Journal of the American Academy of Audiology最新文献

Background: Paraneoplastic cerebellar degeneration (PCD) is a rare neurological disorder caused by tumor-mediated antibodies targeting the cerebellum, often leading to irreversible cerebellar damage. The most common antibody implicated in PCD is anti-Purkinje cell cytoplasmic antibody type-1, associated with malignancies such as breast, gynecological, and lung cancers. Symptoms often include dizziness, imbalance, progressive ataxia, and other cerebellar signs/symptoms, but early presentations may mimic acute vestibular syndrome, thus complicating diagnosis.Purpose: To present a case of PCD and demonstrate how objective vestibular test results facilitated the management of the patient’s medical care.Research Design: Case report.Case Presentation: A 67-year-old female with a history of left breast cancer presented with acute dizziness, imbalance, and left-sided lower-extremity weakness. The patient was referred for objective vestibular testing at the request of her internal medicine doctor.Results: Vestibular testing revealed continuous down-beating nystagmus and abnormal video head impulse test (vHIT) findings of the posterior canals only. Findings and history raised concern for central vestibular origin. Subsequent neurological evaluations revealed progressive cerebellar dysfunction. After a long medical journey, anti-Yo antibodies were detected, confirming a diagnosis of PCD.Conclusions: PCD can present with early vestibular symptoms, such as vertigo and dizziness, and as a result of damage to Purkinje cells in the cerebellum. This damage extends to the central vestibular system structures, which can lead to down-beating nystagmus and impaired vestibular-ocular reflex function as evident by vHIT findings. Early vestibular testing can play a role in the diagnosis, particularly when accompanied by a detailed cancer history.Clinical Relevance Statement: Given the rapid disease progression of PCD, it is crucial for clinicians conducting vestibular testing to understand signs of central nervous system involvement and refer patients promptly for neurological evaluation.

Background: Given the evidence of cognitive deficits in individuals with vestibular dysfunction, reduced cognitive resources may impact the effort required to process auditory information, particularly in adverse listening conditions. Although existing literature suggests impaired performance on cognitive tasks in vestibular disorders in general, research in this area specific to patients with vestibular migraine is limited.Purpose: This article aims to investigate working memory, auditory attention, and listening effort among individuals with vestibular migraine.Research Design: This study employed a non-experimental standard group comparison design.Study Sample: Individuals with vestibular migraine (n = 14) and healthy control subjects (n = 13) were recruited.Data Collection and Analysis: Operation Span and Backward Digit Span tasks were administered to assess the working memory and test of attention in listening to assess auditory attention, and listening effort was assessed using the dual-task paradigm.Results: The Operation Span, Reaction Time for the attention task, and the Repeat and Recall scores for the listening effort task were significantly poorer in the vestibular migraine group than in the control group.Conclusions: These outcomes underscore the cognitive burden imposed by vestibular migraine and emphasize the need for further research to explore the underlying mechanisms and develop targeted interventions to address these deficits.Clinical Relevance Statement: This study emphasizes the clinical importance of early identification of vestibular migraine to mitigate its potential impact on cognitive and auditory functioning. It highlights the need for routine assessment of working memory, attention, and listening effort, enabling timely intervention through targeted rehabilitation strategies to improve patient outcomes.

Background: Behind arthritis and heart disease, hearing loss (HL) is the third most prevalent chronic condition in older Americans, with primary care providers playing a crucial role in its identification. Understanding the practices and perceptions of primary care providers in hearing health is key to understanding gaps in hearing health care for patients.Methods: We conducted a quality improvement study at an urban tertiary academic facility from January–June 2024. Primary care physicians, nurse practitioners, and physician assistants were surveyed on attitudes and practices regarding HL screening, diagnosis, and treatment. Data were analyzed using descriptive statistics to identify patterns and trends.Results: Of 695 subjects queried, there were 62 respondents (response rate: 8.9 percent), most aged 41–55 years (n = 27, 43.5 percent). Many respondents reported they did not routinely screen patients for HL (n = 36, 59 percent), with lack of time being the most cited factor (n = 22, 62.9 percent). Some respondents indicated they followed Medicare guidelines for HL screening (n = 8, 32 percent), though the majority indicated they did not use specific guidelines (n = 15, 60 percent). Many providers reported they did not feel comfortable in their knowledge about hearing aids (n = 39, 62.9 percent) or cochlear implants (n = 51, 82.3 percent); in fact, 62.9 percent of the cohort reported they had never been educated about cochlear implants.Conclusions: These responses identify potential gaps in the hearing health care pipeline, particularly the need for standardized HL screening protocols and increased interprofessional training and education on HL treatments. Future endeavors to target these gaps should be assessed to see whether these gaps can be closed.

Background: The purpose of the Client Oriented Scale of Improvement in Tinnitus (COSIT) is to set treatment goals and assess individual outcomes. The Tinnitus Functional Index (TFI) was developed as a comprehensive questionnaire to measure individual and population responses to tinnitus therapies.Purpose: To investigate the convergent validity and responsiveness of the COSIT and TFI.Study Sample: A secondary data analysis of COSIT and TFI measures from 99 participants who used sound-based therapy with hearing aids or earphones was undertaken.Data Collection and Analysis: Athematic analysis of COSIT goals was applied. Nonparametric statistical methods were used to measure convergence of COSIT "change with treatment scores" and "final scores" to change in TFI scores pretreatment and posttreatment and the final TFI scores with treatment. The level of agreement between the measures was determined using receiver operating characteristic curves. Treatment responsiveness was determined by comparing treatment-related change in total scores and subscales for responders versus nonresponders. Responders were classified as having >13-point change in the total TFI score and COSIT "change" score of >2 (3 = slightly better to 5 = much better).Results: The five most common COSIT goals were reducing tinnitus impact by addressing (1) well-being, (2) hearing, (3) sleep, (4) focus, and (5) context. The TFI and COSIT change scores and TFI and COSIT final scores showed moderate to strong agreement. The COSIT classified a higher percentage (78 percent) of participants as responders than the TFI did (43 percent). There was a fair agreement between the clinically meaningful change scores for TFI and COSIT (κ = 0.29).Conclusions: The TFI and COSIT measured similar constructs, and both differentiated responders from nonresponders. Our results are consistent with the COSIT being an ideal "one for one" tool because of its high responsiveness to individual goals. The TFI is better suited as a "one for all" questionnaire because of its universal content. Clinical trials should consider use of both the COSIT and TFI because of their different, but complementary, strengths.

Background: On October 17, 2022, the U.S. Food and Drug Administration (FDA) formally established a new category of hearing aids (HAs), now available over the counter (OTC). This new self-delivery model bypasses licensed practitioners, meaning consumers may rely more on manufacturer advertising to learn about OTC HA devices.Purpose: This study aimed to (1) document the (a) hearing-health literacy educational content strategies and (b) persuasive messaging strategies present in online advertisements from OTC manufacturers; and (2) analyze how the hearing-related advertising content changed before and after the October 17, 2022, final FDA ruling on OTC devices.Research Design: Pre-post content analysis.Study Sample: A total of 295 branded social media posts from three prominent OTC HA brands were analyzed. All posts from each manufacturer 6 months before and 6 months after the OTC HA final rule on October 17, 2022 (1 year in total) were queried and included in the sample.Data Collection and Analysis: A coding team systematically analyzed the content of the OTC posts. Pearson's χ² tests assessed differences in educational and persuasive messaging content present in the OTC posts before and after the FDA ruling.Results: The results revealed the majority of OTC posts simply urged consumers to visit the brand's website, encouraged immediate product purchase, or detailed features of their OTC HAs, such as the size and discreetness of the devices. Conversely, content vital for effective health communication such as hearing-health information, hearing loss statistics, and usage guidelines were not emphasized. Examination of health literacy content before and after the FDA announcement found that posts featuring hearing-health information significantly increased after the announcement. However, overall, the number of posts containing educational or consumer-informing details about OTC HAs remained low.Conclusions: The findings of this study suggest OTC HA advertisements lack important hearing-health literacy content. Despite FDA approval, the observed promotional orientation of OTC HA advertisements indicates an existing gap in educational content and highlights the need to better incorporate health literacy content into OTC HA marketing to promote informed choices for adult consumers with hearing loss.

Background: The spectral and temporal components of the acoustic signal are processed in the central auditory system and contribute to speech and language processing.Purpose: This study aimed to assess the spectral and temporal auditory processing skills in children with a history of speech and language delay in early childhood.Research Design: The following tests were conducted to address our purpose: frequency following response test, temporal modulation transfer function test, spectral temporally modulated ripple test, and speech intelligibility in noise test.Study Sample: Thirty children aged 7-12 years with a history of speech and language delay in early childhood who caught up with their typically developing peers in middle childhood comprised the test group, and 30 children aged 7-12 years with typical development were included as the control group. Age- and sex-matched groups had typical hearing (audiometric thresholds between 125 Hz and 8 kHz ≤20-dB HL) without middle-ear pathology.Data Collection and Analysis: All tests were performed in a soundproof room, in a controlled environment, in accordance with established protocols and with the cooperation of the children. Shapiro-Wilk (n < 50) and skewness-kurtosis tests were used to determine whether continuous measurements were normally distributed. In the statistical analysis of normally distributed data, an independent t test was used to compare the measurement values according to categorical groups and the Pearson correlation test was used to determine the correlations between the measurement values.Results: The test group scored significantly lower than the control group on the temporal modulation transfer function test, spectral temporal modulation ripple test, and speech intelligibility in noise test (p < 0.05). When the onset, transient, sustained, and offset responses that constitute the frequency following response were analyzed, it was found that there were delays in the onset and offset responses in the test group compared to the control group (p < 0.05).Conclusions: The results suggest that children with a history of speech and language delay in early childhood may have difficulties with auditory processing skills compared to their peers, even if they catch up with their typically developing peers in speech and language skills in middle childhood. Therefore, it is also critical to perform an auditory processing assessment in addition to speech and language assessment.

Background: Consumers frequently use the internet for both health care information as well as the purchase of health care supplies such as custom hearing protection devices (HPDs). These HPDs are often cast from impressions made by consumers using do-it-yourself home ear impression kits. Although not required by law, earmold impressions have typically been taken by audiologists formally trained in the procedures and safety measures of effective earmold impression-taking.Purpose: The purpose of this study was to compare the performance of HPDs made by consumers (i.e., novice impression takers) using do-it-yourself earmold impression kits versus trained professionals (i.e., audiologists).Research Design: Repeated measures/experimental.Study Sample: Two sets of earmold impressions were taken on a group of 10 participants. One set was taken by a novice participant and the other set was taken by an audiologist. Full-shell HPDs were manufactured using each set of impressions and evaluated.Data Collection and Analysis: Custom HPDs made from novice impression takers and audiologists were evaluated using real ear measurements (evaluated using a two-way analysis of variance), occluded testing (evaluated using a one-way analysis of variance), and visual impression evaluations by an HPD manufacturer.Results: The results showed that HPDs manufactured from novice impression takers showed significantly less attenuation than those made from audiologists, and most HPDs made from novice-taken impressions would not have been acceptable for manufacture.Conclusions: These results support the making of earmold impressions for custom HPDs by a trained professional/audiologist. Clinical implications/applications will be discussed.

Background: Sound tolerance issues impact daily activities. Questionnaires effectively assess symptoms and severity of sound intolerance. The Sound Sensitivity Symptoms Questionnaire (SSSQ) is a brief five-item tool designed to evaluate the severities of sound sensitivity and screen different forms of sound sensitivity.Purpose: To evaluate the psychometric properties of the Persian version of the SSSQ (P-SSSQ) among adults with a pure-tone average no greater than 20 dB HL without tinnitus symptoms.Research Design: A cross-sectional survey was conducted. The questionnaire was translated using the International Quality of Life Assessment method. The content validity ratio (CVR) and content validity index (CVI) were determined. A confirmatory factor analysis (CFA), receiver-operating characteristic curve, internal consistency, and test-retest reliability were established. Convergent and discriminant validity were assessed.Study Sample: A total of 100 adults (48 women) from the general population with and without sound sensitivity participated in the study.Data Collection and Analysis: Internal consistency was evaluated using the Cronbach α and McDonald omega coefficients. Test-retest reliability was determined using the intraclass correlation coefficient (ICC) after a 2-week interval. Convergent and discriminant validity were assessed using the Pearson and Spearman correlation coefficients.Result: The CVR and CVI of the questionnaire were excellent. The CFA confirmed a single-factor structure, consistent with the original English version. Internal consistency was acceptable (Cronbach α = 0.75; McDonald omega = 0.79). Test-retest reliability was excellent, with an ICC of 0.92. Convergent validity was supported by moderate correlations with the Hyperacusis Questionnaire (r = 0.571) scores, Misophonia Questionnaire (r = 0.453) scores, and uncomfortable loudness levels (r = -0.652). Discriminant validity was demonstrated by a weak correlation with PTA across ears (r = 0.175).Conclusions: The P-SSSQ is a reliable and valid tool that can quickly assess sound sensitivity symptoms with its single-factor structure and satisfactory model fit. It can be used as a checklist to evaluate various types and severities of sound sensitivity as well as to monitor treatment progress in audiology, otolaryngology, and psychology clinics. A score greater than 4 indicates sound sensitivity with 79 percent sensitivity and 82 percent specificity. Correlations with other questionnaires suggest overlapping sensitivities; therefore, the P-SSSQ is valuable for comprehensively classifying sound sensitivity.

Background: Hearing loss is an important public health concern worldwide, especially because of the global trend of aging populations. Therefore, simple, effective, and efficient methods of hearing screening within communities are needed.Purpose: To develop and validate the effectiveness of a novel three-step hand rub hearing screening (3SHRHS) method to efficiently detect and categorize hearing loss severity.Research Design: This was a prospective study.Study Sample: The recruited participants were 470 adults (940 ears).Data Collection and Analysis: The 3SHRHS test involved the following three sequential steps: palm rub at 2 cm; finger rub at 2 cm; and finger rub at 70 cm. Pure-tone audiometry served as the reference standard for hearing loss classification.Results: The 3SHRHS method demonstrated high sensitivity and specificity for detecting different levels of hearing loss severity. In both quiet and noisy environments, step 1 demonstrated strong evidence of detecting levels more than 55 dB hearing level (HL), whereas step 2 showed moderate evidence of detecting levels exceeding 40 dB HL. However, step 3 exhibited weak evidence of detecting levels greater than 25 dB HL, specifically in quiet environments; therefore, it was considered unreliable for such detections in noisy environments.Conclusion: The 3SHRHS is a rapid and accessible method of detecting and categorizing hearing loss severity. This approach may improve the accessibility of hearing screenings and facilitate early interventions for individuals with hearing loss.