI recipients.

Purpose:  (1) To compare HQoL of adolescent CI recipients to those of peers with typical hearing (TH); (2) to examine, longitudinally, HQoL for a set of CI recipients; and (3) to determine the effects of child, demographic, audiological, speech perception, and language variables on adolescent HQoL.

Research design:  Hearing Environments and Reflections on Quality of Life (HEARQL) questionnaires were completed by children with CIs at elementary (HEARQL-26) and adolescent (HEARQL-28) ages.

Study sample:  Eighty CI recipients and 21 children with TH.

Data collection and analysis:  HEARQL-28 scores for the CI and TH groups were compared using nonparametric tests. Regression models were used to examine longitudinal results and to explore predictor variables for adolescent CI participants' HEARQL-28 scores.

Results:  HEARQL-28 scores for CI participants were lower than those of peers with TH. For both CI and TH adolescents, the HEARQL subscale with the lowest score is "Hearing Situations." CI participants' HEARQL scores at elementary age were not significantly correlated with scores at adolescence. Over 70% of unexplained variance remains even after inclusion of variables with established contributions to traditional CI benefit.

Conclusions:  Self-reported HEARQL scores are largely unexplained for pediatric CI recipients; multidisciplinary explorations of other sources of variance, such as social, emotional, and psychosocial factors, should be pursued.