Journal of the American Academy of Audiology最新文献

Congenital hypothyroidism (CH) is one of the most preventable causes of intellectual disability in the world. Screening programs have led to earlier detection of CH, and children with adequate thyroid supplementation can have minor long-term differences in overall neuropsychological testing compared to baseline. However up to one- fourth of children born with CH suffer from hearing loss even with early and adequate thyroid hormone supplementation. We report a rare case of a patient with hearing loss attributed to congenital hypothyroidism who had complete recovery of hearing after early thyroid hormone replacement.

Background: Cervical vestibular evoked myogenic potentials (cVEMPs) and masseter vestibular evoked myogenic potentials (mVEMPs) are considered to have a common saccular origin. While a few studies have examined both VEMPs in individuals with brainstem disorders as part of a test battery, the relation between these two potentials has rarely been the subject of discussion.

Purpose: The present study explored the relation between mVEMPs and cVEMPs using EMG-scaled parameters in normal-hearing young adults.

Research design: Within-subject study design Study Sample: Twenty young adults between 18 to 39 years of age (11 males, 9 females) participated in the study.

Data collection and analysis: cVEMP and mVEMP were performed on all the participants at 95dBnHL with 500Hz tone burst stimuli. Various VEMP parameters were evaluated including P13 and N23 peak latencies, the amplitude of the P13-N23 complex, and the Interaural Amplitude Asymmetry Ratio (IAAR) in EMG-scaled and unscaled conditions.

Results: All participants exhibited a 100% response rate for cVEMP and mVEMP responses. There were no significant ears and gender effect for both cVEMP and mVEMP. No correlation was found between cVEMP and mVEMP. There was no significant difference found between P1 and N1 latency values of cVEMP and mVEMP; however, a significant variation was observed for peak to peak amplitude both in EMG scaled and unscaled conditions between cVEMP and mVEMP.

Conclusions: Minimal to no association between any parameters of cVEMPs and mVEMPs suggests no significant relationship between these two VEMPs.

Background: The results of tests measuring objective speech intelligibility are similar to those measuring subjective speech intelligibility using speech materials with minimal context. It is unclear if such is the case with contextual materials.

Purpose: To compare objective and subjective intelligibility difference (OSID) between normal-hearing (NH) and hearing-impaired (HI) listeners in the unaided and aided modes using speech materials adapted from the Tracking of Noise Tolerance (TNT) test.

Research design: Single-blind within-subjects design.

Study sample: Twenty-four NH and 17 HI older adults.

Data collection and analysis: Listeners completed the objective and subjective intelligibility measures at 75 dB SPL and 82 dB SPL speech input levels. Five signal-to-noise ratios (SNR) were tested to generate the objective and subjective speech intelligibility performance-intensity (P-I) functions. Both NH and HI listeners were tested in the unaided mode. The HI listeners were also tested using their own hearing aids (HAs). Objective and subjective speech-reception thresholds at a 50% criterion (SRT50s) were estimated from each individual P-I function. The difference between the objective SRT50 and subjective SRT50 was used to estimate OSID.

Results: Objective and subjective SRT50s were significantly better in NH than in HI listeners (χ2(1) = 26.29, p < 0.001) at each speech input level in the unaided mode. However, there was a significant interaction between listener group and intelligibility type (χ2(1) = 9.43, p = 0.002) where SRT50s were lower for subjective than objective P-I functions only in the HI group. The SRT50s of HI listeners were also affected by hearing mode, where both objective and subjective intelligibility was improved when HI listeners were tested while wearing their own HAs. In general, objective and subjective SRT50s showed moderate-to-strong correlations across most combinations of listener groups and test conditions (r = 0.59-0.86, p < 0.01) except for HI listeners tested with their own HAs (r = 0.39, p = 0.128).

Conclusions: Similar objective and subjective intelligibility was observed in NH listeners but better subjective intelligibility than objective intelligibility was noted in HI listeners when tested in the unaided and aided modes.

Background: Falls are a major health concern with potentially dramatic consequences for people over 65 years of age. One crucial determinant in the risk of falls in older adults is postural control, a complex process that requires the contribution of different sensory modalities, namely visual, vestibular, auditory, and somatosensory. While there are well established methods to screen for age-related vision, hearing, tactile and vestibular impairments, there are very few widely available methods to screen for somatosensory function, but studies indicate that ankle audiometry (vibration thresholds) using a common B-71 bone vibrator can serve that purpose. To date, unfortunately, this technique has received little attention as a tool to measure postural instability in older adults.

Purpose: The objective of the present study was to examine postural control in older adults with and without degradation of the somatosensory functions, as determined with ankle audiometry.

Research design: Standard group comparison.

Study sample: 36 healthy elderly aged between 65-80 years old divided in two groups (low vibration threshold (n=18) and high vibration threshold (n=18).

Data collection and analysis: Standard audiometry, video head impulse test, vibration thresholds (big toe, ankle and tibia) and static postural control task using a force platform was performed.

Results: Greater postural instability in participants with higher (worse) vibration thresholds as compared to participants with lower (better) vibration thresholds was observed even though both groups were comparable on hearing threshold and vestibular function.

Conclusion: The results indicate that performing a simple vibration threshold evaluation, using a clinically available B-71 with a cut-off value of 42 dB HL could be an effective, fast and easy to use procedure for detecting people at risk of falls.

Purpose: The goal of this commentary is to present to audiologists the recent consensus definition of misophonia along with current clinical measures useful for audiologists in the diagnosis of misophonia. Up and coming behavioral methods that may be sensitive to misophonia are highlighted. Finally, a call is put out for translational audiologic research with the goal of developing diagnostic criteria for misophonia.

Method: The approach to the consensus definition is described, as well as the main characteristics of misophonia agreed upon by the expert panel. Next, available clinical measures that may be useful to audiologists for the diagnosis of misophonia are presented, followed by a brief review of current behavioral assessment methodology that still requires research to determine sensitivity and specificity to misophonia symptomatology. This discussion leads to the need for establishment of audiologic diagnostic criteria in misophonia, especially when differentiating from hyperacusis.

Conclusions: While the consensus definition for misophonia is an excellent first step in obtaining expert agreement on the descriptors of misophonic triggers, reactions, and behavior, clinical research is critical in developing criteria for misophonia as a specific sound tolerance disorder.

Background: There is a well-known metric to describe average/normal vision, 20/20, but the same agreed upon standard does not exist for hearing. The pure tone average has been advocated for such a metric.

Purpose: We aimed to use a data driven approach to inform a universal metric for hearing status based on pure tone audiometry and perceived hearing difficulty (PHD).

Research design: Cross-sectional national representative survey of the civilian non-institutionalized population in the United States.

Study sample: Data from the 2011-2012 and 2015-2016 cycles of the National Health and Nutrition Examination Survey (NHANES) was used in our analysis. Of 9,444 participants aged 20-69 years old from the 2011-2012 and 2015-2016 cycles, we excluded those with missing self-reported hearing difficulty (n=8) and pure tone audiometry data (n=1,361). The main analysis sample, therefore, included 8,075 participants. We completed a sub-analysis limited to participants with "normal" hearing based on the WHO standard (pure tone average, PTA of 500, 1000, 2000, 4000 Hz < 20 dBHL).

Analysis: Descriptive analyses to calculate means and proportions were used to describe characteristics of the analysis sample across PHD levels relative to PTA. Four PTAs were compared, low frequency (LF-PTA, 500, 1000, 2000 Hz), four frequency PTA (PTA4, 500, 1000, 2000, 4000 Hz), high frequency (HF-PTA, 4000, 6000, 8000 Hz) and all frequency (AF-PTA, 500, 1000, 2000, 4000, 6000, 8000 Hz). Differences between groups were tested using Rao-Scott χ2 tests for categorical variables and F tests for continuous variables. Logistic regression was used to plot receiver operating characteristic (ROC) curves with PHD as a function of PTA. The sensitivity and specificity for each PTA and PHD was also calculated.

Results: We found that 19.61% of adults aged 20-69 years reported PHD, with only 1.41% reporting greater than moderate PHD. The prevalence of reported PHD increased with higher decibel hearing levels (dBHL) categories reaching statistical significance (p < 0.05 with Bonferroni correction) at 6-10 dBHL for PTAs limited to lower frequencies (LF-PTA and PTA4) and 16-20 dBHL when limited to higher frequencies (HF-PTA). The prevalence of greater than moderate PHD reached statistical significance at 21-30 dBHL when limited to lower frequencies (LF-PTA) and 41-55 dBHL when limited to higher frequencies (HF-PTA). Forty percent of the sample had high frequency loss with normal low frequency hearing, representing nearly 70% of hearing loss configurations. The diagnostic accuracy of the PTAs for reported PHD was poor to sufficient (< 0.70), however the HF-PTA had the highest sensitivity (0.81).

Conclusions: We provide three basic recommendations for clinical application based on our analysis. 1). A PTA based metric for hearing ability should in

Background: Exploding Head Syndrome (EHS) is characterised by hearing a sudden loud noise or experiencing a sense of explosion in head during the transition of sleep-wake or wake-sleep. The experience of EHS shares similarities with tinnitus, where an individual perceives a sound without any sound source. To the authors' knowledge, the possible relationship between EHS and tinnitus has not been explored.

Purpose: Preliminary assessment of prevalence of EHS and its related factors among patients seeking help for tinnitus and/or hyperacusis.

Research design: Retrospective cross sectional study Study sample: 148 consecutive patients who sought help for tinnitus and/or hyperacusis at an audiology clinic in the UK.

Data collection and analysis: The data regarding demographics, medical history, audiological measures and self-report questionnaires were collected retrospectively from the patients' records. Audiological measures comprised of pure tone audiometry and uncomfortable loudness levels. The self-report questionnaires which were administered as a part of standard care comprised of the tinnitus handicap inventory (THI), numeric rating scale (NRS) of tinnitus loudness, annoyance and effect on life, Hyperacusis Questionnaire (HQ), Insomnia Severity Index (ISI), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9). To establish presence of EHS, participants were asked "Do you ever hear a sudden, loud noise or feel a sense of explosion in your head at night?".

Results: EHS was reported by 8.1% of patients with tinnitus and/or hyperacusis (n = 12 out of 148). The patients with and without EHS were compared, but no significant relationships were found, between the presence of EHS and age, gender, tinnitus/hyperacusis distress, symptoms of anxiety or depression, sleep difficulties, or audiological measures.

Conclusions: The prevalence of EHS in a tinnitus and hyperacusis population is similar to that in the general population. While there does not seem to be any association with sleep or mental factors, this might be due to the limited variability in our clinical sample (i.e., most patients exhibited high level of distress regardless of EHS). Replication of the results in a larger sample with more variety of symptom severity is warranted.

The American Academy of Audiology recommends early identification of congenital cytomegalovirus (cCMV) through screening to allow for appropriate early diagnosis, intervention, and monitoring for congenital, progressive, and delayed-onset hearing loss in infants with cCMV.Early identification of cCMV is a valuable component in the diagnostic evaluation of infants with sensorineural hearing loss. The Academy recognizes the important role audiologists serve as clinical care providers and educators and advocates for early identification and audiological management of infants with cCMV.

Background Cases of self-reported hearing difficulty despite normal audiometric results have risen with the return of Veterans from recent conflicts in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Auditory outcomes improved despite low compliance among those receiving treatment. Medical chart data appeared more comprehensive for Veterans with, rather than without, auditory complaints. One possibility is that self-reported hearing problems are associated with a subset of these comorbidities, the treatment of which improved auditory outcomes. Purpose This study examined the relationships between Veterans' self-reported auditory problems and other diagnosed medical conditions. Research Design A retrospective chart review was used. Study Sample Participants were 286 Veterans, aged 21 - 52 with normal hearing. Veterans were dichotomized into a group with either self-reported hearing complaints (n = 143) or an aged-matched control group with no auditory complaints (n = 143). Data Collection and Analysis A query of the Computerized Patient Record System was performed with the date range restricted to 2009 to 2018. Metrics of self-perceived hearing handicap, APD testing, and hearing aid use were collected. All diagnoses and related symptoms were recorded. A best subsets regression with principled model selection was performed to investigate the role of these comorbidities on self-perceived hearing loss. Results The Self-Report group had 16 comorbidities that were classified as prevalent, having occurred in ≥33.3% of the group, compared to the age-matched control group, which had 2 comorbidities. The number of diagnosed medical conditions was associated with self-perceived hearing impairment. Specifically, posttraumatic stress disorder (PTSD) and related symptom clusters constituted the largest group of comorbidities that were significantly associated with self-reported hearing problems. Conclusions The significant association between PTSD and self-perceived hearing impairment warrants investigations on whether treatment of PTSD would reduce perceived hearing handicap severity. Further, PTSD assessments could be useful for audiologists to identify potential candidates for auditory complaints with normal audiometric thresholds. Keywords: Auditory processing disorder, hidden hearing loss, comorbidities, Veterans, posttraumatic stress disorder, traumatic brain injury Abbreviations: APD, auditory processing disorder; CAP, central auditory processing; HHIA, Hearing Handicap Inventory for Adults; mTBI, mild traumatic brain injury; PTSD, posttraumatic stress disorder; TBI, traumatic brain injury; U.S., United States.

Background:  Tinnitus, hyperacusis, and difficulties listening in background noise may be associated with the loss of auditory nerve fibers known as the condition of cochlear synaptopathy. Multiple research-based tests of auditory function have been developed to identify the potential for synaptopathy in animals and humans, including assessment of the middle-ear muscle reflex (MEMR). Despite these research-based tests, there is no verified method for measuring or identifying the potential for cochlear synaptopathy using standard audiologic equipment.

Purpose:  The goal of this study was to determine if commonly used audiometric equipment could be configured in a way that approximated the test methods used in the research environment, making it a viable tool in the assessment of patients who present with symptoms consistent with cochlear synaptopathy (tinnitus, hyperacusis, speech-in-noise difficulties).

Methods:  Laboratory-based and clinically based measures of MEMR strength-as estimated from changes in probe pressure/admittance in response to contralateral noise-were compared for 20 subjects. MEMR strength estimated from laboratory equipment increased with increasing intensity of the contralateral noise elicitor.

Results and conclusions:  A moderate positive correlation was found between laboratory- and clinically based measures of MEMR strength. This correlation supports the hypothesis that commonly used clinical equipment can be employed to assess the potential for cochlear synaptopathy in patients who present with the associated symptoms.