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OBJECTIVE: To examine the association between hearing impairment and cognitive function after traumatic brain injury (TBI). SETTING: A total of 18 Level I trauma centers throughout the United States in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. PARTICIPANTS: From February 2014 to June 2018, 2,697 participants with TBI were enrolled in TRACK-TBI. Key eligibility criteria included external force trauma to the head, presentation to a participating Level I trauma center, and receipt of a clinically indicated head computerized tomography (CT) scan within 24 hours of injury. A total of 1,267 participants were analyzed in the study, with 216 participants with hearing impairment and 1,051 participants without hearing impairment. Those with missing or unknown hearing status or cognitive assessment were excluded from analysis. DESIGN: Prospective, observational cohort study. MAIN MEASURES: Hearing impairment at 2 weeks post-TBI was based on self-report. Participants who indicated worse hearing in one or both ears were defined as having hearing impairment, while those who denied worse hearing in either ear were defined as not having hearing impairment and served as the reference group. Cognitive outcomes at 6 months post-TBI included executive functioning and processing speed, as measured by the Trail Making Test (TMT) B/A and the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index Subscale (WAIS-IV PSI), respectively. RESULTS: TBI-related hearing impairment had a small but significantly greater TMT B/A ratio than without TBI-related hearing impairment (mean difference (B) = 0.25; 95% CI = 0.07 – 0.43; p = 0.005). No significant mean differences on WAIS-IV PSI scores were found between participants with and without TBI-related hearing impairment (B = 0.36; 95% CI = −2.07 – 2.60; p = 0.825). CONCLUSION: We conclude that TBI-related hearing impairment at 6 months post-injury was significantly associated with worse executive functioning but not cognitive processing speed.

Carpenters are constantly exposed to a noise level of 82—100 dB(A) in their professional lives. The aim of this study is to evaluate the hearing status of carpenters with pure –tone audiometry and transient evoked otoacoustic emissions test. A total of 62 individuals were enrolled. The study group consisted of 31 carpenters and the controls were age and sex matched healthy individuals who were not exposed to continuous or sudden noise. The average age of the carpenters is 44.58 ± 10.33, the average age of the control group is 41.84 ± 8.65 and there was no statistically significant difference (p = 0.262). There was a significant hearing loss in the study group nearly at all frequencies when compared to the control group (p

Introduction: Tympanoplasty is typically performed in conjunction with a canal wall down mastoidectomy in patient with Chronic Otitis Media Squamous. The results from experimental and clinical studies of the type III stapes columellar reconstruction have shown that interposing a disk of cartilage between the graft and the stapes head improves hearing in the lower frequencies by 5 to 10 dB. They hypothesize that the cartilage acts to increase the “effective” area of the graft that is coupled to the stapes, which leads to an increase in the middle ear gain of the reconstructed ear. Aims: To assess the hearing improvement after cartilage augmented Type III Tympanoplasty in chronic otitis media squamous disease. Methods: This study was conducted in 44 patients with Chronic Otitis Media squamous in the patients attending the department of Otorhinolaryngology in NGMC teaching hospital from November 2018 to March 2020. Canal Wall Down mastoidectomy with cartilage augmented type III Tympanoplasty and was done. Augmentation was done with thin 3-4 mm conchal cartilage interposed between stapes and Temporalis fascia graft. Results: There were 11(25%) male and 33(75%) female, with mean age of 29.48 years, ranging from minimum of 15 years to maximum 56 years. The preoperative mean A–B gap was 21.82 and postoperatively means AB gap was 12.20 dB with overall AB gap gain was 9.64 dB. Conclusion: Significant hearing improvement is seen in Canal Wall Down mastoidectomy Chronic Otitis Media squamous after cartilage augmented type III tympanoplasty.

Purpose Since its inception nearly a century ago, the audiogram has become the gold standard for reporting an individual's hearing status. The interpretation of the audiogram, namely, where normal hearing ends and hearing loss begins, impacts all areas of audiology: research, clinical, and medicolegal. Where to define normal hearing was the subject of great debate during the early decades of audiology. Revisiting this history reveals how the 25-dB HL cutoff came to be; a decision concerned more with the legal consequences than the scientific persuasiveness of the definition of normal hearing. Since the 1970s, the 25-dB HL cutoff has defined normal-hearing control groups in research and informed treatment recommendations in the clinic. Conclusions Today, in 2020, closer evaluation of this so-called normal-hearing group reveals a variety of deficits not captured by the audiogram. The history of how normal hearing came to be defined in conjunction with this growing body of research serves as a good reminder to look beyond the audiogram. This is especially important as the field of audiology looks ahead toward improved diagnostics, earlier detection, and new technologies/treatments.

Degree of distress perceived due to tinnitus is different in every individual. Underlying mechanisms for this are yet unclear.Investigating the relationship between hearing status and tinnitus distress.This is a case-control study. 38 individuals with tinnitus, divided into normal hearing (NHT,NHT group showed significantly lower degrees of tinnitus distress compared to HIT group (The present study suggests hearing status may play critical role for experienced tinnitus distress, even in individuals with mild to moderate hearing impairment.This is the first study to investigate the relationship between behavioral hearing ability and tinnitus distress when controlling for age, sex, educational background and age at tinnitus onset. The results provide important information regarding management of tinnitus patients.

Children with hearing loss (HL) remain at risk for poorer language abilities than normal hearing (NH) children despite targeted interventions; reasons for these differences remain unclear. In NH children, recent research suggests that speech discrimination is related to language outcomes, yet we know little about it in children with HL under the age of two years. We utilized a vowel contrast, /a-i/, and a consonant-vowel contrast, /ba-da/, to examine speech discrimination in 47 NH infants and 40 infants with HL. At Mean age = 3 months, EEG recorded from 11 scalp electrodes was used to compute the time-frequency mismatched response (TF-MMR(SE)) to the contrasts; at Mean age = 9 months, behavioral discrimination was assessed using a head turn task. A machine learning (ML) classifier was used to predict behavioral discrimination when given an arbitrary TF-MMR(SE) as input, achieving accuracies of 73% for exact classification and 92% for classification within a distance of one class. Linear fits revealed a robust relationship regardless of hearing status or speech contrast. TF-MMR(SE) responses in the delta (1–3.5 Hz), theta (3.5–8 Hz), and alpha (8–12 Hz) bands explained the most variance in behavioral task performance. Our findings demonstrate the feasibility of using TF-MMR(SE) to predict later behavioral speech discrimination.

Background: Cyclosporin A (CsA) is an important drug regimen for difficult to treat nephrotic syndrome (NS) with few information known about its ototoxicity. Aims: Assessment the hearing status in children with difficult to treat idiopathic NS on CsA treatment. Material and Methods: This prospective cohort study included 2 groups: Group I: 15 children with steroid sensitive idiopathic nephrotic syndrome on steroids only as a line of treatment was used as comparing group to group II which included 15 children recently diagnosed difficult to treat NS starting CsA as steroids sparing drug, hearing functions were assessed using standard, high-frequency audiometry and transient otoacoustic emissions (TOAEs) at base line for both groups and after 6 months of CsA treatment for group II. Results: There was significant elevation of hearing threshold in extended high frequency (> 8 KHz) (subclinical hearing loss) after six months of CsA. There was positive correlation between Cyclosporin A trough level and elevated hearing threshold in pure tone audiometry and extended high frequency (> 8 KHz). There was insignificant difference between groups according to TOAEs. There was statistically significant positive correlation between extended high frequency range and serum trough CsA level in group II. Conclusions: CsA is a potential cause of hearing impairment in children with difficult to treat NS so all patients on CsA need routine audiological assessment especially with high serum CsA level and long duration.

Purpose: The study aims to investigate headphone listening habits of college-going students and for those using headphones, correlate self-reported hearing status with average audiometric hearing thresholds. Method: Headphone listening habits and awareness of adverse effects of the same was profiled in college-going students using a questionnaire distributed through online platform. Hearing thresholds were then compared for those with and without self-report of hearing difficulty. 341 responses were obtained from students between 17 and 23 years of age. For the second part of the study, a convenience sample of 30 willing students from among these 341 was selected. Pure tone thresholds were obtained for various frequencies with a high frequency audiometer. PTA (average of 500, 1000, 2000 Hz) and HFPTA (average of 4000, 6000, 8000, 10000 Hz) were calculated for both the ears and compared for those with and without reported hearing difficulty. Results: 78% students reported headphone usage for less than 3 hours per day, while 22% reported usage for more than 3 hours per day. 77% respondents were aware that listening to loud sounds can alter hearing sensitivity, but many (54.83%) did not have awareness about the minimum safe hours of listening. There was a weak positive correlation between self-reported hearing difficulty and poor ear HFPTA (r = 0.2304). Conclusion: Majority of students used insert earphones even after knowing the adverse effect of the same. There was a weak correlation found between the self-reported hearing problems and audiometric hearing thresholds. Implication: More awareness is needed about the ill effects of headphone usage amongst the young teenage population. Proper counseling and management strategies are required for people who report difficulty in hearing.

Objective: To evaluate Hearing Status in Pre and Post-operative Canal Wall Down Mastoidectomy with Type III Tympanoplasty with or without cartilage augmentation. Methods: This was a prospective study, done in Otolaryngology & Head Neck Surgery department of Sir Salimullah Medical College Mitford Hospital(SSMCMH) and Bangabandhu Sheikh Mujib Medical University(BSMMU) , Dhaka, Bangladesh. 1stJuly to 31st December, 2012. Forty patients were studied in this series. Results: The results concluded that mean pre and post-operative air bone gap were 38.5 dB and 29.69 dB respectively with a net gain of 8.81 dB in Canal wall down mastoidectomy with cartilage augmented Tympanoplasty type III which is statistically significant. The postoperative PTA-ABG ranged from 25-36 dB , the ABG closure was 11-15 dB in 40% case. Whereas mean pre and post-operative air bone gap were 37.19 dB and 34.19 dB respectively with a net gain of 3 dB in Canal wall down mastoidectomy without cartilage augmented Tympanoplasty type III which is statistically insignificant. The post-operative PTA-ABG ranged from 26.25-41.75 dB, the ABG closure was 0-5 dB in 35% case. Conclusion: Hearing results after cartilage augmentation in type iii Tympanoplasty showed improvement at individual and mean post-operative PTA-ABG and also improvement in ABG closure suggesting thin cartilage disc increased the effective vibrating area of tympanic membrane graft. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 86-94

Background Clear speech is an effective communication strategy to improve speech intelligibility. While clear speech in several languages has been shown to significantly benefit intelligibility among listeners with differential hearing sensitivities and across environments of different noise levels, whether these results apply to Korean clear speech is unclear on account of the language's unique acoustic and linguistic characteristics. Purpose This study aimed to measure the intelligibility benefits of Korean clear speech relative to those of conversational speech among listeners with normal hearing and hearing loss. Research Design We used a mixed-model design that included both within-subject (effects of speaking style and listening condition) and between-subject (hearing status) elements. Data Collection and Analysis We compared the rationalized arcsine unit scores, which were transformed from the number of keywords recognized and repeated, between clear and conversational speech in groups with different hearing sensitivities across five listening conditions (quiet and 10, 5, 0, and –5 dB signal-to-noise ratio) using a mixed model analysis. Results The intelligibility scores of Korean clear speech were significantly higher than those of conversational speech under most listening conditions in all groups; the former yielded increases of 6 to 32 rationalized arcsine units in intelligibility. Conclusion The present study provides information on the actual benefits of Korean clear speech for listeners with varying hearing sensitivities. Audiologists or hearing professionals may use this information to establish communication strategies for Korean patients with hearing loss.

Cel pracyOcena stanu słuchu pracowników Wydziału W-68 Zakładu Metalurgicznego WSK Rzeszów narażonych na działanie hałasu – po upływie 3 i 10 lat pracyMateriał i metodaDo badań zakwalifikowano 30 pracowników zatrudnionych w latach 2003–2014 na stanowiskach z dużym narażeniem narządu słuchu na hałas. Badanie retrospektywne przeprowadzono za pomocą analizy kart badań profilaktycznych pracowników Zakładu. W badaniu wzięto pod uwagę: wiek, czas pracy, narażenie na hałas oraz narażenie na inne czynniki mogące mieć wpływ na narząd słuchu. Porównano średni ubytek słuchu po 3 i 10 latach pracyWynikiŚredni wiek badanych pracowników wynosił 46,1 lat i mieścił się w przedziale od 35 do 60 lat. Wszyscy pracowali w systemie 3-zmianowym, 8 godzin dziennie, w narażeniu na hałas. Dodatkowym czynnikiem mogącym oddziaływać na narząd słuchu były wibracje, przy czym średni ich poziom wynosił 0,96 NDN (najwyższe dopuszczalne natężenie). Zakres hałasu, na który narażeni byli pracownicy, wynosił od 80 do 88 dB w miejscu pracy, a jego średni poziom wynosił 87 dB. Średni ubytek słuchu – wyliczony jako średnia arytmetyczna dla 0,5 Hz, 1 kHz, 2 kHz i 4 kHz – po 3 latach pracy wynosił 11,7 dB HL dla ucha prawego i 11,9 dB HL dla ucha lewego. Natomiast po 10 latach pracy średni ubytek słuchu wynosił 16 dB HL dla ucha prawego oraz 17,2 dB HL dla ucha lewego. Największy ubytek słuchu odnotowano dla częstotliwości 2 i 4 kHz po 10 latach pracy – wynosił odpowiednio 14 i 24 dB HL dla ucha prawego oraz 15 i 28 dB HL dla ucha lewego.WnioskiAnaliza przedstawionych wyników wykazuje szkodliwy wpływ hałasu na stan narządu słuchu. Zaobserwowano podwyższenie progu słuchu średnio o 4,3 dB dla ucha prawego i o 5,3 dB dla ucha lewego po 10 latach pracy. Charakterystyczne jest podwyższenie progu słuchu dla częstotliwości powyżej 2 kHz, co wiąże się z wpływem hałasu przemysłowego na narząd słuchu.

This study aimed to maximise the ability of stimulus-frequency otoacoustic emissions (SFOAEs) to predict hearing status and thresholds based on machine-learning models.SFOAE data and audiometric thresholds were collected at octave frequencies from 0.5 to 8 kHz. Support vector machine, k-nearest neighbour, back propagation neural network, decision tree, and random forest algorithms were used to build classification models for status identification and to develop regression models for threshold prediction.About 230 ears with normal hearing and 737 ears with sensorineural hearing loss.All classification models yielded areas under the receiver operating characteristic curve of 0.926-0.994 at 0.5-8 kHz, superior to the previous SFOAE study. The regression models produced lower standard errors (8.1-12.2 dB, mean absolute errors: 5.53-8.97 dB) as compared to those for distortion-product and transient-evoked otoacoustic emissions previously reported (8.6-19.2 dB).SFOAEs using machine-learning approaches offer promising tools for the prediction of hearing capabilities, at least at 0.5-4 kHz. Future research may focus on further improvements in accuracy and reductions in test time to improve clinical utility.

Background: Noise induced hearing loss is a well known recognized hazard in factory workers. This is due to the fact that the level of noise in most factories exceed the WHO acceptable limits. This was an 8 year follow up study on glass factory workers to determine the effect of noise on their hearing status over that period.Materials and Methods: Audiometry was carried out on the factory workers using a diagnostic audiometer. This was repeated after 8 years. All the workers had their ears examined prior to Audiometry which was done in a quiet area in the factory clinic. Thereafter data was collected and analysed.Results: The subsequent screening showed that all the workers had increased threshold of hearing and the Prevalence rate of hearing impairment had increased from 9.1% to 40.8%. All workers admitted to intermittent use of personal protective devices (ear muffs/ear plugs) despite being counselled on their use 8 years earlier.Conclusion: Hearing Conservation measures should be instituted in factories. Pre-employment screening should be mandatory as well as annual audiological screening and the labour laws should be strengthened to ensure adequate compliance by industries.

To discriminate among degrees of auditory performance of the Digits-in-Noise (DIN) test.We performed Pearson's correlations and age- and sex-adjusted linear regression models to examine the correlation between pure-tone average (PTA) from pure-tone audiometric tests and speech recognition thresholds (SRT) from the DIN test. Then, optimal SRT cut-points by PTA-defined hearing status (0-25 dB HL [normal], 26-40 dB HL [mild hearing loss], 41-50 dB HL [moderate hearing loss]) were compared across three methods: Youden, Nearest, and Liu. SRT-defined categories of auditory performance were compared to PTA-defined hearing categories to examine the convergence of similar categories.The correlation between SRT and PTA was 0.65 (95% Confidence Interval: 0.63, 0.67) in the overall sample. The variability of SRT explained by PTA after age and sex adjustment was 54%. Optimal cut-points for the overall sample across the three methods were: ≤ -5.55 dB SNR (normal); -5.55 to ≤ -3.80 dB SNR (insufficient performance); -3.80 dB SNR (poor performance). When comparing the SRT- or PTA-defined categories, 59.8% had concordant hearing categories and 40.2% had discordant hearing categories.Discrimination of degrees of auditory performance may add greater utility of the DIN test.

OBJECTIVES: The purpose of this study was to explore the effects of nonverbal intelligence on spoken language performance in children with hearing loss who use amplification and spoken language. Specifically, we compared language performance measured by norm-referenced measures compared to spontaneous language sample measures. DESIGN: Nonverbal intelligence and spoken language skills were analyzed using norm-referenced nonverbal intelligence and language assessments and language sample analyses in 92 children ages three to six who varied by hearing and nonverbal intelligence status. All children had nonverbal intelligence within the average or above-average range. RESULTS: Regression analyses revealed that, after controlling for maternal education and hearing status, nonverbal intelligence contributed unique variance to norm-referenced language measures but not spontaneous language measures. CONCLUSION: Performance on norm-referenced language measures is influenced by nonverbal intelligence, whereas functional language use measured by spontaneous language samples is not. These findings suggest that spontaneous language measures may contribute additional value to language assessment batteries that is independent of nonverbal intelligence.

Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. Results This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (p > 0.5). Conclusion Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets.

Introduction We investigated the relation between self-reported hearing loss and risk of subjective cognitive function (SCF) decline among women. Methods We conducted a longitudinal study of 20,193 women in the Nurses' Health Study aged ≥66 years who reported their hearing status and had no subjective cognitive concerns in 2012. SCF scores were assessed by a 7-item questionnaire in 2012 and 2014. SCF decline was defined as a new report of at least one cognitive concern during follow-up. Results Self-reported hearing loss was associated with higher risk of SCF decline. Compared with women with no hearing loss, the multivariable-adjusted odds ratios (95% confidence interval) for incident SCF score ≥1 were 1.35 (1.25, 1.47), 1.39 (1.24, 1.56), and 1.40 (1.21, 1.75) among women with mild, moderate, and severe hearing loss, respectively. Recent progression of hearing loss was associated with even higher risk. Discussion Self-reported hearing loss was associated with higher risk of incident subjective cognitive function decline in women.

Objective: To evaluate hearing outcome after type I tympanoplasty in inactive mucous type of chronic otitis media. Methods: It was a cross-sectional study conducted in the department of Otolaryngology & Head Neck Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, from July 2014 to June 2016. 50 cases were selected by matching inclusion and exclusion criteria. Paired t-test and Z test was used to analyze the variables. P values

Limited studies exist that connect using signed language with mathematics performance of deaf and hard of hearing children. In the present study, the authors examined 257 participants and compared their results on the Northwest Evaluation Association: Measures of Academic Progress (NWEA MAP) to their results on an assessment of American Sign Language (ASL) skills. It was found that better ASL skills tended to result in better MAP performance. These results are moderated by factors such as age, gender, parental hearing status, and learning disability identification.

Objective We conducted a meta-analysis and systematic review of literature comparing pre-reading and general reading in school-age children with nonsyndromic cleft palate with or without cleft lip (NSCP/L) to their peers without NSCP/L. Methods Our literature search identified 1238 possible records. After screening we identified 11 samples for inclusion for systematic review and eight for meta-analysis. We compared 292 children with NSCP/L to 311 peers for 23 pre-reading effect sizes and 17 general reading effect sizes (EFg). We conducted a random-effects metaregression using robust variance estimation. Results On average school-age children with NSCP/L scored lower on pre-reading (EFg = −0.36) and general reading measures (EFg = −0.38) compared to their peers. We conducted post-hoc analyses on phonological awareness and word decoding effect sizes; children with NSCP/L performed lower on phonological awareness (EFg = −0.22) and word decoding (EFg = −0.39) compared to their peers. There was weak evidence that hearing status and/or speech-language functioning might moderate reading development. There was limited evidence that age or socioeconomic status moderated reading development. However, samples did not consistently report several characteristics that were coded for this project. Conclusions Our findings suggest that school-age children with NSCP/L have persistent reading problems. Further research is needed to explore reading development in children with NSCP/L, as well as the relationships among hearing, speech, language, and reading development.

Background This study examines speech production accuracy in children with Down syndrome and concurrent relationships with hearing, language and reading ability. It also examines change in speech production accuracy over a 21-month period. Methods A group of 50 children with Down syndrome (aged 5-10 years) completed measures of speech accuracy, non-verbal IQ, reading (single-word reading, letter-sound knowledge and phoneme blending) and language (expressive and receptive vocabulary and receptive grammar). Hearing was assessed by parental report. Speech accuracy was reassessed 21 months later. Results Although there was considerable variability in the sample, speech was characterised by high levels of errors. There were no effects of gender, hearing status or non-verbal IQ on speech production accuracy. In contrast, speech production accuracy was significantly related to age and to measures of receptive vocabulary, phoneme blending and word reading. There was no significant improvement in speech production accuracy over time. Conclusions Children with Down syndrome experience difficulties producing accurate sounds in speech. These difficulties are related to age and to vocabulary and reading skills and persist over time, highlighting the need for intensive targeted speech intervention in this group of children.

Objectives The aim of this pilot study is to assess the prevalence of hearing disorders in school-age children in Lagos, Nigeria. Methods The study group consisted of 236 children aged 5 to 11 years old. Children were assessed by otoscopy, transiently evoked otoacoustic emissions, and pure-tone audiometry screening. Results Abnormal audiograms were found in 46 (19.5%) of the tested children. Otoscopy data suggest that the most frequent hearing abnormalities were related to cerumen and otitis media. Low agreement (55%) was found between otoacoustic emissions outcomes and pure-tone audiometry data. Conclusion Given the high prevalence of hearing problems in this group of primary school students, there is a strong need to monitor the hearing status of children in this geographical area.

Objective: To compare the hearing status after modified radical mastoidectomy with and without reconstruction. Materials and Methods: This was a cross sectional observational study which was carried out in the departments of Otolaryngology and Head-Neck surgery of Bangabondhu Sheikh Mujib Medical University Dhaka Medical College during the period of April’2012 to September ’2012. A Total 30 patients of CSOM (Atico-antral variety) underwent modified radical mastoidectomy (MRM) with or without reconstruction were included in this study. Patients were divided into two groups according to operative procedure. Patient underwent MRM without reconstruction belonged to group I (n=15) and with reconstruction was considered as group II(n=15). Patients were examined thoroughly and preoperative hearing level was assessed by pure tone audiometry one week before operation. Both groups of patients were operated by general anesthesia under microscope with post auricular approach. In group II, temporalis fascia and cartilage were taken as graft materials after doing modified radical mastoidectomy. Post operative patients were followed up at regular intervals. Pure tone audiogram (PTA) was done after 8 weeks and hearing assessment was compared by closure of air bone gap. Results: In this study majority of patients were within 11-20 years and most of patients were male. Closure of air-bone gap was higher in patients underwent MRM with reconstruction. Conclusion: Reconstruction following MRM causes better hearing gain and also improves the quality of life. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 41-46

Otosclerosis is the most frequent cause of conductive hearing loss in patients with intact tympanic membrane. It can be treated by surgery with various techniques. Because of limited manipulation and comparably similar results, stapedotomy at present is preferred over other surgical techniques by most surgeons. Here we present the operative results of 35 otosclerotic patients who underwent stapedotomy between January 2009 - October 2010 in the department of Otolaryngology- Head & Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Shahid Suhrawardhy medical college & hospital, Dhaka. The aim of this study was to evaluate the hearing results following stapedotomy in otosclerosis surgery. The average air-bone gap of patients improved significantly to 21.74 dB after operation. Other hearing parameters of patients (including air conduction, bone conduction, speech discrimination score, and tinnitus) also improved. No patient experienced persistent vertigo after the operation and pre operative tinnitus resolved in 12 out of 22 patients. Stapedotomy is a safe and effective modality for improving conductive hearing loss in otosclerotic patients. Bangladesh J Otorhinolaryngol; October 2019; 25(2): 85-93

To evaluate the hearing outcome in canal wall down mastoidectomy with middle ear reconstruction, prospective longitudinal study was done at National Institute of ENT, Dhaka from March 2015 to September 2016. Total 22 patients were included in the study undergoing canal wall down mastoidectomy with 6 months postoperative followup. Hearing outcomes were observed and compared with the preoperative hearing tests. Among the 22 patients 9 (39.1% of subjects) patients had hearing gain, 12 (52.2%) had hearing loss and 1 (4.3%) had no change in hearing postoperatively.Although disease clearance is the main objective in canal wall down mastoidectomy, hearing gain can be achieved if combined with ossiculoplasty and tympanoplasty. The hearing gain or loss depends upon the extension of disease and status of the ossicular chain. Most patients usually experience hearing loss more than the preoperative period due to removal of ossicle or ossicles for the sake of disease clearance. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 195-198

Background: Canal wall down procedure may be with or without reconstruction such as tympanic membrane, ossicular chain or posterior canal wall reconstruction. To preserve and improvement of hearing, prevent discharge and recurrence, now a days canal wall down mastoidectomy with reconstruction such as type III tympanoplasty under magnification is a modern advancement in otology. Objectives: To find out hearing status before mastoidectomy and hearing status after canal wall down mastoidectomy with and without reconstruction. Methods: Prospectove study done on 3 tertiaty hospitals in Dhaka. Number of patients were 40 who underwent for modified radical mstoidectomy, 20 were with reconstruction and 20 without reconstruction (Type 3 Tympanoplasty) Results: hearing was deteriorated in most of the cases (60%) of MRM without tympanoplasty. Air Bone (AB) Gap Increased 3.65dB after CWD without reconstruction. Closer of AB gap (9.77 dB) occurred after CWD with reconstruction. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 146-152

Objective: To observe hearing status in case of canal wall down mastoidectomy with type III tympanoplasty. Methods: This was a cross sectional study which was carried out in the departments of Otolaryngology and Head-Neck surgery of Bangabondhu Sheikh Mujib Medical University during the period of July’ 2011 to March’ 2012.A Total 38 patients having cholesteatoma underwent canal down mastoidectomy with type III tympanoplasty,were included in this study. Patients were divided into two groups according to their age. Age belonged to 18 years and more than 18 years were considered as child and adult respectively. Patients were examined thoroughly and preoperative hearing level was assessed by pure tone audiometry one one week before operation. Post operative patients were followed up at regular intervals. Pure tone audiogram (PTA) was done after 8 weeks and hearing assessment was compared by closure of air bone gap. Results: In this study majority of patients were within 13-17 years in child group and 18- 35years in adult group. Most of patients were male.Closure of air-bone gap was significantly higher in adults. Improvement of hearing status was more in adults. Conclusion: CWD mastoidectomy with tympanoplasty not only lowers recurrence rate but also improves hearing status although less likely in child and younger age group than adults. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 52-58

Objective: To assess degree, type and cause of hearing loss in children under 12 years of age in preschool for hearing impaired children. Methods: This cross sectional study was carried out in children of integrated preschool for hearing impaired children (IPSHIC) of SAHIC, Mohakhali, Dhaka, from September 2010 to March 2011. 50 deaf children were included with age 3-12 years and clinically detected hearing impairment. Data were collected by detailed history, clinical examination and audiometric findings and result were expressed in table form. Results: Most of the children presented with bilateral profound hearing loss and majority of patients presented with sensorineural type of hearing loss. Family history positive in 36% cases and consanguineous marriage were found in 34%.Commonest causes of deafness was infection. Conclusion: Early detection with universal neonatal screening should be practiced in our country and early rehabilitation reveals better out come. Bangladesh J Otorhinolaryngol; April 2016; 22(1): 36-39

Background: Otosclerosis is a disease of the otic capsule that is characterized by resorption and redeposition of bony tissue. Stapes surgery has established its position as the primary treament of conductive hearing loss in otosclerosis. It is anticipated that the hearing level of approximately 90% of patients should improve after surgery. Objective: To evaluate the hearing status of an otosclerotic patient and compare their preoperative and postoperative hearing status. Methods: In this prospective study, 34 patients with otosclerosis from head-Neck Surgery department of Sir Salimullah Medical College & Mitford Hospital, Bangladesh ENT Hospital, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Period from January 2008 to December 2008. The patients were examined and hearing assessment after admission into the hospital pre-operatively and in the post-operative period. Results: In this study most of the cases were age group 21-30 years (50%), male (64-71%), middle socio economic condition (67-71%), rural (58-82%), primary educated (35-29%). It was observed that most common symptom was progressive deafness; duration of hearing loss was 2-5 years, pre-operative conductive type of hearing loss (50-55 dB). It was also observed that after surgery, hearing status were improved in 82.35% cases, the most of the patients were within 21-30 years age group. Conclusion: Stapedotomy obtaining closure of the air-bone gap to within 10dB of the preoperative bone conduction level in 90% of their patients. So, it is supperior to other procedures Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 137-142

Purpose One in 59 children is diagnosed with autism spectrum disorder (ASD). Due to overlapping symptoms between hearing loss and ASD, children who are suspected of having ASD require an audiological evaluation to determine their hearing status for the purpose of differential diagnosis. The purpose of this article is twofold: (a) to increase audiologists' knowledge of ASD by discussing the challenges associated with testing and interpreting clinical data for children with ASD or suspected ASD and (b) to provide visual supports that can be used to facilitate audiological assessment. Method Eight children (ages 4–12 years) were recruited as video model participants. Videos were filmed using scripts that used concise and concrete language while portraying common clinical procedures. Using the video models, corresponding visual schedules were also created. Conclusion Although obtaining reliable hearing data from children with ASD is challenging, incorporating visual supports may facilitate testing. Video models and visual schedules have been created and made freely available for download online under a Creative Commons License (Creative Commons–Attribution-NonCommercial-ShareAlike 4.0 International License). Incorporating visual supports during clinical testing has the potential to reduce the child's and family's stress, as well as to increase the probability of obtaining a reliable and comprehensive audiological evaluation. Future research is warranted to determine the effectiveness and feasibility of implementing these tools in audiology clinics. Supplemental Material https://doi.org/10.23641/asha.10086434

Background: The electrophysiology of auditory nerve mature is particularly important for unilateral hearing loss.Objectives: To assess the hearing status in young children with congenital monaural ...

This study examined the career decision-making self-efficacy (CDMSE) of deaf and typically hearing young adults and the contribution of career-related family support and expectations to this type of self-efficacy. Participants were 110 young adults: 50 deaf persons and 60 persons with typical hearing. They completed the Career Decision-Making Self-Efficacy Scale and the Family Influence Scale. Study groups did not differ in their CDMSE. However, deaf participants reported lower levels of financial support and higher levels of family expectations compared to participants with typical hearing. An interaction was found between hearing status and family's financial status in participants' CDMSE, and family support and expectations significantly contributed to certain CDMSE factors only among the participants with typical hearing. Deaf participants who used only sign language reported lower levels of self-efficacy to gather career-related information compared to deaf participants who used only spoken language. Implications for research and practice are discussed.

OBJECTIVES: This study aims to determine the impact of controlling cochlear-source mechanism on the accuracy with which auditory status is identified using otoacoustic emissions (OAEs) in two groups of normal-hearing and mild-to-moderately hearing-impaired subjects. DESIGN: Data were collected from 212 normal-hearing (NH) and mild-moderately hearing-impaired (HI) subjects who fell into two categories based on a distortion product OAE (DPOAE) screening protocol: the uncertain-identification group (where errors were likely), and the certain-identification group (where errors were unlikely). DPOAE fine-structure patterns were recorded at intervals surrounding f(2)= 1, 2 and 4 kHz (f(2)/f(1) ratio = 1.22), with L(2)= 35, 45 and 55 dB SPL (L(1)/L(2) ratio = 10 dB). The discrete cosine transform was used to smooth fine structure, limiting the source contribution to the distortion source only. Reflection-source OAEs were also recorded using amplitude-modulated stimulus frequency OAEs (AM-SFOAE; Neely et al., 2005). Area under the relative operating characteristic (A(ROC)) curve was used to quantify test accuracy when the source contribution was controlled versus the condition where both sources contribute. Additionally, failure rate, fixed at 5% for NH ears, as a function of behavioral-threshold category was evaluated. RESULTS: When data for the entire subject group were examined, reducing the reflection-source contribution to the DPOAE did not result in better test performance than the best control condition at any frequency tested. When the NH subjects were restricted to those with confirmed fine structure, A(ROC) analyses indicated that reducing the reflection-source contribution resulted in several small increases in the accuracy (2-5%) with which auditory status was identified relative to the best control condition. This improvement was observed for the lowest stimulus levels (i.e., L(2) = 35 or 45 dB SPL). In this subset of subjects, distortion-source DPOAEs resulted in more accurate identification of mild hearing loss for a fixed false-positive rate of 5% in NH ears at lower L(2)s, conditions with poor accuracy in the larger group of subjects. The impact of controlling the source contribution on the identification of moderate losses was less clear in the reduced subject group, with some conditions where the distortion-source DPOAE was more accurate than the control condition and other conditions where there was no change. There was no evidence that reflection-source AM-SFOAEs more accurately identified ears with hearing loss when compared to any of the DPOAE conditions in either the large or reduced group of subjects. CONCLUSION: While improvements in test accuracy were observed for some subjects and some conditions (e.g., mild hearing losses and low stimulus levels in the reduced subset of subjects), these results suggest that restricting cochlear source contribution by “smoothing” DPOAE fine structure is not expected to improve DPOAE test accuracy in a general population of subjects. Likewise, recording reflection-source OAEs using the AM-SFOAE technique would not be expected to more accurately identify hearing status compared to mixed- or single-source DPOAEs.

The use of virtual humans (i.e., avatars) holds the potential for interactive, automated interaction in domains such as remote communication, customer service, or public announcements. For signed language users, signing avatars could potentially provide accessible content by sharing information in the signer’s preferred or native language. As development of signing avatars has gained traction in recent years, many different methods of creating signing avatars have been developed, and the resulting avatars vary widely in their appearance, the naturalness of their movements, and their facial expressions--all of which may potentially impact users’ acceptance of the avatars. We designed a study to test the effects of these intrinsic properties of different signing avatars, while also examining the extent to which people’s own language experiences change their responses to signing avatars. We created video stimuli showing individual signs produced by 1) a live human signer (Human), 2) an avatar made using computer-synthesized animation (CS Avatar), and 3) an avatar made using high-fidelity motion capture (Mocap avatar). We surveyed 191 American Sign Language users, including Deaf (N = 83), Hard-of-Hearing (N = 34), and Hearing (N= 67) groups. Participants rated the three signers on multiple dimensions which were then combined to form ratings of Attitudes, Impressions, Comprehension, and Naturalness. Analyses demonstrated that the Mocap avatar was rated significantly more positively than the CS avatar on all primary variables. Correlations revealed that signers who acquire sign language later in life are more accepting of, and likely to have positive impressions of signing avatars. Finally, those who learned ASL earlier were more likely to give lower, more negative ratings to the CS avatar, but this association was not seen for the Mocap avatar or the Human signer. Together, these findings suggest that movement quality and appearance significantly impact users’ ratings of signing avatars, and show that signed language users with earlier age of ASL exposure are the most sensitive to movement quality issues seen in computer-generated avatars. We suggest that future efforts to develop signing avatars be considerate of retaining the fluid movement qualities which are integral to signed languages.

Objective: Hearing loss is associated with higher health expenditures and poor healthcare utilization. This study aims to build on these findings by characterizing the association between hearing status and healthcare-seeking behaviors among Medicare beneficiaries. Methods: Cross-sectional log-binominal regression was used to assess the association between self-report hearing and healthcare-seeking behaviors (avoidance or delay of care, personal health concerns, and sharing health status) using the 2016 Medicare Current Beneficiary Survey ( N = 12,140). Results: Beneficiaries with trouble hearing had significantly higher risks of avoiding and delaying health care compared to those without trouble hearing. Conversely, trouble hearing was not associated with concern for health status or sharing health status. Discussion: These findings may help explain higher costs associated with hearing loss as avoidance of care can exacerbate health problems. Further work is needed to understand underlying causes and whether addressing hearing loss modifies the observed association.

In this paper, we characterize establishment of joint attention in hearing parent–deaf child dyads and hearing parent–hearing child dyads. Deaf children were candidates for cochlear implantation who had not yet been implanted and who had no exposure to formal manual communication (e.g., American Sign Language). Because many parents whose deaf children go through early cochlear implant surgery do not themselves know a visual language, these dyads do not share a formal communication system based in a common sensory modality prior to the child’s implantation. Joint attention episodes were identified during free play between hearing parents and their hearing children ( $N = 4$ ) and hearing parents and their deaf children ( $N = 4$ ). Attentional episode types included successful parent-initiated joint attention, unsuccessful parent-initiated joint attention, passive attention, successful child-initiated joint attention, and unsuccessful child-initiated joint attention. Group differences emerged in both successful and unsuccessful parent-initiated attempts at joint attention, parent passive attention, and successful child-initiated attempts at joint attention based on proportion of time spent in each. These findings highlight joint attention as an indicator of early communicative efficacy in parent–child interaction for different child populations. We discuss the active role parents and children play in communication, regardless of their hearing status.

Previous research has demonstrated relationships between cognitive autonomy (ability to think independently) and perceived social support (perceptions of available quality environmental support) among different samples (e.g., Michaelamp; Attias, 2016). The present study examined 116 typically hearing and 91 deaf or hard of hearing (DHH) adults, who completed the Cognitive Autonomy and Self-Evaluation Inventory (Beckert, 2007) and the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988). Significant correlations were found between most of the cognitive autonomy and social support variables, with no significant differences between the correlations for the two groups. Participants who were DHH reported higher levels of four of the five cognitive autonomy variables than the participants with typical hearing. Additionally, for the DHH group, family status, education level, and age at detection of hearing loss significantly predicted some of the cognitive autonomy variables. Implication for research and practice are discussed.

Air-bone gap (ABG) is an important indicator of hearing status after myringoplasty. A number of factors have been associated with ABG, but some patients still have ABG without identifiable cause. This study aimed to evaluate the relationship between tympanic membrane (TM) vibration using laser Doppler vibrometry (LDV) and ABG after myringoplasty. Between January 2013 and January 2015, 24 patients with ABG of unknown cause after myringoplasty were enrolled at the Beijing Tongren Hospital. Thirty normal controls were recruited from the hospital staff. All patients underwent primary overlay myringoplasty. Pre- and postoperative air conduction (AC) and bone-conduction (BC) thresholds, and ABG were measured. Umbo velocity transfer function (UVTF) for vibration of TM was measured with LDV. Air conduction thresholds were significantly reduced after myringoplasty (all P < .05), while BC thresholds were not significantly changed (all P > .05). ABG was significantly reduced after myringoplasty (all P < .05). Air-bone gap was correlated with UVTF at 1.0 kHz (r = −0.46; P = .024). For patients with UVTF >0.08 mm/s/Pa, ABG was correlated with UVTF (r = −0.56; P = .029). For post-myringoplasty ABG without readily observable causes, there was a significant relationship between ABG and TM vibration. These results provide new insights in the understanding of this relationship and may help explain ABG after myringoplasty when there are no clear contributing factors.

Background/aim Chemopreventative therapeutics may be helpful in familial adenomatous polyposis (FAP) management; however, prospective chemopreventative studies are complicated by potential ototoxicity and pre-existing hearing loss. The aim of this study was to establish and compare baseline hearing status of children and adolescents with FAP and their unaffected siblings. Patients and methods Twenty FAP pediatric patients with documented mutation of the adenomatous polyposis coli (APC) gene and nine unaffected sibling controls underwent baseline hearing evaluation, including audiometry, speech perception testing, and middle and inner ear physiologic measures. Results of the FAP cohort were compared to the unaffected sibling cohort. Results Two (5%) children with FAP presented with baseline hearing loss of unknown etiology, likely unrelated to their FAP diagnosis. No significant differences were found in any of the hearing measures between groups. Conclusion Mutation of the APC gene is not necessarily indicative of higher risk for baseline hearing loss in the pediatric population.

Objective To determine the association between self-reported hearing status and risk of hospitalisation among Chinese middle-aged and older adults. Design Prospective cohort study. Discrete-time hazards models and negative binomial models were fitted to examine the relationship. Study sample About 11,902 participants aged 45 years or older with no hospitalisation at baseline. Results 49.28-62.70% of the participants reported their hearing as fair or poor. For older adults aged 60 and above, compared to people with excellent and very good hearing, those with good, fair or poor hearing reported shorter time to first hospitalisation [hazard ratio (HR) = 1.38, 1.38, 1.63, respectively]. They also manifested greater number of hospitalisations [incident rate ratio (IRR) = 1.21, 1.25, 1.54, respectively], and longer duration of hospitalisation (IRR = 1.36, 1.26, 1.53, respectively). However, there was no significant association between hearing status and hospitalisation for middle-aged adults for none of the hearing categories. Conclusions Although no significant relationship between hearing and hospitalisation was found for middle-aged adults, older adults with poorer hearing experienced greater risk of hospitalisation. Given that hearing impairment is highly prevalent among older adults, future analyses are needed to investigate whether hearing rehabilitative therapies could help mitigate hospitalisations in hearing-impaired older adults.

The assessment of the integrity of the neural responses with ABR, aims to assist in the differential diagnosis of retrocochlear alterations. The gold standard stimulus for this assessment is Click. However, the CE-Chirp® Level Specific was developed to optimize the triggering of neural responses.to compare neural responses obtained with CE-Chirp® LS stimulus to those obtained with Clicks at 70 dB nHL in hearing infants, in order to analyze advantages in using CE-Chirp® LS.Eighteen infants with normal hearing were evaluated with Eclipse EP25 ABR System. Clicks and CE-Chirp® LS stimuli were presented using ER-3A insert earphones at 70 dB nHL, rate 45.1/s, and alternating polarity. A 30 Hz high-pass and 1500 Hz low-pass filter was applied, and ±40 μV artifact rejection level. Absolute latency of waves I, III and V and their interpeak intervals I-III, III-V and I-V were measured, as well as interaural difference for wave V and interpeak I-V, and wave V amplitude.Although 18 infants were included in the study, it was possible to collect data only in 30 ears for Click stimulus, and 33 ears for CE-Chirp® LS, according to exclusion criteria. It was possible to record waves I, III, and V for both stimuli at 70 dB nHL in all normal-hearing infants. CE-Chirp® LS stimulus evoked a higher wave V amplitude than Click (p 0.001). Wave I absolute latency was statistically different between stimuli (p 0.001), being delayed for CE-Chirp® LS. Wave III absolute latency was statistically different between stimuli only for the right ear (p = 0.021), and wave V absolute latency was similar in both stimuli (p = 0.210). Interpeak intervals I-III and I-V were statistically different between stimuli (p 0.001), being reduced for CE-Chirp® LS. Interpeak interval III-V was different between the stimuli only for right ears (p = 0.006). There was no difference between stimuli for interaural difference wave V (p = 1.33) and interaural difference interpeak I-V (p = 0.409).It is possible to use CE-Chirp® LS stimulus in order to analyze neural synchrony in infants at 70 dB nHL, since better morphology waveforms were observed, and higher wave V amplitudes could be recorded. We suggest that new studies with infants with neurological disabilities and various hearing status, to observe how CE-Chirp® LS stimulus evokes neural responses in these conditions.

This study examined the effects of (a) schema-enriched communication and (b) computer-based messaging on the sharing of knowledge and problem solving in teams with deaf or hard of hearing (DHH) and typical hearing (TH) postsecondary students. Four-member teams comprising either all DHH, all TH, or two DHH and two TH postsecondary students solved a complex problem. Measures consisted of (a) shared written information, (b) creation of a matrix with information for solving the problem, (c) recognition of information shared by team members, and (d) quality of the team’s problem solution. A total of 126 DHH and 126 TH postsecondary students participated in the study in teams with one of the three combinations of hearing status. Enriched communication increased teams’ sharing of written information, creation of a matrix, recognition of information shared by teammates and quality of the problem solution in teams.

OBJECTIVES Binaural pitch fusion is the perceptual integration of stimuli that evoke different pitches between the ears into a single auditory image. Adults who use hearing aids (HAs) or cochlear implants (CIs) often experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3 to 4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The main goal of this study was to measure binaural pitch fusion in children with different hearing device combinations and compare results across groups and with adults. A second goal was to examine the relationship of binaural pitch fusion to interaural pitch differences or pitch match range, a measure of sequential pitch discriminability. DESIGN Binaural pitch fusion was measured in children between the ages of 6.1 and 11.1 years with bilateral HAs (n = 9), bimodal CI (n = 10), bilateral CIs (n = 17), as well as normal-hearing (NH) children (n = 21). Depending on device combination, stimuli were pure tones or electric pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Interaural pitch match functions were measured using sequential presentation of reference and comparison stimuli, and varying the comparison stimulus to find the pitch match center and range. RESULTS Children with bilateral HAs had significantly broader binaural pitch fusion than children with NH, bimodal CI, or bilateral CIs. Children with NH and bilateral HAs, but not children with bimodal or bilateral CIs, had significantly broader fusion than adults with the same hearing status and device configuration. In children with bilateral CIs, fusion range was correlated with several variables that were also correlated with each other: pure-tone average in the second implanted ear before CI, and duration of prior bilateral HA, bimodal CI, or bilateral CI experience. No relationship was observed between fusion range and pitch match differences or range. CONCLUSIONS The findings suggest that binaural pitch fusion is still developing in this age range and depends on hearing device combination but not on interaural pitch differences or discriminability.

OBJECTIVES: We investigated the impact of both intrinsic and extrinsic cognitive demands on auditory and secondary task performance in older adults with normal hearing (NH) and adults using hearing aids (HAs) in an ecologically relevant listening environment. DESIGN: Fifteen adults with NH and 15 adults using HAs (60 to 72 years of age) were recruited to perform the "Audiovisual True-to-Life Assessment of Auditory Rehabilitation"-paradigm (AVATAR), which combines an auditory-visual speech-in-noise task with three secondary tasks on either auditory localization or visual short-term memory in a preload multitask paradigm. Intrinsic demands were altered by presenting speech either at equivalent speech accuracy levels of 50% correct (SPIN50%) or equivalent speech-to-noise ratios of +5dB SNR (SPIN+5dB). We manipulated the amount of extrinsic cognitive demands by including one (dual condition) or three secondary tasks (quadruple condition). Performance decrements on the secondary tasks were considered to reflect an increase in resource allocation to speech understanding and thus an increase in listening effort. In addition, we administered a cognitive test battery as well as a questionnaire on self-reported hearing difficulties and subjective measures of effort and motivation. RESULTS: Speech understanding and secondary task performance on the visual short-term memory task were lower in the SPIN50% condition compared to SPIN+5dB. Whereas speech understanding at SPIN50% was equally high in the dual and quadruple conditions, the quadruple condition resulted in lower secondary task performance on the visual short-term memory task, higher levels of self-reported effort, and lower motivation compared to the dual-task condition. The same was true for experimental conditions at SPIN+5dB. Additionally, adults with NH outperformed adults using HAs on speech understanding, auditory localization, and self-reported hearing abilities, but no group differences were observed on secondary task costs or cognitive measures. CONCLUSIONS: This study showed that, irrespective of the hearing status of the listener, speech performance was not affected by the amount of extrinsic cognitive demands, but was worse and required more effort under conditions with a more negative SNR. Also, increasing the extrinsic cognitive demands resulted in lower performance on one of the secondary tasks, suggesting that more complex listening environments require more effort. Although adults with NH outperformed HA users on speech understanding and auditory localization, the two groups did not differ with respect to secondary task costs. ispartof: EAR AND HEARING vol:42 issue:3 pages:615-628 ispartof: location:United States status: accepted