Journal of the American Academy of Audiology最新文献

Background: The chirp stimulus is a type of stimulus designed to neutralize the lack of temporal synchronization in the cochlea caused by progressive wave delay. The CE-Chirp® stimulus is a modified form of the chirp stimulus that allows for better neural synchronization and the recording of larger amplitude responses. Purpose: This study compared wave V latencies and amplitudes of CE-Chirp and chirp stimuli in auditory evoked brainstem responses (ABRs). Research Design: This was a cross-sectional analytical research study. Study Sample: Data of 25 healthy individuals (15 female and 10 male individuals) between 20 and 26 years of age (22.84 ± 1.81 years) were included. Data Collection and Analysis: Pure-tone audiometry, tympanometry, chirp ABR, and CE-Chirp ABR tests were applied. Chirp (broadband [BB] chirp [BB-chirp] and narrowband [NB] chirp [NB-chirp]) and CE-Chirp ABRs were evaluated at 20, 40, 60, and 80 decibels for normal hearing level (dBnHL) at BB and NB frequencies (1,000, 2,000, and 4,000 Hz). Results: The BB frequency evaluation showed a significant difference between the BB-chirp stimulus and CE-Chirp stimulus in terms of latency (p = 0.01 at 20, 40, 60, and 80 dBnHL), but no significant difference in amplitude (p > 0.05 at 20, 40, 60, and 80 dBnHL). The comparison of the NB-chirp stimulus and CE-Chirp stimulus showed that CE-Chirp stimulus latencies were significantly shorter than chirp stimulus latencies when a high stimulus intensity was applied at NB frequencies. Conclusions: A comparison of chirp and CE-Chirp stimuli revealed a significant difference in latency at BB frequencies, but different results were observed at NB frequencies. Amplitude comparisons of stimuli revealed different findings at different frequencies and different stimulus intensities. Additional research is necessary to determine the latency and amplitude differences between chirp and CE-Chirp stimuli.

Background: Osteogenesis imperfecta (OI), characterized by brittle bones and frequent fractures, often manifests with earlier onset hearing loss compared with the general population. Purpose: This study aims to assess the frequency of audiology testing in OI individuals and evaluate a portable audiometry device to enhance audiogram participation. Research Design: This is a prospective observational study. Study Sample: Ninety-seven participants were prospectively enrolled. Data Collection and Analysis: Participants underwent a one-time audiology test using SHOEBOX Audiometry Pro with RadioEar DD450 circumaural headphones (Clearwater Clinical Limited, Ottawa, ON, Canada). Hearing loss was defined as having a pure tone threshold (PTT) of ≥25 dB at one or more tested frequencies. Results: Most participants (54/97) reported undergoing professional audiology testing less often than once every 2 years. The most common reported reason for infrequent testing was because patients did not perceive issues with their hearing, even if hearing loss was subsequently found during screening. Seventy-one percent (69/97) of participants had hearing loss (PTT ≥ 25 dB) at one or more frequencies. Conclusions: Using a portable audiometry device in OI clinics could facilitate early hearing loss detection and improve follow-up care, enhancing quality of life.

Vestibular function testing is recommended in children who report dizziness and in children with imbalance or delays in gross motor milestones related to sensorineural hearing loss. This clinical consensus statement developed by the American Academy of Audiology serves as a guide for assessing vestibular function in the pediatric population and allows for expected variations in practice and available equipment. It focuses on the pediatric approach to test administration and interpretation, offers protocols and tips for testing, and provides additional information on individual tests of vestibular function. Basic, practical knowledge of vestibular testing is required to incorporate the guidance provided in this consensus statement. Children have activities of daily living that are different from those of adults, so the overall goal of assessment and intervention should be to arrive at the best recommendations to help children meet their vestibular goals without hindrance to educational, social, and developmental outcomes. As this area of pediatric vestibular testing develops, more normative data and test techniques will be included, and this guidance will continue to evolve.

Background: Large vestibular aqueduct syndrome (LVAS) is the most common inner ear malformation in children with hearing loss; however, imaging is required to determine the definitive diagnosis. Purpose: This study aimed to preliminarily determine the sensitivity and specificity of air-conducted and bone-conducted cervical vestibular evoked myogenic potentials (VEMPs) and ocular VEMPs and wideband acoustic immittance (WAI) as screening tools for LVAS and identify candidates for imaging. Research Design: This was a prospective observational study. Study Sample: The sample included 10 participants (17 ears) with LVAS and 15 control participants. Intervention: All participants completed cervical and ocular VEMP testing in response to air-conducted and bone-conducted stimuli and WAI testing. Results: Ears with LVAS had significantly higher air-conducted cervical and ocular VEMP amplitudes but reduced bone-conducted VEMP amplitudes. Because of this pattern reversal, air-conducted amplitudes were subtracted from bone-conducted amplitudes. This novel outcome was the best individual factor for differentiating ears of the control group from ears with LVAS and is a sensitive clinical indicator of LVAS, with 82 percent sensitivity and 80 percent specificity for cervical VEMP and 88 percent sensitivity and 80 percent specificity for ocular VEMP. Ears with LVAS exhibited significant differences in WAI absorbance of control ears at select low, mid, and high frequencies, and they also exhibited characteristic low-frequency peaks in individual responses that could be detected using an automated algorithm with moderate sensitivity (64 percent) and specificity (72 percent). Conclusions: This is the first report of the use of VEMP and WAI responses of individuals as screening tools for LVAS. VEMP and WAI could be used to determine which individuals are good candidates for radiographic imaging and decrease the time required to determine a diagnosis. The test results also demonstrated patterns that differed from those of other third window disorders. Therefore, important physiologic differences between LVAS and other third window disorders require further investigation.

Background: The masseter vestibular-evoked myogenic potential (mVEMP) is a short-latency electromyographic potential that assesses the integrity of the vestibule-masseteric reflex pathway. Due to limited normative studies, there is no optimal mVEMP protocol to be implemented clinically. Apart from the conventional electrode configuration, a naïve montage referred to as the forehead reference has been used in recent studies. Purpose: This study compared latency and amplitude parameters of mVEMP between the zygomatic and forehead electrode configurations to address the optimal electrode montage to elicit mVEMP. Research Design: Cross-sectional research study. Study Sample: Thirty healthy participants (mean age: 23.3 years; 14 males and 16 females). Data Collection and Analysis: Participants underwent mVEMP testing under two-electrode montage conditions (zygomatic and forehead reference electrode montages). Results: Statistically significant increases in P1 latency, decrease in N1 latency, reduction of P1-N1 interpeak interval, enlargement of both unrectified and electromyography-rectified amplitudes, and lower interaural amplitude asymmetry ratio were observed for the forehead electrode montage compared to the conventional zygomatic montage. Conclusions: mVEMP response waveforms obtained using forehead reference electrode montage are superior to the zygomatic montage. Hence, the forehead montage is suggested for further research on mVEMP.

Background: Since the development of word-recognition materials to test the transmission properties of auditory devices and human auditory systems, a carrier sentence or phrase (e.g., Say the word) has been used to preface the test word. For practical reasons, only the amplitude of the carrier phrase was somewhat controlled. The current American National Standards Institute standard for audiometers continues to specify the level of the test word should be the same communication level as the carrier phrase. Purpose: The development of an amplitude calibration protocol for use with short-duration speech signals that are characterized by substantial amplitude modulations is described. Research Design: Protocol 1 evaluated the average maximum root-mean-square (rms) amplitudes of 12.5-, 25-, 50-, and 100-ms voiced phoneme segments of each test word in 0.0227-ms increments to determine the segment duration to use. Protocol 2 used the 50-ms segment with the maximum rms amplitude among the 200 words in each list to normalize independently the amplitudes of the carrier phrases and test words to a target rms amplitude for each speaker. Study Sample: Digital copies of the 200 monosyllabic words in three versions of Northwestern University Auditory Test No. 6 (NU-6) and one version of the W-22 each spoken by a different speaker were evaluated using the numeric digital values transcribed from the audio files. Two iterations of the protocol were compiled. Data Collection and Analysis: In-house routines were used to analyze the waveform data, the results of which were evaluated with central tendency statistical analyses. Results: The finalized protocol is based on the rms amplitude of a 50-ms segment of the sustained, voiced phoneme of each test word. The protocol directly links the rms amplitudes of the calibration tone and of the 50-ms word segments as opposed to the currently used linking of the calibration tone rms amplitude to a peak meter deflection of the carrier phrase from which the amplitude of the test word is inferred. Conclusions: The effectiveness of the calibration protocol was demonstrated successfully on the four sets of word-recognition materials. The rms amplitude adjustments made independently to the individual carrier phrase and test-word utterances produced overall rms amplitudes for each of the four speakers that were homogenized slightly for the carrier phrases but substantially for many of the test words. Clinical Relevance Statement: The calibration protocol described provides an objective procedure that can be implemented and, most importantly, replicated with numeric accuracy to equate test-word (and carrier phrase) amplitudes among short speech signals like monosyllabic words and among speaker versions of those materials.

Background: High prevalence of hearing loss and its physical, mental, and social impacts when unaddressed underscore a need for early identification. However, in-person hearing assessment may be inaccessible in certain countries and areas. As such, numerous smartphone-based and web-based applications (apps) have been developed to perform remote hearing assessment, and yet many of them remain unvalidated. Purpose: The purpose of this study was to evaluate the performance, ecological validity, and usability of two freely available smartphone-based hearing assessment apps-Hearing Test (Android) and Mimi Hearing Test (iOS)-alongside a web-based app, MDHearing Aid. Research Design: This is a cross-sectional validation study. Study Sample: This study included 60 adults with hearing thresholds no greater than 20 dB HL or any degree of sensorineural hearing loss. Data Collection and Analysis: Participants completed standard audiometric testing followed by assessments using three apps in a controlled laboratory setting. The assessments were repeated by participants at home the subsequent day. The mHealth App Usability Questionnaire (MAUQ) was administered to evaluate the apps' usability. Performance metrics included sensitivity, specificity, accuracy, and test-retest reliability. Intraclass correlation coefficient (ICC) estimates were calculated to measure the apps' accuracy, test-retest reliability, and ecological validity. Results: All apps had moderate to good sensitivity (0.67-1.00) and specificity (0.72-0.99). The Hearing Test app showed poor accuracy at lower frequencies (ICC: 0.24-0.53) and moderate to good accuracy above 1000 Hz (ICC: 0.74-0.83). The Mimi Hearing Test showed poor accuracy at lower frequencies (ICC: 0.27-0.50) and moderate to good accuracy above 2000 Hz (ICC: 0.68-0.85). The web-based MDHearing Aid test showed moderate to good accuracy across frequencies (ICC: 0.64-0.85). All apps had moderate to excellent test-retest reliability (ICC: 0.66-0.99) and showed poor ecological validity below 500 Hz (ICC: 0.20-0.51) and moderate to excellent ecological validity above 1000 Hz (ICC: 0.54-0.95). Usability was rated highly across all apps, with MAUQ scores ranging from 5.4 to 5.9 out of 7. Conclusions: The examined apps exhibit varied accuracy levels and generally reasonable sensitivity, specificity, test-retest reliability, ecological validity, and usability. With additional validation, the Hearing Test app may be useful for hearing screening and monitoring in adults. There is a necessity for further research to unlock the examined apps' full clinical potential.