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Purpose: The aim of the current scoping review is to identify the studies reporting ototoxicity monitoring in individuals with head and neck cancer (HNC) undergoing radiation therapy and/or chemoradiation therapy across the world. The specific objectives were to identify and report the test protocol used, identify the most common timeline of follow-up, and identify barriers and facilitators influencing the implementation of the monitoring program. Method: A comprehensive search was conducted across six electronic databases, including PubMed, Embase, Web of Science, Scopus, Google Scholar, and ProQuest. The scoping review method adhered to relevant guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and frameworks. The database search was carried out by two independent researchers, and studies were selected based on specific inclusion and exclusion criteria. Results: This scoping review identified 13 studies that fulfilled the inclusion criteria of this study. Only one study reported findings from the perspective of ototoxicity monitoring. Another study explicitly mentioned that ototoxicity monitoring was a standard of care in their hospital. Only one study reported using the relevant guidelines for monitoring ototoxicity. Specialized tests such as high-frequency audiometry, distortion product otoacoustic emissions, and vestibular tests were rarely used. Ototoxicity monitoring was influenced by awareness-related factors, technical factors, treatment-related factors, and organizational factors. Conclusions: Research on ototoxicity monitoring programs is in its early stages, highlighting the need for standardized practices and multidisciplinary collaboration to enhance health care services for HNC patients. A standardized approach, improved awareness, and the incorporation of patient perspectives are crucial to enhancing ototoxicity monitoring in HNC patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to investigate the age-related changes of the Contralateral Acoustic Reflex Suppression (CARS) test in individuals with normal hearing and to provide age-related normal values. Method: The study included 66 individuals aged 18-65 years. The participants were divided into three age groups, respectively, 18-30 years, 31-45 years, and 46--65 years. Acoustic reflex threshold and acoustic reflex amplitude measurements were performed at frequencies of 500, 1000, and 2000 Hz in the presence and absence of suppressive noise from the contralateral ear. Results: In the comparison of suppression amounts according to age groups, the highest suppression amount at all frequencies was observed in the 18-30 years age group. Conclusions: It is known that changes in the function of the efferent hearing system occur due to aging. In the CARS test, a decrease in the amount of suppression produced by the efferent system has been observed due to aging. [ABSTRACT FROM AUTHOR]

Purpose: Hearing aid (HA) processing delay results in asynchronous overlap of the input sound and the delayed amplified sound at the eardrum in open-ear fittings. This may distort the temporal cues used for stop-consonant voicing distinctions. The current study evaluated the impact of HA processing delay on voiced--voiceless categorization of syllable initial consonants /d/ and /t/ for a range of voice onset times (VOTs). Method: Nineteen older listeners (Mage = 73 years) with mild--moderate sensorineural hearing loss participated. All listeners performed the voiced--voiceless categorization task in double-blind within-subjects design. Thirteen stimulus tokens along the /di:/ - /ti:/ continuum were created by varying VOTs. Stimuli were then processed using an HA simulator, which simulated the overall sound pressure levels measured at the eardrum in open-ear fittings with four processing delay times (0, 0.5, 5, and 8 ms). Individualized stimuli were generated for each listener based on their audiogram and presented via calibrated ear inserts at the most comfortable listening level. Performance across all VOT intervals was fitted with psychometric functions, which were then used to estimate the voiced--voiceless crossover point and the slope parameter for each simulated delay condition. Results: The crossover point along the voiced--voiceless continuum shifted systematically with increased processing delay toward voiced /di:/ over unvoiced /ti:/ percepts. The shift in the crossover point between the 0-ms reference condition and the 8-ms processing delay condition corresponded to 5.8 ms of change in VOT. The 8-ms processing delay condition resulted in significantly shallower categorization slopes compared to the 0- and 0.5-ms delay conditions. Conclusions: Temporal distortions created by HA processing delay in open-ear fittings impacted voicing perception of syllable initial stop-consonant stimuli near the voiced--voiceless crossover point. Short HA processing delay should be considered for open-ear fittings to preserve the natural VOT cues used for voicing detection. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the benefits of a Bluetooth self-fitting device using an in situ hearing screening test and self-fitting processes. Method: Thirty Mandarin-speaking individuals (16 men and 14 women) with mild-to-moderate hearing loss participated in this study. The hearing screening test was conducted using neckband earphones of a Bluetooth self-fitting device controlled by a smartphone app. The hearing screening tests were compared with the pure-tone audiometry in an audiometric booth. The amplification benefits of the self-fitting program-aided condition were evaluated and compared with those of unaided and preset program-aided conditions using the Mandarin Hearing in Noise Test (MHINT) and questionnaires. Results: The pure-tone audiometry and hearing screening test results exhibited strong positive correlations at all test frequencies. In the environment with 90° noise, the sentence reception thresholds (SRTs) obtained for the self-fitting program-aided condition were significantly lower (p = .032) than those obtained for the unaided condition, whereas no significant difference was observed between the preset program-aided and the unaided conditions. Moreover, the participants' satisfaction ratings for the devices were consistent with their MHINT results, with a strong positive correlation observed between satisfaction with self-fitting and user satisfaction in smartphone app's control, functionality, and learning. Younger participants were significantly more satisfied in learning to use the app. Conclusions: Bluetooth self-fitting devices can be used for simplified in situ hearing screenings with a sensitivity of 90.4%. The satisfaction ratings and improvements in SRTs indicate significant clinical benefits of the self-fitting program compared with the preset program, particularly in the 90°-noise environments. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine whether providing realistic auditory or somatosensory cues to spatial location would affect measures of vestibulo-ocular reflex gain in a rotary chair testing (RCT) context. Method: This was a fully within-subject design. Thirty young adults age 18-30 years (16 men, 14 women by self-identification) completed sinusoidal harmonic acceleration testing in a rotary chair under five different conditions, each at three rotational frequencies (0.01, 0.08, and 0.32 Hz). We recorded gain as the ratio of the amplitude of eye movement to chair movement using standard clinical procedures. The five conditions consisted of two without spatial information (silence, tasking via headphones) and three with either auditory (refrigerator sound, tasking via speaker) or somatosensory (fan) information. Two of the conditions also included mental tasking (tasking via headphones, tasking via speaker) and differed only in terms of the spatial localizability of the verbal instructions. We used linear mixed-effects modeling to compare pairs of conditions, specifically examining the effects of the availability of spatial cues in the environment. This study was preregistered on Open Science Framework (https://osf.io/2gqcf/). Results: Results showed significant effects of frequency in all conditions (p < .05), but the only pairs of conditions that were significantly different were those including tasking in one condition but not the other (e.g., tasking via headphones vs. silence). Post hoc equivalence testing showed that the lack of significance in the other comparisons could be confirmed as not meaningfully different. Conclusions: These findings suggest that the presence of externally localizable sensory information, whether auditory or somatosensory, does not affect measures of gain in RCT to any relevant degree. However, these findings also contribute to the increasing body of evidence suggesting that mental engagement ("tasking") does increase gain whether or not it is provided via localizable instructions. [ABSTRACT FROM AUTHOR]

Objective: Phone- and tablet-based hearing testing systems are now widely available. Here, we evaluated one such system from TympaHealth by comparing air conduction thresholds and resultant hearing aid targets and output, measured with the TympaHealth system with those measured using standard audiometry. Design: The hearing thresholds of 35 adults were measured using standard audiometry and the TympaHealth system. Each set of thresholds was used to generate NAL-NL2 targets and program a hearing aid. The data from each system were compared. Results: Bland--Altman analyses showed overall mean differences between thresholds measured with each system to be small, with 85% of TympaHealth thresholds being within ±5 dB of the standard audiometric thresholds, although TympaHealth thresholds were higher (poorer) than the standard audiometric thresholds. The hearing aid targets and gains generated from the standard audiometric thresholds were lower (less amplification) than those generated from the TympaHealth thresholds but again, mean differences at each frequency were small and likely imperceptible. Conclusion: These findings support the possibility that valid hearing testing can take place outside of a clinical booth using portable systems like that from TympaHealth, opening up the possibility of testing hearing and fitting hearing aids through pharmacies, opticians, and in care homes. [ABSTRACT FROM AUTHOR]

Purpose: Impairments of hearing and auditory processing (AP) have been indicated as risk factors for dementia, but it remains unclear if persons with clinically diagnosed mild cognitive impairment (MCI) show such impairments. The objective of these analyses was to compare AP between those with and without a clinical diagnosis of MCI using a battery of AP measures. Method: Data from 274 older adults from the Keys to Staying Sharp randomized clinical trial (NCT03528486) were analyzed. A battery of AP measures in which three domains (temporal processing, binaural processing, and degraded speech understanding) were addressed by six tests was administered. Analyses were registered at https://osf.io/nga4v. Results: Those with and without a clinical diagnosis of MCI differed significantly in age, p = .002; pure-tone hearing in the left ear, p = .007; sex, p = .015; and race, p < .001. These covariates were included in multivariate analysis of covariance, which indicated significant differences between persons with and without MCI on measures of binaural processing (ps ≤ .006), but not on measures of temporal processing or degraded speech (ps ≥ .093). Pure-tone hearing averages did not significantly differ among those with or without MCI after adjusting for age, sex, and race (ps ≥ .292). Conclusions: AP in the binaural domain is impaired in MCI, but peripheral hearing did not significantly differ between those with and without MCI. Poor performance on AP measures of binaural processing may reflect problems dividing attention and may be indicative of dementia risk. Results have clinical implications for early detection of and intervention for cognitive impairment. [ABSTRACT FROM AUTHOR]

Purpose: Bone conduction hearing devices (BCDs) that deliver sound across the skin (i.e., transcutaneous) are suitable for some individuals who have con- ductive or mixed hearing losses. Prescriptive targets for percutaneous devices are available, for example, from the Desired Sensation Level--Bone Conduction Hearing Device (DSL-BCD) algorithm. These targets, however, may require modification for use with transcutaneous BCDs. The current study investigated three key variables that may inform target modification: (a) comparison of thresholds measured using an audiometric bone conduction (BC) transducer versus transcutaneous BCDs that offer in situ threshold measurement, (b) trans- cutaneous BCD default force level outputs versus recommended DSL percuta- neous BC targets, and (c) the preferred listening levels (PLLs) of adults wearing transcutaneous BCDs in a laboratory setting. Method: Bilateral conductive hearing loss was simulated in 20 normal-hearing adults via earplugs. Thresholds were measured using a B-71 BC transducer and two commercially available BCDs coupled to a soft headband. DSL percu- taneous BC targets were generated, and PLLs were obtained for a 60-dB SPL speech stimulus. Force level outputs were measured using a skull simulator on the Audioscan Verifit2 at the hearing aids' default settings and at the partici- pants' PLL for each device. Results: On average, audiometric BC thresholds were significantly better than those measured in situ with each BCD. PLLs were similar to prescribed targets for one device with the smoother response shape and agreed in the high fre- quencies for both devices. Conclusions: In situ thresholds are significantly higher than audiometric BC thresholds, suggesting that device-based in situ measurement more accurately accounts for the signal transmission from transcutaneous BCDs. PLLs differed from the percutaneous targets and varied between devices, which may indicate that either target modifications or manipulations of device frequency response shaping are needed to approximate PLL with transcutaneous BCD devices. [ABSTRACT FROM AUTHOR]

Purpose: Population-based evidence in the interrelationships among hearing, brain structure, and cognition is limited. This study aims to investigate the cross-sectional associations of peripheral hearing, brain imaging measures, and cognitive function with speech-in-noise performance among older adults. Method: We studied 602 participants in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) brain magnetic resonance imaging (MRI) ancillary study, including 427 ACHIEVE baseline (2018--2020) participants with hearing loss and 175 Atherosclerosis Risk in Communities Neurocognitive Study Visit 6/7 (2016--2017/2018--2019) participants with normal hearing. Speech-in-noise performance, as outcome of interest, was assessed by the Quick Speech-in-Noise (QuickSIN) test (range: 0--30; higher = better). Predictors of interest included (a) peripheral hearing assessed by pure-tone audiometry; (b) brain imaging measures: structural MRI measures, white matter hyperintensities, and diffusion tensor imaging measures; and (c) cognitive performance assessed by a battery of 10 cognitive tests. All predictors were standardized to z scores. We estimated the differences in QuickSIN associated with every standard deviation (SD) worse in each predictor (peripheral hearing, brain imaging, and cognition) using multivariable-adjusted linear regression, adjusting for demographic variables, lifestyle, and disease factors (Model 1), and, additionally, for other predictors to assess independent associations (Model 2). Results: Participants were aged 70-84 years, 56% female, and 17% Black. Every SD worse in better-ear 4-frequency pure-tone average was associated with worse QuickSIN (-4.89, 95% confidence interval, CI [-5.57, -4.21]) when participants had peripheral hearing loss, independent of other predictors. Smaller temporal lobe volume was associated with worse QuickSIN, but the association was not independent of other predictors (-0.30, 95% CI [-0.86, 0.26]). Every SD worse in global cognitive performance was independently associated with worse QuickSIN (-0.90, 95% CI [-1.30, -0.50]). Conclusions: Peripheral hearing and cognitive performance are independently associated with speech-in-noise performance among dementia-free older adults. The ongoing ACHIEVE trial will elucidate the effect of a hearing intervention that includes amplification and auditory rehabilitation on speech-in-noise understanding in older adults. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the short- and long-term effects of a new cognitive sound exposure therapy (CSET) in patients with hyperacusis. Method: A new therapy was developed to reduce hyperacusis using sound exposure combined with breathing and relaxation strategies from both accep- tance and commitment therapy and cognitive behavioral therapy. Patients who were referred to the Speech and Hearing Centers located in Hengelo and Zwolle in the Netherlands and aged ≥ 18 years with hyperacusis as main complaint and no or mild hearing loss were included in this study. Patients were seen for CSET between June 2020 and August 2022. The sessions took place biweekly. Sessions ended when exposure reached a level with a maximum of 70--80 dB SPL. Short-term effects between the start and the end of therapy were based on tolerable level of sound exposure (dB SPL), subjective-level hinderance of hypera- cusis, and sensitivity to sound using the Hyperacusis Questionnaire (HQ). The long-term effect was based on HQ 6 months after the end of therapy. Linear mixed-effects and regression models were applied to study outcomes over time. Results: In total, 30 patients, 15 men and 15 women, aged between 24 and 76 years were included in this study. The mean number of sessions during ther- apy was 6 and ranged between 4 and 8. Results showed an increase of exposure level (mean change was +23.7 dB with an SD of 7.9, p< .001), a decrease in sensitivity to daily sounds (mean [SD] change was -1.6 [2.1], p<.001),anda decrease in HQ (mean [SD] change was -9.8 [4.9], p< .001), between the start and the end of therapy. There was no significant change in HQ after the end of therapy and 6 months later; mean (SD) change was 0.2 (4.3), p=.81. Conclusions: The evaluation of CSET indicated a decrease in short- and long- term sensitivity to sound in patients with hyperacusis. Additionally, CSET has shown a positive impact, not only for the sounds used in the therapy sessions but also in transferring benefits to everyday sounds. The results of combining psychoeducation, sound exposure, and counseling are promising and warrant further evaluation. [ABSTRACT FROM AUTHOR]

Purpose: Aging increases risk for hearing loss, cognitive decline, and social isolation; however, the nature of their interconnection remains unclear. This study examined the interplay between age-related hearing loss, cognitive decline, and social isolation in adults by testing the ability to understand speech in background noise, a challenge frequently reported by many older adults. Method: We analyzed data collected from 128 adults (20-79 years of age, Mage = 51 years) recruited as part of the Aging Brain Cohort at the University of South Carolina repository. The participants underwent testing for hearing, cognition, and social interaction, which included pure-tone audiometry, a words-in-noise (WIN) test, a hearing questionnaire (Speech, Spatial and Qualities of Hearing Scale [SSQ12]), a social questionnaire (Patient-Reported Outcomes Measurement Information System-57 Social), and the Montreal Cognitive Assessment. We used a single pure-tone average (PTA) threshold value and a single WIN threshold value for each participant because there were no differences on average between the left and right ears. Results: Poorer hearing was significantly associated with cognitive decline, through both PTA and WIN thresholds, with a stronger association observed for WIN threshold. Adults with poorer hearing also exhibited greater social isolation, as evidenced by their WIN threshold and SSQ12 score, although not through PTA. This connection was more pronounced with the WIN threshold than with the SSQ12 score. Cognition was not related to social isolation, suggesting that social isolation is affected more by the ability to understand words in noise than by cognition in a nondemented population. Conclusions: Understanding speech in challenging auditory environments rather than mere threshold detection is strongly linked to social isolation and cognitive decline. Thus, inclusion of a word-recognition-in-noise test and a social isolation survey in clinical settings is warranted. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated student performance and perception of a simulated hearing screening utilizing an adult standardized patient (SP). It explored the relationship between student performance and student perception of the simulation. Method: Sixty-nine first-year speech pathology graduate students completed a high-fidelity simulation to demonstrate competency in hearing screening administration with an adult SP. Student performance was assessed by supervising educators through standardized rubrics in the following domains: (a) explaining the task, (b) following the university screening protocol, (c) demonstrating clinical and critical thinking, and (d) using the audiometer efficiently. Students also completed surveys to provide feedback regarding their simulation experience. Results: The median rating for student performance across the four domains evaluated was determined using nonparametric tests, while a one-sample t test was used to determine average ratings. Additionally, central tendency and dispersion measures were computed using rubric ratings of students' performance in each domain evaluated. Overall, students performed well in this simulation, with nearly all students demonstrating competency in explaining the task and demonstrating clinical/critical thinking. Following the screening protocol and using the audiometer efficiently showed the most room for improvement. Student survey responses generally indicated that this was a positive and beneficial learning experience and provided constructive feedback for future iterations of this simulation. Conclusions: Hearing screening simulations effectively train graduate speech-language pathology students in the necessary skills. Student perceptions of this simulation were resoundingly positive. [ABSTRACT FROM AUTHOR]

Purpose: A corpus of English matrix sentences produced by 60 native and nonnative speakers of English was developed as part of a multinational coalition task group. This corpus was tested on a large cohort of U.S. Service members in order to examine the effects of talker nativeness, listener nativeness, masker type, and hearing sensitivity on speech recognition performance in this population. Method: A total of 1,939 U.S. Service members (ages 18–68 years) completed this closed-set listening task, including 430 women and 110 nonnative English speakers. Stimuli were produced by native and nonnative speakers of English and were presented in speech-shaped noise and multitalker babble. Keyword recognition accuracy and response times were analyzed. Results: General(ized) linear mixed-effects regression models found that, on the whole, speech recognition performance was lower for listeners who identified as nonnative speakers of English and when listening to speech produced by nonnative speakers of English. Talker and listener effects were more pronounced when listening in a babble masker than in a speech-shaped noise masker. Response times varied as a function of recognition score, with longest response times found for intermediate levels of performance. Conclusions: This study found additive effects of talker and listener nonnativeness when listening to speech in background noise. These effects were present in both accuracy and response time measures. No multiplicative effects of talker and listener language background were found. There was little evidence of a negative interaction between talker nonnativeness and hearing impairment, suggesting that these factors may have redundant effects on speech recognition. [ABSTRACT FROM AUTHOR]

Purpose: Diminished basal cochlear function, as indicated by elevated hearing thresholds in the extended high frequencies (EHFs), has been associated with lower levels of click-evoked and distortion-product otoacoustic emissions measured at lower frequencies. However, stimulus-frequency otoacoustic emissions (SFOAEs) at low-probe levels are reflection-source emissions that do not share the same generation mechanism as distortion-source emissions. The primary objective of the present study was to examine the influence of hearing thresholds in the EHFs on SFOAEs measured at lower frequencies. Method: SFOAEs were recorded from both ears in 45 individuals with normal hearing thresholds in the conventional audiometric frequencies (0.25–8 kHz). Hearing thresholds were also measured at EHFs (10, 12.5, and 16 kHz). SFOAE magnitudes and signal-to-noise ratios (SNRs) were averaged across 1, 2, and 4 kHz probe frequencies and also averaged for high-probe frequencies (2 and 4 kHz). Results: SFOAE magnitudes and SNRs were significantly higher for ears with better EHF hearing relative to poorer EHF hearing, categorized based on the median split. In addition, hearing in the EHFs significantly contributed to the variance in all SFOAE measures, except for the high-frequency SFOAE magnitudes model. However, hearing thresholds at the probe frequencies did not significantly contribute to the variance in SFOAEs. Conclusions: The study findings suggest that alterations in the basal cochlea, as revealed by EHF hearing thresholds, could be associated with diminished cochlear functioning in relatively apical regions, shown by SFOAEs at lower frequencies, in individuals with normal audiograms. These findings underscore the significance of considering EHF thresholds in audiological evaluations, as alterations in these frequencies may reflect broader cochlear health status. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to inform the revision of a targeted surveillance risk registry by identifying which risk factors predict postnatally identified hearing loss (PNIHL) in children who pass newborn hearing screening and to determine whether hearing surveillance beyond the age of 1 year is warranted. Method: We used retrospective analysis of the audiological outcomes of children born in the state of Queensland, Australia, between January 1, 2010, and December 31, 2019, who passed the newborn hearing screen with risk factors. Results: Approximately one third of children were lost to follow-up and could not be included in the analysis. Risk factors that predicted PNIHL in the analyzed cohort were as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infections, and family history of permanent childhood hearing loss. Severe asphyxia did not predict PNIHL but yielded some cases of significant bilateral hearing loss. Hearing loss in children with a history of prolonged ventilation was mild and/or unilateral in nature (except in cases where the hearing loss was due to an unrelated etiology). There were no cases of PNIHL in children with hyperbilirubinemia or neonatal bacterial meningitis. For the risk factors that predicted PNIHL, nearly all hearing losses were detected by 1 year of age, except for children with family history where one quarter of hearing losses had a later onset. Conclusions: The four risk factors recommended for efficient postnatal identification of hearing loss are as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infection, and family history of permanent childhood hearing loss. Hearing surveillance through to 1 year old is sufficient except for children with a family history, where a second phase assessment is indicated. Alternative targeted surveillance protocols and models of care are required to minimize loss to follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to provide a viewpoint on the recently published results showing the positive effect hearing intervention can have on mitigating the risk of cognitive decline in elderly individuals with hearing impairment. We intend to trigger a broader discussion on the implications of these results from an implementation science perspective. Methods: Recently published results were reviewed and contextualized. Results: In our view, these recent findings provide a great opportunity for hearing care professionals to change the perspective on hearing care being an essential service that contributes not only to managing challenges with audibility but to enabling healthy living and aging. Conclusion: As exciting as these findings are, from our perspective, they are also a call to action for the audiology field in terms of clinical implementation science. The findings guide us toward a more interprofessional approach in order to develop and test new, more holistic models of hearing care. [ABSTRACT FROM AUTHOR]

Purpose: Masseter vestibular evoked myogenic potentials (mVEMP) involve the connection between the vestibular complex and trigeminal nerve nuclei. Given the theory that migraine is caused by increased activation of the trigeminal nerve, it is believed that mVEMP responses may have influenced in migraine patients. Method: The study included 20 individuals with migraine and 20 healthy controls. Latency, amplitude, and interaural amplitude asymmetry ratio of mVEMP responses recorded in migraine patients were compared with control group. Results: Considering the mVEMP normalization study conducted by Başöz et al. (2021) in a similar age group and in the same clinic, latency prolongation and amplitude decrease were observed in subjects with migraines. Migraine is considered a central pathology, as shown in the cervical and ocular VEMP (cVEMP/oVEMP) literature. No difference was observed in the interaural amplitude asymmetry ratio, which is important in peripheral pathologies. Additionally, when the number of pathological ears was examined in order to understand the total exposure, it was observed that the number of pathological ears was significantly higher in the migraine group. Conclusion: In future studies, using mVEMP together with cVEMP and oVEMP tests, which allow evaluation of otolith organs and vestibular nuclei, will be valuable in determining the lesion location. [ABSTRACT FROM AUTHOR]

Purpose: Many factors create barriers for early hearing detection and intervention (EHDI), especially those related to unfavorable social determinants of health (SDOH). The primary aim of this study was to evaluate diagnostic timing of infants at risk for congenital hearing loss in consideration of known barriers. Understanding the specific barriers to early diagnosis can inform interventions to improve timeliness of diagnosis and subsequent habilitation. Method: A retrospective chart review was completed for infants referred for diagnostic audiologic testing at a tertiary urban-setting Children's Hospital from 2018 to 2021. After exclusion criteria were applied, 1,488 infants were included in the analysis. Various factors were recorded from electronic medical records including those specific to SDOH. Time to diagnosis was derived and compared across five factors of interest that have previously been shown to impact diagnostic timeline, including (a) insurance type, (b) race/ethnicity, (c) presence of middle ear dysfunction at first auditory brainstem response (ABR), (d) proximity to diagnostic center, and (e) diagnostic timing before and during/after the COVID-19 pandemic. Results: Across the study time period, 77% of infants referred for diagnostic testing had confirmed diagnosis by the EHDI benchmark of 3 months. Analysis of time to diagnosis across factors of interest revealed no clinically significant differences for insurance type, race/ethnicity, proximity to diagnostic center, or timing in reference to the COVID-19 pandemic. Presence of middle ear dysfunction on first ABR was found to significantly protract final diagnostic timing. Conclusions: Although some known barriers for EHDI can be universal, other factors may have a differential impact on an infant's timeline to diagnosis based on their specific location, which can interact differently with additional known barriers. Understanding local challenges will serve to better guide programs in implementing facilitators that will address their specific needs for improved outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of the study is to investigate whether the presence of residual hearing before cochlear implantation has an effect on temporal pattern recognition skills and musical perception in adults. Method: The study included adults with cochlear implants who were between the ages of 20 and 45 years. Adults with cochlear implants were divided into two groups: absent (n = 20) and available (n = 20) groups according to residual hearing before implantation. Frequency Pattern and Duration Pattern tests were applied to evaluate temporal pattern recognition, and the "Music-Related Quality of Life Questionnaire" was applied to evaluate musical perceptions. Results: There were no statistically significant differences between the groups in terms of cochlear-implanted hearing thresholds and speech recognition scores, musical perception, and musical activities, according to their residual hearing. On the other hand, the frequency and duration pattern recognition skills were statistically significantly better in adults with residual hearing. Also, statistically significant correlations were obtained in terms of temporal skills and musical perception subskills. Conclusions: The presence of residual hearing before cochlear implantation may affect temporal auditory processing skills. It is concluded that the integration of cochlear implants may affect temporal processing skills in adults as well as quality of life. It is recommended that experts be aware of this issue and pay attention to residual hearing. [ABSTRACT FROM AUTHOR]

Purpose: So far, there have been no in-depth analyses of the connection between tinnitus sensation--level loudness and sleep quality. Accordingly, the present study was formulated as a mediation analysis focused on exploring this relationship. Method: Overall, 1,255 adults with consecutive subjective tinnitus who had sought outpatient treatment were enrolled in the present study. Results: Direct effects of tinnitus sensation--level loudness on sleep quality were not statistically significant (95% confidence intervals [CI] include zero), as measured by the point estimate, -0.016. However, the 95% CI for indirect effects did not include zero when assessing the Self-Rating Anxiety Scale (SAS) scores, the Self-Rating Depression Scale (SDS) scores, the visual analogue scale (VAS) scores, and self-reported tinnitus annoyance. Conclusions: These results suggest that tinnitus sensation--level loudness does not directly have an effect on sleep quality. However, it indirectly impacts sleep quality, mediated by SAS scores, SDS scores, the impact of tinnitus on life measured using the VAS, and self-reported tinnitus annoyance. As such, alleviating anxiety and depression in patients with tinnitus may result in reductions in their insomnia even if there is no reduction in tinnitus loudness. Importantly, otolaryngologists and other clinicians treating tinnitus should refer patients with tinnitus suffering from insomnia with comorbid depression or anxiety for appropriate psychological and/or psychiatric treatment. [ABSTRACT FROM AUTHOR]

Purpose: An increase in the 1000/500 Hz frequency amplitude ratio (FAR) of the cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively) may serve as a potential biomarker for diagnosing Meniere's disease (MD). However, the aging process can also result in an increased FAR for VEMPs. In older patients, distinguishing whether changes in VEMP FAR are due to MD or aging processes becomes difficult. We aimed to investigate the effects of age on VEMP FARs and establish a FAR-normative range for different age groups. Method: cVEMP and oVEMP were recorded from a total of 106 participants grouped as young, middle-aged, and older adults using air-conducted tone bursts at 500, 750, and 1000 Hz at 125 dB pSPL. The FAR was calculated for the cVEMP and oVEMP for the following frequencies: FAR1 = 1000/500, FAR2 = 1000/750, and FAR3 = 750/500. Results: A significant age-related effect was observed on the cVEMP FAR. Although the oVEMP FAR showed an increasing trend with age, it was not statistically significant. Age-based normative FAR values are provided. Conclusions: Drawing from the normative FAR from this study, there is evidence that the existing MD diagnostic criteria would misidentify a considerable number of older adults. Therefore, to reduce false positives, we recommend a more stringent cVEMP and oVEMP FAR criterion in older adults. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate barriers and facilitators experienced by clinical educators and graduate students when talking with patients about difficult emotions and thoughts related to their hearing. Method: A longitudinal observational design was used and an Implementation Research Logic Model guided the process. Five clinical educators and five graduate students participated in the study. Participants completed pre- and postmeasures and attended individual debriefing sessions during the 8-month study period. Results: Four themes emerged from the debriefing sessions: (a) learning process, (b) confidence, (c) barriers, and (d) supervision. Participants described that the Acceptance and Action Questionnaire--Managing Child Hearing Loss and Acceptance and Action Questionnaire--Adult Hearing Loss served as a reminder to ask about patients' internal barriers and increased awareness of their discomfort in talking about patient emotions. Participants also described barriers and struggles related to supporting students in gaining counseling skills. Conclusions: Screening for internal challenges helped clinicians remember to talk with patients about their difficult thoughts and emotions. Clinician hesitancy to engage in conversations with patients about their emotions can interfere with opportunities for patients to share their struggles and with training student in these skills. [ABSTRACT FROM AUTHOR]

Purpose: The study's aims were (a) to evaluate hearing status and (b) word recognition ability of Hmong speakers using four validated monosyllabic word recognition tests in the White Hmong dialect and (c) to assess the relationship between the participant's language and the average word recognition percent correct scores, adjusting for age, gender, and degree of hearing loss. Method: Participants listened to two randomly assigned validated Hmong word lists (male/female talker) for each ear. Pure-tone air- and bone-conduction thresholds as well as word recognition ability were measured. Descriptive statistics were calculated to analyze the percent correct of word lists and classify hearing status. A nonparametric regression analysis was used to assess the relationship between the participant's language and the average word recognition percent correct scores, adjusting for age, gender, and degree of hearing loss. Results: Forty-eight Hmong (25 females, 23 males; Mage = 44.4) participated in this study. Thirty-three participants had hearing loss in at least one ear, and 15 had hearing within normal limits bilaterally. Participants with normal, mild, or steeply sloping hearing loss reached an average word recognition score of > 94% on Hmong lists by both male and female talkers. Participants with moderate-to-severe hearing loss scored 68% on average for the male talker Hmong lists and 60% on average for the female talker Hmong lists. Gender was significantly positively associated with average word recognition percent correct on the female word lists (b = -0.224, p = .047) but not statistically significant for the male word lists (b = 7.579, p = .141). Conclusion: Findings provide support for the use of the four Hmong word lists in clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention. Description of Counseling Components: The counseling protocol includes five components. First, the patient’s audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine. Results and Conclusion: The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention. [ABSTRACT FROM AUTHOR]

Purpose: Nonword repetition (NWR) has been described as a clinical marker of developmental language disorder (DLD), as NWR tasks consistently discriminate between DLD and typical development (TD) cross-linguistically, with Cantonese as the only reported exception. This study reexamines whether NWR is able to generate TD/DLD group differences in Cantonese-speaking children by reporting on a novel set of NWR stimuli that take into account factors known to affect NWR performance and group differentiation, including lexicality, sublexicality, length, and syllable complexity. Method: Sixteen Cantonese-speaking children with DLD and 16 age-matched children with TD repeated two sets of high-lexicality nonwords, where all constituent syllables are morphemic in Cantonese but meaningless when combined, and one set of low-lexicality nonwords, where all constituent syllables are nonmorphemic. Low-lexicality nonwords were further classified on sublexicality in terms of consonant–vowel (CV) combination attestedness (whether or not CV combinations in nonword syllables occur in real Cantonese words). Results: Children with DLD scored significantly below their peers with TD. Effect sizes showed that high-lexicality nonwords and nonword syllables with attested CV combinations offered the greatest TD/DLD group differentiation. Nonword length and syllable complexity did not affect TD/DLD group differentiation. Conclusions: NWR can capture TD/DLD group differences in Cantonese speaking children. Lexicality and sublexicality effects must be considered in designing NWR stimuli for TD/DLD group differentiation. Future studies should replicate the present study on a larger sample size and a younger population as well as examine the diagnostic accuracy of this NWR test. [ABSTRACT FROM AUTHOR]

Purpose: Pitch variations (tone productions) have been reported as a measure to differentiate Cantonese-speaking children with and without childhood apraxia of speech (CAS). This study aims to examine fundamental frequency (F0) changes within syllables and the effects of syllable structure, lexical status, and syllable positions on F0 in Cantonese-speaking preschool children with and without CAS. Method: Six children with CAS, six children with non-CAS speech sound disorder plus language disorder (S&LD), 22 children with speech sound disorder only (SSD), and 63 children with typical speech-language development (TD) performed the tone sequencing task (TST). Growth curve analysis was employed to analyze and compare the F0 values within syllables with three Cantonese tones (high level, high rising, and low falling). The analysis considered the effects of syllable structure (vowel and consonant–vowel), lexical status (word and nonword), and syllable position (initial, medial, and final) on F0, as well as comparisons within and between groups. Results: Within each group, the effects of syllable structure and position on F0 values were found with different patterns. Between-group comparisons showed that the CAS group had reduced F0 contrasts. The CAS group could be differentiated from the control groups based on interactions of F0 with syllable structure and position, but not lexical status. The dissimilarity of F0 values detected between the CAS and SSD/TD groups was more prominent than that observed between the CAS and S&LD groups. Conclusions: This study demonstrated that Cantonese-speaking children with CAS had difficulty in varying F0 within syllables as compared to those without CAS, suggesting pitch variation difficulty and language-specific impairment profiles in CAS. Future investigations of objective measures for identifying Cantonese speakers with CAS and cross-linguistic investigations using growth curve analysis and the TST are suggested. [ABSTRACT FROM AUTHOR]

Purpose: Literature suggests a dependency of the acoustic metrics, smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR), on human voice loudness and fundamental frequency (F0). Even though this has been explained with different oscillatory patterns of the vocal folds, so far, it has not been specifically investigated. In the present work, the influence of three elicitation levels, calibrated sound pressure level (SPL), F0 and vowel on the electroglottographic (EGG) and time-differentiated EGG (dEGG) metrics hybrid open quotient (OQ), dEGG OQ and peak dEGG, as well as on the acoustic metrics CPPS and HNR, was examined, and their suitability for voice assessment was evaluated. Method: In a retrospective study, 29 women with a mean age of 25 years (± 8.9, range: 18–53) diagnosed with structural vocal fold pathologies were examined before and after voice therapy or phonosurgery. Both acoustic and EGG signals were recorded simultaneously during the phonation of the sustained vowels /ɑ/, /i/, and /u/ at three elicited levels of loudness (soft/comfortable/loud) and unconstrained F0 conditions. Results: A linear mixed-model analysis showed a significant effect of elicitation effort levels on peak dEGG, HNR, and CPPS (all p < .01). Calibrated SPL significantly influenced HNR and CPPS (both p < .01). Furthermore, F0 had a significant effect on peak dEGG and CPPS (p < .0001). All metrics showed significant changes with regard to vowel (all p < .05). However, the treatment had no effect on the examined metrics, regardless of the treatment type (surgery vs. voice therapy). Conclusions: The value of the investigated metrics for voice assessment purposes when sampled without sufficient control of SPL and F0 is limited, in that they are significantly influenced by the phonatory context, be it speech or elicited sustained vowels. Future studies should explore the diagnostic value of new data collation approaches such as voice mapping, which take SPL and F0 effects into account. [ABSTRACT FROM AUTHOR]

Purpose: Many standardized assessments in speech-language pathology can be administered via telepractice. However, the literature is limited on reporting the equivalency of assessment administration between in-person and remote testing. The SCAN--3 for Adolescents and Adults: Tests for Auditory Processing Disorders (SCAN-3:A) is widely used by speech-language pathologists and audiologists to screen for auditory processing disorder (APD). The purpose of this study was to compare in-person and remote administration results on the screening subtests of the SCAN-3:A to determine test--retest consistency across the two settings. Method: Eleven undergraduate and graduate students with normal hearing were administered the Gap Detection, Competing Words--Free Recall (CW-FR) and Auditory Figure Ground (AFG) screening subtests from the SCAN-3:A both inperson and via telepractice with the order counterbalanced across administrations. Specific modifications were made to accommodate remote assessment. Results: Screening pass/fail decisions were above 80% agreement for each of the three subtests. Significant correlations (p < .05) between in-person and remote scores were found for the CW-FR and AFG subtests. The mean score difference between administration type was not significant for the CW-FR subtest (p = .921) but was significant for the AFG subtest (p < .05). Conclusions: These preliminary findings provide tentative, partial support for remote administration of the SCAN-3:A with adherence to specific recommendations. Some technical challenges were reported as well as other logistical limitations associated with remote administration. Recommendations to accommodate telepractice considerations for remote screening of APD are provided. [ABSTRACT FROM AUTHOR]

Purpose: This aim of this tutorial was to review assessment tools for speechlanguage pathologists working with Urdu speakers in the United States. Method: We outlined cultural and linguistic considerations for speech-language pathologists to consider when assessing Urdu speakers. We also reviewed available Urdu-language tests for pediatric and adult populations by their assessment area and evaluated whether they had been validated for Urdu speakers. Results: Speech-language pathologists should consider the impact of cultural and linguistic differences when planning assessment. In particular, many Urdu speakers are Muslim; hence, clinicians unfamiliar with the religion should open communication with clients about assessment preferences. Testing instruments covering the major areas of speech-language pathology are available for Urdu speakers in the United States. Conclusions: Speech-language pathologists can use the tools presented in this tutorial to evaluate both body impairments for Urdu speakers and the impact on an individual's participation. A summary of resources for Urdu speakers with links to assessments is provided in Supplemental Material S1. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to assess the existence of developmental effects on the performance of the Vocale Rapide dans le Bruit (VRB) speech-in-noise (SIN) identification test that was recently developed for the French language and to collect reference scores for children and adolescents. Method: Seventy-two native French speakers, aged 10–20 years, participated in the study. Each participant listened and repeated four lists of eight sentences, each containing three key words to be scored. The sentences were presented in free field at different signal-to-noise ratios (SNRs) using a four-talker babble noise. The SNR yielding 50% of correct repetitions of key words (SNR50) was recorded for each list. Results: A strong relationship between age and SNR50 was found, better performance occurring with increasing age (average drop in SNR50 per year: 0.34 dB). Large differences (Cohen’s d ≥ 1.2) were observed between the SNR50 achieved by 10- to 13-year-old participants and those of adults. For participants aged 14–15 years, the difference fell just above the 5% level of significance. No effects of hearing thresholds or level of education were observed. Conclusions: The study confirms the existence of developmental effects on SIN identification performance as measured using the VRB test and provides reference data for taking into account these effects during clinical practice. Explanations as to why age effects perdure during adolescence are discussed. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we examined the utility of vowel intelligibility testing for assessing the impact of dysarthria on speech characteristics in people with amyotrophic lateral sclerosis (ALS). We tested the sensitivity and specificity of overall vowel identification, as well as that of vowel-specific identification, to dysarthria presence and severity. We additionally examined the relationship between vowel intelligibility and sentence intelligibility. Method: Twenty-three people with ALS and 22 age- and sex-matched control speakers produced sentences from the Speech Intelligibility Test (SIT), as well as 10 American English monophthongs in /h/–vowel–/d/ words for the vowel intelligibility test (VIT). Data for SIT and VIT scores came from 135 listeners. Diagnostic accuracy of VIT measures was evaluated using the area under the curve of receiver operator characteristics. We then examined differences between control speakers, speakers with mild dysarthria, and speakers with severe dysarthria in their relationship between SIT and VIT scores. Results: The results suggest that the overall vowel intelligibility score showed high sensitivity and specificity in differentiating between speakers with and without dysarthria, even those with milder symptoms. In addition, single-vowel identification scores showed at least acceptable group differentiation between the mild and severe dysarthria groups, though fewer single vowels were acceptable discriminators between the control group and the group with mild dysarthria. Identification accuracy of /ɪ/ in particular showed excellent discrimination across all groups. Examination of the relationship between SIT and VIT scores suggests a severity-specific relationship. Speakers with SIT scores above 70% generally had higher SIT than VIT scores, whereas speakers with SIT below 70% generally had higher VIT than SIT scores. Discussion: Vowel intelligibility testing can detect speech impairments in speakers with mild dysarthria and residual articulatory function in speakers with severe dysarthria. Vowel intelligibility testing may, therefore, be a useful addition to intelligibility testing for individuals with dysarthria. [ABSTRACT FROM AUTHOR]

Purpose: Infants prenatally exposed to opioids exhibit withdrawal symptomology that introduce physiological noise and can impact newborn hearing screening results. This study compared the referral rate and physiological noise interpreted by number of trials rejected due to artifact on initial newborn hearing screenings of infants with prenatal opioid exposure (POE) and infants with no opioid exposure (NOE). Furthermore, within the POE group, it examined the relationship of referral rates with severity of withdrawal symptomology, and with maternal and infant risk factors. Method: This study used a retrospective cohort design of electronic medical records from six delivery hospitals in South-Central Appalachia. Newborn hearing screenings were conducted using automated auditory brainstem response (ABR) for 334 infants with POE and 226 infants with NOE. Severity of withdrawal symptomology was measured using the Modified Finnegan Neonatal Abstinence Scoring Tool, which includes observation of behaviors that introduce physiological noise. Results: There was no significant difference in newborn hearing screening referral rate between infants with POE and infants with NOE. Referral rate was not affected by maternal or infant risk factors. Infants with POE had statistically significant higher artifact (defined as rejected ABR sweeps) than infants with NOE. There was a strong positive correlation between Finnegan scores and artifact but not referral rates. Sensitivity and specificity analysis indicated artifact decreased substantially after Day 4 of life. Conclusions: Referral rates of infants with POE were similar to those of infants with NOE. Nevertheless, the withdrawal symptomology of infants with POE introduces physiological noise reflected as artifact on ABR, which can affect efficiency of newborn hearing screenings. [ABSTRACT FROM AUTHOR]

Purpose: The Joint Committee on Infant Hearing recommends hearing screening before 1 month of age, audiologic diagnosis before 3 months of age, and enrollment in early intervention before 6 months of age (1-3-6 benchmarks of Early Hearing Detection and Intervention [EHDI] programs). Nearly 98% of newborns have their hearing screened, but many, who do not pass or do not complete their newborn hearing screening, fail to complete the EHDI process. Historically, lower socioeconomic level, more complex infant health status, and farther geographical location reduce rates of EHDI follow-up, but levels vary widely across states. This study examined barriers to the EHDI process by comparing census-based variables at the state and regional levels to national and Texas EHDI outcomes, respectively. Method: We used correlational analysis to assess relationships between U.S. Census data (state- and region-specific population and geographic characteristics, sociodemographic and geographic factors, and health and health insurance) and EHDI data (newborn screening, audiologic diagnosis, and early intervention) at the national level and in Texas. Results: Nationally, higher labor force participation, lower unemployment rates, and presence of health insurance significantly correlated with higher rates of completing EHDI benchmarks. Larger population size and density and higher socioeconomic factors coincided with higher rates of completing the EHDI process and lower rates of loss to follow-up (LTF) or loss to documentation in Texas. Conclusions: Population, socioeconomic, and demographic factors significantly correlate with following through with the EHDI process, with weak correlations at the national level and strong correlations at the state level. These findings underscore the need to increase our attention to underserved, economically challenged, and/or geographically distanced families who have children with a higher risk of becoming LTF in the EHDI process. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this tutorial is to clarify the use of speech sounds as stimuli for auditory evoked potentials and how these might contribute to our understanding of speech, language, learning, and hearing disorders. Speechevoked auditory brainstem responses (ABRs), auditory steady-state responses, auditory middle latency responses, mismatch negativity, P300, cortical onset responses, and the acoustic change complex are reviewed. Method: The author drew upon her scholarship in this area from over 4 decades of research and teaching to summarize the major findings when using speech stimuli to evoke auditory potentials that have been used in clinical contexts. Results: Speech-evoked auditory potentials contribute to our understanding of how the brain processes the acoustic features of speech sounds, providing information that is complementary to psychophysical tests. When psychophysical tests cannot be performed owing to neurodevelopmental immaturity or disability, or cognitive disability, speech-evoked auditory potentials may be used to estimate the benefit of amplification or implantation for speech, language, and hearing. Conclusions: The benefit of using auditory evoked potentials for evaluation is that they provide insight into the brain mechanisms underlying hearing and listening disorders that audiologists aim to treat. While we can use the known correlations between perceptual and electrophysiological responses for "crosschecking" our evaluation results, examining when discrepancies occur is also especially meaningful. For example, the complex ABR reveals subcortical issues in temporal processing that would not be evident in ABRs to clicks or tone bursts, nor in behavioral testing. P300 can document slower neural processing of speech stimuli that may be relevant to the rehabilitation of older adults, even when word recognition scores appear to be congruent with the pure-tone audiogram. In these ways, auditory evoked potentials for speech provide audiologists with tools for demonstrating to clients how their brain responds to speech and opening the conversation for rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to (a) compare the Revised Hearing Handicap Inventory (RHHI) and pure-tone average (PTA) in their abilities to predict hearing aid use and (b) report the optimal cut-point values on the RHHI and PTA that predict hearing aid use. Method: Participants were from a community-based cohort study. We evaluated the ability of the RHHI and PTA as (a) continuous variables and (b) binary variables characterized by the optimal cut point determined by the Youden Index to predict hearing aid use. RHHI scores range from 0 to 72, and PTA was defined as averaged thresholds at frequencies 0.5, 1.0, 2.0, and 4.0 kHz in the worse ear. We used logistic regression models and receiver operating characteristic curves with corresponding concordance statistics (c-statistics) and 95% confidence intervals (CIs) to determine the predictive ability of models and chisquare tests to determine whether c-statistics were significantly different. Results: This study included 581 participants (Mage = 72.9 [SD = 9.9] years; 59.9% female; 14.3% Minority race). The c-statistics for the RHHI (0.79, 95% CI [0.75, 0.83]) and PTA (0.81, 95% CI [0.78, 0.85]), as continuous variables, were not significantly different (p = .25). The optimal cut points for the RHHI and PTA to predict hearing aid use were 6 points and 32.5 dB HL, respectively. The c-statistics for the RHHI (0.72, 95% CI [0.68, 0.76]) and PTA (0.75, 95% CI [0.71, 0.79]), as binary variables, were not significantly different (p = .27). Conclusion: The RHHI and PTA are similar in their ability to predict hearing aid use. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to observe sensory gating--related networks underlying cortical auditory evoked potential (CAEP) peak components in individuals with and without minimal tinnitus, as measured using the Tinnitus Handicap Inventory (THI). This analysis was performed on previously published sensory gating responses in normal-hearing adults with and without minimal tinnitus. Method: Independent component analysis was performed for each individual CAEP gating component (Pa, P50, N1, and P2). Significant components were retained for source localization analyses within the following groups: no tinnitus, tinnitus with a THI score ≤ 6, and tinnitus with a THI score > 6. Brain source localization was performed on the gating difference wave for each component using standardized low-resolution brain electromagnetic tomography. Results: Gating-related networks were identified within each group. Different regional sources were observed between groups, with parietal sources underlying the Pa and P50 components as tinnitus severity increased. A larger prefrontal regional activation was also shown for the N1 gating component as tinnitus severity increased. These results expand upon the functional gating responses via CAEP waveforms in a previously published study. Conclusions: The auditory gating response, as measured via CAEPs, has previously been shown to significantly correlate with an increase in tinnitus severity in adults with normal hearing. The corresponding changes in the gating response appear to be supported by different cortical regions in those without tinnitus, those with a THI score ≤ 6, and those with a THI score > 6. Next, functional differences between localized cortical regions should be tested. [ABSTRACT FROM AUTHOR]

Purpose: Standard clinical audiologic assessment is limited in its ability to capture variance in self-reported hearing difficulty. Additionally, the costs associated with clinical testing in audiology create financial barriers for hearing health care in developing countries like Mexico. This study used an open-source Spanish-language tool called PART (Portable Automated Rapid Testing) to test the hypothesis that a battery of assessments of auditory processing can complement standard clinical audiological assessment to better capture the variance of self-reported hearing difficulty. Method: Forty-three adults between 40 and 69 years of age were tested in Mexico City using a traditional clinical pure-tone audiogram, cognitive screening, and a battery of PART-based auditory processing assessments including a speechon- speech competition spatial release from masking task. Results were compared to self-reported hearing difficulty, assessed with a Spanish-language adaptation of the Hearing Handicap Inventory for the Elderly--Screening Version (HHIE-S). Results: Several measures from the PART battery exhibited stronger correlations with self-reported hearing difficulties than the pure-tone audiogram. The spatial release from masking task best captured variance in HHIE-S scores and remained significant after controlling for the effects of age, audibility, and cognitive score. Conclusions: The spatial release from masking task can complement traditional clinical measures to better account for patient's self-reported hearing difficulty. Open-source access to this test in PART supports its implementation for Spanish speakers in clinical settings around the world at low cost. [ABSTRACT FROM AUTHOR]

Purpose: Wideband acoustic immittance (WAI) is a promising measure of middle-ear mechanics. In contrast to standard tympanometry, which is generally measured at a single stiffness-dominated low frequency, WAI detects mechanical effects on both the mass and stiffness properties of the middle ear across a wide range of frequencies, resulting in a more comprehensive assessment of middle-ear mechanics in healthy and pathological ears. Despite a plethora of research demonstrating the clinical utility of this measure, clinical adoption of WAI is still limited. This work explores audiologists' use and perceptions of WAI, with the goal of identifying the barriers to its clinical adoption. Method: A survey on the perception and use of WAI by clinical audiologists in the United States was developed and administered using the Research Electronic Data Capture application. The survey was distributed broadly across the United States. Participation was voluntary and anonymous, and no compensation was provided. Results: Findings from 132 survey respondents across 32 states were included in the analyses. Overall, findings suggest the largest barriers to clinical adoption of WAI are lack of access to equipment that measures WAI and lack of training and/or confidence in measuring or interpreting WAI. Conclusions: Several barriers to clinical adoption of WAI were identified. However, findings also provide optimism in that audiologists utilizing WAI find it more useful than standard tympanometry, and most audiologists who do not currently use WAI are open to implementing the measure in their clinical practice. We proposed steps to address the highest priority issues and increase the clinical viability of WAI. [ABSTRACT FROM AUTHOR]

Purpose: U.S. national data for otoscopic examinations of 13,055 individuals aged 6-80+ years included in the National Health and Nutrition Examination Survey surveys for 2011-2012, 2015-2016, and 2017-2020 were analyzed and described. Method: Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined. Results: Overall, the prevalence of abnormal otoscopy was approximately 12%-15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logisticregression analyses for the 6-19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non- Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age. Conclusion: Abnormal otoscopy, typically excessive cerumen, was observed in about 12%-15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity. [ABSTRACT FROM AUTHOR]

Purpose: The U.S. Food and Drug Administration finalized regulations for overthe- counter hearing aids (OTC-HAs) on August 17, 2022. Little is known about the comparative performance of OTC-HAs and prescription HAs. This study compared amplification accuracy of prescription HAs and direct-to-consumer devices (DTCDs, including personal sound amplification products [PSAPs] and OTC-HAs). Method: Eleven devices were programmed to meet prescriptive targets in an acoustic manikin for three degrees of hearing loss. Devices consisted of highand low-end HAs, PSAPS, and OTC-HAs. Each was tested, and deviations from target measured with an HA analyzer at every combination of 10 frequencies and low-, average-, and high-level inputs. Accuracy was compared using a multilevel Poisson model with device-specific intercepts controlling for input level, frequency, and device type. Results: For mild--moderate hearing loss, deviations from targets were not statistically different between high- and low-end HAs, but PSAPs (5.50 dB, SE = 0.92 dB) and OTC-HAs (8.83 dB, SE = 1.10 dB) had larger differentials. For flat moderate hearing loss, compared to high-end HAs, average differentials were larger for all device types at all input levels and frequencies (Low HA: 3.82 dB, SE = 1.10 dB; PSAP: 9.24 dB, SE = 1.22 dB; OTC-HA: 8.61 dB, SE = 1.19 dB). For mild sloping to severe hearing loss, compared to high-end HAs, OTC-HAs (9.72 dB, SE = 1.20 dB) and PSAPs (7.34 dB, SE = 1.07 dB) had larger differentials and significant variability at the highest and lowest frequencies. Half (three) of the PSAPs and OTC-HAs met most targets within ±5 dB. Conclusions: DTCDs were unable to meet prescriptive targets for severe types of hearing loss but could meet them for mild hearing loss. This study provides an examination of current hearing devices. More research is needed to determine whether meeting prescriptive targets provides any benefit in the outcomes and performance with DTCD devices. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to reveal occupational effects on the hearing of hot air balloon (HAB) pilots and examine the relationship between the duration of experience and these effects. Method: This study included 31 male HAB pilots and a control group of 32 male participants. Tympanometry, eustachian tube function (ETF) test, pure-tone audiometry, and transient evoked otoacoustic emission (TEOAE) tests were performed. Results: Pure-tone audiometry results were significantly worse at 125, 500, and 6000 Hz in the right ear and 125, 500, 4000, and 6000 Hz in the left ear in the HAB group than the control group. Although tympanometry evaluation parameters did not differ between the HAB and control groups, ETF test was significantly worse in the HAB group than the controls bilaterally. TEOAE results were significantly worse at 1000, 2000, and 4000 Hz in the right ear and 4000 Hz in the left ear in the HAB group than the controls. There was a significant positive correlation for 125, 4000, 6000, and 8000 Hz between the duration of experience and right ear hearing thresholds. For the left ear, the duration of experience showed a significant positive correlation at 3000, 4000, 6000, and 8000 Hz. When the relationship between the duration of experience and TEOAE results was evaluated, a significant negative correlation was found at 4000 Hz in the left ear. Conclusion: In HAB pilots, in whom eustachian tube dysfunction is quite common, noise and high altitude affected hearing, especially low and high frequencies, and the duration of experience was found to be associated with hearing thresholds. [ABSTRACT FROM AUTHOR]

Purpose: The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a randomized clinical trial designed to determine the effects of a bestpractice hearing intervention versus a successful aging health education control intervention on cognitive decline among community-dwelling older adults with untreated mild-to-moderate hearing loss. We describe the baseline audiologic characteristics of the ACHIEVE participants. Method: Participants aged 70-84 years (N = 977; Mage = 76.8) were enrolled at four U.S. sites through two recruitment routes: (a) an ongoing longitudinal study and (b) de novo through the community. Participants underwent diagnostic evaluation including otoscopy, tympanometry, pure-tone and speech audiometry, speech-in-noise testing, and provided self-reported hearing abilities. Baseline characteristics are reported as frequencies (percentages) for categorical variables or medians (interquartiles, Q1-Q3) for continuous variables. Between-groups comparisons were conducted using chi-square tests for categorical variables or Kruskal--Wallis test for continuous variables. Spearman correlations assessed relationships between measured hearing function and self-reported hearing handicap. Results: The median four-frequency pure-tone average of the better ear was 39 dB HL, and the median speech-in-noise performance was a 6-dB SNR loss, indicating mild speech-in-noise difficulty. No clinically meaningful differences were found across sites. Significant differences in subjective measures were found for recruitment route. Expected correlations between hearing measurements and self-reported handicap were found. Conclusions: The extensive baseline audiologic characteristics reported here will inform future analyses examining associations between hearing loss and cognitive decline. The final ACHIEVE data set will be publicly available for use among the scientific community. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the effectiveness of television (TV) streaming on hearing aid user performance and satisfaction in quiet and in noise. Method: Twenty experienced hearing aid users were evaluated in quiet and in noise (5 dB SNR) under three hearing aid conditions: hearing aids, streaming with hearing aid microphones attenuated by 6 dB, and streaming with hearing aid microphones muted. The audiovisual Connected Speech Test served as the signal, and the ipsilateral competing message from the Synthetic Sentence Identification--Ipsilateral Competing Message (SSI-ICM) served as the noise. Measures of speech understanding, satisfaction with sound quality and clarity, and preference were obtained. Results: Speech understanding was significantly better in quiet than in noise, and streaming improved performance in noise when the hearing aid microphones were muted. Sound quality satisfaction was significantly better in quiet than in noise but was not impacted significantly by the hearing aid settings. Speech clarity satisfaction was significantly better in quiet than in noise, and streaming improved satisfaction in noise when the hearing aid microphones were muted. More participants preferred streaming with the microphones muted in quiet, in noise, and overall; however, results did not reach statistical significance. Conclusions: Hearing aid users did not benefit from TV streaming with the microphones attenuated or muted when listening in quiet. TV streaming was more beneficial to hearing aid users when listening in noise with the microphones muted. Hearing aid users should be counseled on the impact of the hearing aid microphone settings when using a TV streamer, particularly in noise. [ABSTRACT FROM AUTHOR]

Purpose: This study discusses the history and current state of the newborn hearing screening program in Québec and aims to assess general challenges associated with establishing universal newborn hearing screening (UNHS) programs. Method: We reviewed the statistics of the occurrence and long-term effects of congenital hearing loss and the immediate and long-term benefits of UNHS and its limitations. The resources for this study included financial reports related to establishing UNHS in different health care systems; Canadian provincial, territorial, and federal regulations and publications; local and nationwide media; and interviews health care staff and program managers. Results: Because of its benefits and its cost-effectiveness, UNHS programs have been implemented in many health care systems around the world. Despite Canada's success in offering a wide array of health care services to its citizens, certain provinces trail behind others in developing UNHS programs. Although there have been recent improvements in the screening rate of the province of Québec, nearly half of all Québec newborns continue to not be screened for hearing loss. The reasons for the current low screening rate include delays in implementation, information-technology complications, operating costs, and lack of public awareness. Conclusions: For UNHS to be implemented in a timely fashion, those involved in the process should first understand what challenges may arise. Québec's experience with this process may provide useful lessons for other health care systems. [ABSTRACT FROM AUTHOR]

Purpose: This study focuses on 7- to 9-year-old children attending primary school in Swedish areas of low socioeconomic status, where most children's school language is their second language. The aim was to better understand what factors influence these children's narrative listening comprehension both in an ideal listening condition (in quiet) and for the primary school classroom, a typical listening condition (with multitalker babble noise). Method: A total of 86 typically developing 7- to 9-year-olds performed a narrative listening comprehension test (Lyssna, Förstå och Minnas [LFM]; English translation: Listen, Comprehend, and Remember) in two listening conditions: quiet and multitalker babble noise. They also performed the crosslinguistic nonword repetition test and a digit span backwards (DSB) test. A predictive statistical model including these factors, the children's degree of school language exposure, parental education level, and age was derived. Results: Listening condition had the strongest predictive value for LFM performance, followed by school language exposure and nonword repetition accuracy. Parental education level was also a significant predictor. There was a significant three-way interaction effect between listening condition, age, and DSB performance. Conclusions: Multitalker babble noise has a negative effect on children's narrative listening comprehension. The effect of multitalker babble noise could be explained by age differences in the ability to allocate working memory capacity during the narrative listening comprehension task, suggesting that younger children may be more vulnerable for missing information when listening in background noise than their older peers. Supplemental Material: https://doi.org/10.23641/asha.25209248 [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop a time-efficient music exposure and testing paradigm that safely creates temporary cochlear dysfunction that could be used in future temporary threshold shift (TTS) studies. Method: A 30-min audio compilation of pop rock music tracks was created. Adult volunteers with normal hearing were then exposed to this music material monaurally through headphones for 30 min at 97 dBA or 15 min at 100 dBA. Levels were measured from the ear of a manikin and are considered to provide an equivalent daily noise dose based on a 3-dB exchange. We assessed the changes in their hearing, by means of distortion product otoacoustic emission (DPOAE) testing, and standard and extended high-frequency pure-tone audiometry before and after exposure. There were 17 volunteers in total. In the first trial, eight volunteers (four females; Mdnage = 31 years [interquartile range, IQR = 4.25]) were included. Although TTS was observed in all eight participants for at least one frequency, a large variation in affected frequencies was observed. To address this issue, the audio material was further remastered to adjust levels across the different frequency bands. Fourteen adults (nine newly recruited and five from the first trial; seven females; Mdnage = 31 years [IQR = 5]) were exposed to the new material. Results: All but two of 17 participants presented clinically significant TTS or decrease in DPOAE amplitude in at least one frequency. Statistically significant average TTS of 7.43 dB was observed at 6 kHz. There were statistically significant average DPOAE amplitude shifts of -2.55 dB at 4 kHz, -4.97 dB at 6 kHz, and -3.14 dB at 8 kHz. No participant presented permanent threshold shift. Conclusions: A monaural music paradigm was developed and shown to induce statistically significant TTS and DPOAE amplitude shifts, without evidence of permanent loss. This realistic and time-efficient paradigm may be considered a viable option for experimental studies of temporary music-induced hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: Although conversational recast treatment is generally efficacious, there are many ways in which the individual components of the treatment can be delivered. Some of these are known to enhance treatment, others appear to interfere with learning, and still others appear to have no impact at all. This study tests the potential effect of clinicians’ recast length on child learning during a recast treatment. Method: Twenty-six preschool children were treated for grammatical errors using Enhanced Conversational Recast Treatment. Half heard recasts of four or fewer words (Short Recast condition), and half heard recasts of five or more words (Extended Recast condition). Outcome measures included generalization of the treated grammatical form, spontaneous use of these forms, change in mean length of utterances in words, and the number of children in each condition who showed a clinically meaningful response. Results: There was strong evidence of improvements in the use of grammatical forms targeted by the treatment compared with forms that were tracked but not treated. Twenty children (11 in the Short Recast condition and nine in the Extended Recast condition) showed a clinically meaningful response. There was minimal support for the hypothesis that the length of clinician utterance influenced either progress on a grammatical form targeted by the treatment or on the child’s mean length of utterance in words. Conclusions: The study adds to the evidence for the efficacy of Enhanced Conversational Recast Treatment. However, there is little evidence that clinicians need to regulate the length of the recast they provide to children. [ABSTRACT FROM AUTHOR]

Purpose: Dynamic pitch, which is defined as the variation in fundamental frequency in speech, is one of the acoustic cues that affect speech recognition in noise. Built on the evidence that a symmetrical manipulation of dynamic pitch led to poorer speech recognition, the present study examined the effect of an asymmetrical manipulation method on speech recognition in noise by younger and older adults. Method: Speech recognition accuracy in noise was measured from younger adults with normal hearing in Experiment 1, and speech reception threshold (in dB SNR) from older adults with normal hearing to mild–moderate hearing loss in Experiment 2. The dynamic pitch contours of the speech stimuli were manipulated using both symmetrical and asymmetrical methods. Results: Younger adults recognized speech better in noise with asymmetrical than symmetrical manipulation, and with weakened than strengthened dynamic pitch. A substantial amount of variability was observed in a group of older listeners. This variability was predominately predicted by the listeners’ age but not hearing thresholds or their ability to perceive dynamic pitch in fluctuating noise. Conclusions: The asymmetrical manipulation of dynamic pitch had a less negative effect than the symmetrical manipulation. This effect also interacted with pitch-change direction. These findings suggest the influence of perceptual naturalness on speech recognition with signal modification. Directions for future research are also discussed. [ABSTRACT FROM AUTHOR]

Purpose: The significance of extended high-frequency (EHF) hearing (> 8 kHz) is not well understood so far. In this study, we aimed to understand the relationship between EHF hearing loss (EHFHL) and speech perception in noise (SPIN) and the associated physiological signatures using the speech-evoked frequency-following response (sFFR). Method: Sixteen young adults with EHFHL and 16 age- and sex-matched individuals with normal hearing participated in the study. SPIN performance in right speech–right noise, left speech–left noise, and binaural listening conditions was evaluated using the Turkish Matrix Test. Additionally, subcortical auditory processing was assessed by recording sFFRs elicited by 40-ms /da/ stimuli. Results: Individuals with EHFHL demonstrated poorer SPIN performances in all listening conditions (p< .01). Longer latencies were observed in the V (onset) and O (offset) peaks in these individuals (p ≤ .01). However, only the V/A peak amplitude was found to be significantly reduced in individuals with EHFHL (p< .01). Conclusions: Our findings highlight the importance of EHF hearing and suggest that EHF hearing should be considered among the key elements in SPIN. Individuals with EHFHL show a tendency toward weaker subcortical auditory processing, which likely contributes to their poorer SPIN performance. Thus, routine assessment of EHF hearing should be implemented in clinical settings, alongside the evaluation of standard audiometric frequencies (0.25–8 kHz). [ABSTRACT FROM AUTHOR]

Purpose: This article aimed to evaluate associations of self-reported hearing loss with health care access and delays and difficulties communicating with health care providers during the COVID-19 pandemic. Method: The COVID-19 Community Impact Survey was administered online to a sample of participants from the population-based Survey of the Health of Wisconsin study cohort in Spring 2021. Hearing loss was defined as self-reported fair or poor hearing. Difficulty with health care access and delays were defined as self-reporting needing but not getting medical care or self-reporting delays in appointments due to COVID-19, respectively. Poor communication with health care providers was defined as self-reported difficulties communicating with health care providers due to wearing a mask during the COVID-19 pandemic. Logistic regression models were used to evaluate associations between hearing loss and the health care outcomes. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). First, models were adjusted for age and sex. Next, models were additionally adjusted for education, race/ethnicity, self-rated health, and number of chronic conditions. Results: This study included 1,582 participants (62.3% women; 11.9% non- White; age range: 18-75+ years). The number of participants with hearing loss was 196 (12.4%). After multivariable adjustment, self-reported hearing loss was associated with poorer health care access (OR = 2.41, 95% CI [1.62, 3.59]), health care delays (OR = 1.93, 95% CI [1.37, 2.71]), and increased difficulty communicating with health care providers wearing face masks (OR = 3.31, 95% CI [2.15, 5.08]) during the COVID-19 pandemic. Conclusions: The impacts of the COVID-19 pandemic on difficulties accessing and using health care are likely exacerbated for individuals with hearing loss. There is a need for interventions that will optimize health care experiences for individuals with hearing loss, particularly when face masks and/or telecommunications are used to provide health care services. [ABSTRACT FROM AUTHOR]