Search

Objective: The speech intelligibility index (SII) is used to quantify the audibility of the speech. This study examined the relationship between self-reported hearing aid (HA) outcomes and the difference in aided SII (SII A ) calculated from the initial fit (IF) gain and that prescribed as per the second generation of National Acoustic Laboratory Non-Linear (NAL-NL2)., Design: A prospective observational study., Study Sample: The study included 718 first-time and 253 experienced HA users. All users had a valid real-ear measurement (REM) at three input levels (55, 65 and 80 dB SPL)., Results: The gain provided by IF was lower than NAL-NL2 at 55 and 65 dB SPL. IF gain exhibited reduced compression than NAL-NL2 as input levels increased from 55 to 80 dB SPL. On average, the SII A provided by IF was significantly lower than that for NAL-NL2 at all input levels. The difference in SII A between IF and NAL-NL2 at 80 dB SPL input level with 0 dB signal-to-noise ratio (SNR) turned out to be a predictor for self-reported outcome for first-time HA users., Conclusion: The study suggests that an SIIA close to that provided by NAL-NL2 at high input levels would be preferred to obtain a better self-reported outcome. .

Objective: We aimed to assess the association between occupational noise exposure and tinnitus. Further, to assess whether the association depends on hearing status., Design: In this cross-sectional study, tinnitus (>1 h daily) was regressed on job exposure matrix (JEM)-based or self-reported occupational noise exposure, adjusted for confounders., Study Sample: The 14,945 participants (42% men, 20-59 years) attended a population-based study in Norway (HUNT4, 2017-2019)., Results: JEM-based noise exposure, assessed as equivalent continuous sound level normalised to 8-h working days (LEX 8 h), over the working career or as minimum 5 years ≥85 dB) was not associated with tinnitus. Years of exposure ≥80 dB (minimum one) was not associated with tinnitus. Self-reported high noise exposure (>15 h weekly ≥5 years) was associated with tinnitus overall and among persons with elevated hearing thresholds (prevalence ratio (PR) 1.3, 1.0-1.7), however not statistically significantly among persons with normal thresholds (PR 1.1, 0.8-1.5)., Conclusions: Our large study showed no association between JEM-based noise exposure and tinnitus. This may to some extent reflect successful use of hearing protection. High self-reported noise exposure was associated with tinnitus, but not among normal hearing persons. This supports that noise-induced tinnitus to a large extent depends on audiometric hearing loss.

Objectives: The purpose of this study was to describe changes in audiometric thresholds over time in children whose hearing loss demonstrated early mild progression., Design: This was a retrospective follow-up study to examine long-term audiologic results in children with progressive loss., Study Sample: We examined audiologic data for 69 children, (diagnosed from 2003 to 2013), who had been previously categorised as having "minimal" progressive hearing loss., Results: Children had a median of 10.0 (7.5, 12.1) years of follow-up and a median age of 12.5 (IQR: 11.0, 14.5) years; 92.8%; 64 of 69) of children continued to show progressive hearing loss (defined as a decrease of ≥10 dB at two or more adjacent frequencies between 0.5 and 4 kHz or a decrease in 15 dB at one frequency) in at least one ear since diagnosis. Further examination showed that 82.8% of ears (106 of 128) had deterioration in hearing. Of the 64 children, 29.7% (19/64) showed further deterioration since the first analysis., Conclusion: More than 90% of children identified as having minimal progressive hearing loss continued to show deterioration in hearing. Ongoing audiological monitoring of children with hearing loss is indicated to ensure timely intervention and to better counsel families.

Objective: To introduce the urban outdoor version of the Situated Phoneme (SiP) test and investigate its test-retest reliability., Design: Phonemic discrimination scores in matched-spectrum real-world (MSRW) maskers from an urban outdoor environment were measured using a three-alternative forced choice test paradigm at different phoneme-to-noise ratios (PNR). Each measurement was repeated twice. Test-retest scores for the full 84-trial SiP-test, as well as for four types of contrasting phonemes, were analysed and compared to critical difference scores based on binomial confidence intervals., Study Sample: Seventy-two adult native speakers of Swedish (26-83 years) with symmetric hearing threshold levels ranging from normal hearing to severe sensorineural hearing loss., Results: Test-retest scores did not differ significantly for the whole test, or for the subtests analysed. A lower amount of test-retest score difference than expected exceeded the bounds of the corresponding critical difference intervals., Conclusions: The urban outdoor SiP-test has high test-retest reliability. This information can help audiologists to interpret test scores attained with the urban outdoor SiP-test.

Objective: To investigate the effects of previous occupational noise exposure in older adults with hearing loss on (1) audiometric configuration and acoustic reflex (AR) thresholds and (2) self-reported hearing abilities and hearing aid (HA) effectiveness., Design: A prospective observational study., Study Sample: The study included 1176 adults (≥60 years) with bilateral sensorineural hearing loss. Pure-tone audiometry, AR thresholds, and responses to the abbreviated version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire were obtained, along with information about previous occupational noise exposure., Results: Greater occupational noise exposure was associated with a higher prevalence of steeply sloping audiograms in men and women and a 0.32 (95% CI: -0.57; -0.06) scale points lower mean SSQ12 total score among noise-exposed men. AR thresholds did not show a significant relation to noise-exposure status, but hearing thresholds at a given frequency were related to elevated AR thresholds at the same frequency., Conclusions: A noise exposure history is linked to steeper audiograms in older adults with hearing loss as well as to poorer self-reported hearing abilities in noise-exposed men. More attention to older adults with previous noise exposure is warranted in hearing rehabilitation.

Objective: The ability to discriminate natural soundscapes recorded in a temperate terrestrial biome was measured in 15 hearing-impaired (HI) listeners with bilateral, mild to severe sensorineural hearing loss and 15 normal-hearing (NH) controls., Design: Soundscape discrimination was measured using a three-interval oddity paradigm and the method of constant stimuli. On each trial, sequences of 2-second recordings varying the habitat, season and period of the day were presented diotically at a nominal SPL of 60 or 80 dB., Results: Discrimination scores were above chance level for both groups, but they were poorer for HI than NH listeners. On average, the scores of HI listeners were relatively well accounted for by those of NH listeners tested with stimuli spectrally-shaped to match the frequency-dependent reduction in audibility of individual HI listeners. However, the scores of HI listeners were not significantly correlated with pure-tone audiometric thresholds and age., Conclusions: These results indicate that the ability to discriminate natural soundscapes associated with changes in habitat, season and period of the day is disrupted but it is not abolished. The deficits of the HI listeners are partly accounted for by reduced audibility. Supra-threshold auditory deficits and individual listening strategies may also explain differences between NH and HI listeners.

Objective: Hearing disorders are common among music professionals, as they are frequently exposed to sound levels exceeding 100 dB(A). By assessing auditory fatigue, situations that are deleterious for hearing could be identified, allowing the deployment of preventive measures before permanent impairment occurs. However, little is known about the factors contributing to auditory fatigue. The objective is to determine the exposure parameters most influencing auditory fatigue during occupational exposure to amplified music., Design: Auditory fatigue was defined as variations of both pure tone auditory (ΔPTA) and efferent reflex thresholds (ΔER) during the workday. Noise exposure was monitored and information on the volunteers was gathered using a questionnaire., Study Sample: The population consisted of 43 adult volunteers exposed to amplified music (sound, light or stage technicians, security agents, barmen) and 24 unexposed administrative agents., Results: ΔPTA and ΔER were positively correlated with the energy of noise exposure and its stability over time, i.e a steady noise tends to create more auditory fatigue., Conclusion: In addition to a global decrease of music levels and a systematic use of hearing protection, our results advocate for the provision of quiet periods within noise exposures as they reduce auditory fatigue accumulation and long-term risks for hearing.

Objective: The goal of this study was to determine open field stapedius reflex thresholds (oSRTs) in CI patients with fittings based on subjective loudness ratings. A further objective was to compare these oSRTs and those of eSRT-based fittings that are similar to the oSRTs of normal hearing., Design: Impedance measurements of the ear drum were taken while subjects were wearing their audio processors. The stapedius reflex was elicited by electrical stimulation transmitted through the activated CI system in response to an acoustic stimulus presented in the free sound field., Study Sample: Subjects were 50 experienced CI users ( n  = 57 ears) with CI fittings based on subjective loudness scaling., Results: A reference range for the oSRTs was defined that was identified in CI patients with eSRT-based fittings. Sound levels for stapedius reflex detection were inside the reference target range in 70% of the cases, below the reference range (i.e. down to 40 dB HL) in 20% of the cases, and above the reference range in 10% of the cases., Conclusion: Stapedius reflex detection in a free sound field may help detect fittings with too high or too low stimulation levels that might reduce audiological performance.

Firefighter hoods must provide protection from elevated temperatures and products of combustion while simultaneously being comfortable and limiting interference with firefighting movement or completion of fireground activities. This study was to quantify the impact of hood design (traditional knit hood vs. several models of particulate-blocking hoods) on wearability measures such as range of motion, noise production and hearing threshold. Firefighters' perceptions of wearability were also collected. In a controlled laboratory environment, 24 firefighters performed movement and hearing tests. Wearing particulate-blocking hoods resulted in decreased rotational range of motion, and thicker hoods reduced hearing ability. Design, but not necessarily the number of layers, affected noise production by the hood during head movement. Practitioner summary: Particulate-blocking hoods resulted in reduced rotational range of motion relative to the traditional design and the no-hood condition. Hoods with additional layers resulted in decreased hearing ability. Noise production was increased in designs of particulate-blocking hoods with a membrane-based blocking layer independent of the number of layers.

Objective: This study evaluated the diagnostic performances of a tablet-based hearing screening test by assisted-test and self-test modes., Design/method: Measurements were performed with the SoTone tests in normal hearing and hearing-impaired adult participants using an Android tablet and calibrated Bluetooth headphones. The duration of assisted- and self-test modes were compared. Receiver operating characteristic (ROC) curves were plotted after calculations of sensitivity and specificity at 20, 30, and 35 dB HL cut-off values., Study Sample: 217 participants performed the tests. The effect of test mode (assisted versus self) was compared in a sample of 103 participants., Results: Self-test duration (89 s) was significantly longer than the assisted-test duration (75 s) ( p  = 0.003, Wilcoxon test). For the 20, 30, and 35 dB HL cut-off values, sensitivity was between 92% and 96%, and specificity was between 79 and 90%. Concordance of results between assisted-test and self-test modes was excellent (Cohen's kappa = 0.81, p  < 0.001)., Conclusions: The SoTone hearing screening test is accurate for identifying the presence of a suspected hearing loss at 20 dB HL or more in adults. It can be used either in assisted-test or self-test modes.

Objective: The present study sought to determine the cochlear frequency regions represented by Auditory Brainstem Responses (ABRs) obtained using the high-pass noise/derived response (HP/DR) technique., Design: Broadband noise sufficient to mask the ABR to 50 dB nHL clicks was HP filtered (96 dB/oct) at 8000, 4000, 2000, 1000 and 500 Hz. Mixed with the clicks and HP noise masker was narrowband noise. Three derived response bands, denoted by the upper and lower high-pass noise frequencies, were obtained: DR4000-2000, DR2000-1000, and DR1000-500., Study Sample: Ten adults with normal hearing, aged 19-27 years (mean age: 22.4 years), were recruited from the community., Results: Frequencies contributing to each DR were determined from the wave V percent amplitude (or latency shift) vs narrowband masker frequency profiles (relative to a no-narrowband-noise condition). Overall, results indicate derived band centre frequencies were closer to the lower HP cut-off frequencies for DR4000-2000 and DR2000-1000, and approximately halfway between the lower HP cut-off and the geometric mean of the two HP frequencies for DR1000-500, with bandwidths of 0.5-1 octave in width., Conclusions: These results confirm the validity of the HP/DR technique for assessing narrow cochlear regions (≤1.0 octave wide), with centre frequencies within ½-octave of the lower HP frequency.

Objective: In automated hearing threshold determination procedures, prespecified response- time limits can be applied to evaluate whether a stimulus was truly heard by checking whether the test subject reacts to the onset and the offset of the stimuli within given time intervals. The influence of different response-time limits on the threshold of normal-hearing test subjects was investigated., Design: Two-stage hearing threshold level measurements applying the ISO 8253-1 (2010) bracketing procedure were performed. Pre-tests at 125 Hz and 1000 Hz were carried out with maximum accepted response times of 600 ms, 1000 ms, and 1200 ms. Subsequently, thresholds were measured at the seven octaves between 125 Hz and 8000 Hz with maximum accepted response times of 600 ms and 1000 ms., Study Sample: 15 test subjects in pre-tests, 25 test subjects in the main study., Results: Threshold levels determined with a maximum accepted response time of 1000 ms are 2.6 dB lower than those obtained with a maximum accepted response time of 600 ms (95% CI -1.6 dB to 6.9 dB). The threshold shift was similar at all frequencies., Conclusions: Based on this study, response-time limits after both stimulus onset and offset of at least 1000 ms are recommended.

Objective: Automated pure-tone audiometry is frequently used in teleaudiology and hearing screening. Given the high prevalence of age-related hearing loss, older adults are an important target population. This study aimed to investigate the accuracy of automated audiometry in older adults, and to examine the influence of test frequency, age, sex, hearing and cognitive status., Design and Study Sample: In a population-based study, two age-homogeneous samples of 70-year-olds ( n  = 238) and 85-year-olds ( n  = 114) were tested with automated audiometry in an office using circum-aural headphones and, around 4 weeks later, with manual audiometry conducted to clinical standards. The differences were analysed for individual frequencies (range: 0.25-8 kHz) and pure-tone averages., Results: The mean difference varied across test frequencies and age groups, the overall figure being -0.7 dB (SD = 8.8, p  < 0.001), and 68% to 94% of automated thresholds corresponded within ±10 dB of manual thresholds. The poorest accuracy was found at 8 kHz. Age, sex, hearing and cognitive status were not associated with the accuracy (ordinal regression analysis)., Conclusions: Automated audiometry seems to produce accurate assessments of hearing sensitivity in the majority of older adults, but with larger error margins than in younger populations, and is not affected by relevant patient factors associated with old age.

Objective: In standards IEC 60645-1 and ANSI S3.6, the free-field equivalent earphone output level method is assumed as the reference for speech audiometry. Three calibration procedures for this method were compared in this study., Design: Speech audiometry was conducted with Dutch consonant-vowel-consonant words for the following conditions: 1. TDH39 earphones, 2. loudspeaker, and 3. free-field simulated with TDH39 earphones. The first calibration procedure was based on the empirically determined difference between the speech recognition threshold (SRT) with earphones and a loudspeaker. The second procedure was based on the theoretical free-field correction, derived from the known speech spectrum and the free-field to coupler difference. The third calibration procedure corresponded to the results of the free-field simulated speech material under earphones., Study Sample: The sample included 20 normal hearing subjects., Results: The differences between the observed SRT in the free-field and earphone conditions and the free-field and simulated free-field conditions were 7.1 dB and 0.6 dB, respectively., Conclusion: The three calibration procedures for the free-field equivalent output method yielded approximately the same results, and therefore all appear to be useful for TDH39 earphones.

Objective: Consumer-grade insert earphones (IEs) can be utilised for audiometry, but their calibration values and threshold reliability may differ from the audiometric IE. This study measured the equivalent threshold sound pressure levels (ETSPLs), and the test-retest threshold variation when a consumer IE (Sennheiser CX100) was fitted with: (1) silicone stock ear tips that came along with the earphone, (2) replacement foam ear tips (KZ acoustics) and (3) silicone otoacoustic emission (OAE) probe ear tips., Design and Study Sample: Study 1 determined ETSPL values in 25 normal-hearing subjects aged 18-25 years at seven test frequencies (500-8000 Hz). Study 2 assessed the intra- and inter-session test-retest threshold reliability in a separate group of 50 adult subjects., Results: The ETSPL values for the consumer IE deviated from the reference values for audiometric IEs, with the largest differences (7-9 dB) observed at 500 Hz across ear tips. This is likely related to shallow tip insertions. However, test-retest threshold variations were comparable to those reported for audiometric transducers., Conclusions: Ear tip-specific corrections to the reference thresholds in the standards are required for calibration of consumer IEs used in low-cost audiometry when their ear tips only allow superficial insertion into the ear canal.

Objective: The aim of the research was to evaluate the feasibility of measuring the bone conduction hearing threshold using self-administered mobile audiometry., Design: A single-centre, closed, cross-over trial was carried out on patients from the ENT Department. A mobile-based, self-administered, audiologist-assisted assessment of the bone conduction hearing threshold was carried out by means of the open-access, freeware app Hearing Test using two types of bone conduction headphones: professional B71 bone transducer and commercially available AfterShokz Openmove open-ear headphones., Study Sample: Seventy-seven ears., Results: A test-retest examination revealed the lowest standard deviation for open-ear headphones at 3.33 dB (95% CI 2.92-3.79). When compared with pure tone audiometry, the intraclass correlations of 0.95 (95% CI 0.94-0.96) and 0.90 (95% CI 0.88-0.92) were obtained for the bone transducer and for the open-ear headphones, indicating excellent and good reliability, respectively. However, the regression slope of 0.67 was found for the air-bone gap when using open ear headphones, which was significantly different from 1 ( p  < 0.001)., Conclusions: Open-ear headphones provide an alternative for estimating bone conduction once the air-bone gap has been adjusted by a factor of 1/0.6 7 ≅1.5. They demonstrate improved reproducibility over the bone transducer and are much easier to use with a mobile device. Trial Registration: Wroclaw Medical University, Science Support Centre, BW60/2020.

Objective: To determine the reliability and validity of the Quick Repeat-Recall Test (Q-RRT)., Design: Within-subject repeated measures. Participants completed the Q-RRT at a speech level of 75 dB SPL in 2 noise configurations at signal-to-noise ratios of 5, 10, and 15 dB in a counterbalanced order, along with the full-RRT. The Q-RRT was repeated after 1-3 weeks to estimate within-session and between-session reliability. Participants also completed external validation measures relating speech-in-noise ability (Hearing-In-Noise Test, HINT), memory (Reading Span Test, RST; Forward Digit Span Test, DST-F), and noise acceptance (Tracking of Noise Tolerance, TNT)., Study Sample: Twenty-five normal-hearing listeners (mean age = 63.9 years)., Results: Group Repeat and Recall scores were similar between the full-RRT and the Q-RRT. However, Listening Effort and Tolerable Time ratings were significantly poorer for the full-RRT than the Q-RRT. The average repeat scores correlated with the HINT scores, while the recall scores correlated with the DST-F and RST scores. Tolerable Time ratings also correlated with the TNT scores. Within-session and between-session test-retest reliability using intraclass correlation coefficients were fair-to-excellent (0.41-0.91) depending on the outcome measures., Conclusions: The Q-RRT is a reliable and valid measure of speech-in-noise ability, working memory, listening effort, and noise acceptance.

Objective: To gather preliminary reference data on older normal-hearing (NH) adults for the refined Tracking of Noise Tolerance (TNT) test., Design: Within-subject repeated measures. Participants were tested on the TNT in the sound-field and under headphones. In the sound-field, speech stimuli were presented at 75 dB SPL and 82 dB SPL from 0° with a speech-shaped noise presented either from 0° or 180° at a level controlled by the participants. The order of signal level, mode of presentation, noise azimuth, and TNT passages were counterbalanced across listeners. Testing was repeated for one condition after 1-3 weeks to estimate within-session and between-session reliability., Study Sample: Twenty-five NH listeners (51-82 yrs of age)., Results: Mean TNT scores (TNT Ave ) were about 4 dB at a speech input of 75 dB SPL and 3 dB at 82 dB SPL. The TNT Ave was similar between the headphone and sound-field presentations in the co-located noise. TNT Ave scores measured with noise-back were about 1 dB better than those measured from the front. The 95% confidence intervals of absolute test-retest differences were about 1.2 dB within-session and 2.0 dB between sessions., Conclusions: The refined TNT may be a reliable tool to measure noise acceptance and subjective speech intelligibility.

Objective: The objective of this study is to determine the noise effective masking level (EML) and inter-aural attenuation (IA) for click and CE-Chirp signals presented though a Radioear B-81 to elicit the auditory brainstem responses in normally hearing, young adults., Design and Study Sample: A total of 26 conveniently sampled adults (13 male and 13 female, aged 18-25 years; 52 ears), with pure-tone hearing thresholds not >15 dB nHL at octave frequencies from 250 to 8000 Hz, and subjective thresholds for the bone-conducted click and CE-Chirp not >10 dB nHL., Results: At stimulus intensities of 30 and 40 dB nHL, the contralateral EML was 67.86 ± 0.78 and 77.80 ± 0.81 dB SPL (respectively) for the click and 72.11 ± 0.74 and 83.53 ± 0.78 dB SPL (respectively) for the CE-Chirp. At stimulus intensities of 30 and 40 dB nHL, the IA was 3.46 ± 2.34 and 3.38 ± 2.03 dB (respectively) for both the click and the CE-Chirp., Conclusion: EML and IA values are reported for click and CE-Chirp signals presented at 30 and 40 dB nHL though a Radioear B-81 to elicit the ABR in normally hearing, young adults.

Objective: The ear's spectral resolution or frequency selectivity (FS) is a fundamental aspect of hearing but is not routinely measured in clinical practice. This study evaluated a simplified FS testing procedure for clinical use by replacing the time-consuming two-interval forced choice (2IFC) method with method of limits (MOL) carried out using a custom-made software and consumer-grade equipment., Design and Study Sample: Study 1 compared the FS measure obtained with MOL and 2IFC procedure at two centre frequencies (CFs) (1 and 4 kHz) in 21 normal-hearing listeners. Study 2 determined the FS measure using MOL at five CFs (0.5-8 kHz) in 32 normal-hearing and nine sensorineural hearing loss listeners and compared them with their thresholds in quiet., Results: FS measurements with MOL and 2IFC methods were highly correlated and had statistically comparable intra-subject test-retest reliability. FS measures determined with MOL were reduced in the hearing-impaired compared to normal-hearing listeners at the CF corresponding to their hearing loss. Linear regression analysis showed significant relationship between FS deterioration and quiet threshold loss ( p  < 0.0001, R 2 = 0.56)., Conclusions: The simplified and affordable FS testing method can be used alongside audiometry to provide additional information about the cochlear function.

Objective: To evaluate differences in tinnitus impact, hyperacusis and hearing threshold level (HTL) between patients with unilateral and bilateral tinnitus. For patients with unilateral tinnitus, to compare audiological variables for the tinnitus ear and the non-tinnitus ear. To assess whether the presence of unilateral tinnitus increases the likelihood of interaural hearing asymmetry (relative to bilateral tinnitus) that warrants referral for an MRI scan., Design: Retrospective cross-sectional., Study Sample: Data regarding HTLs and responses to self-report questionnaires were collected from the records of 311 patients attending a tinnitus clinic., Results: 38.5% had unilateral tinnitus and the ears with tinnitus had higher HTLs and greater HTL slopes than the ears without tinnitus. There was no significant difference in tinnitus impact and hyperacusis between patients with unilateral and bilateral tinnitus. 40% of patients with unilateral tinnitus and 13% of patients with bilateral tinnitus had a between-ear difference in HTL ≥15 dB at two adjacent frequencies (2AF15 asymmetry). Unilateral tinnitus increased the risk of 2AF15 asymmetry by a factor of 4.4., Conclusions: Unilateral tinnitus increases the risk of having interaural asymmetry in HTLs that warrants referral for an MRI scan.

Objective: To develop the Cantonese matrix (YUEmatrix) test according to the international standard procedure and examine possible different outcomes in another tonal language., Design: A 50-word Cantonese base-matrix was established. Word-specific speech recognition functions, speech recognition thresholds (SRT), and slopes were obtained. The speech material was homogenised in intelligibility by applying level corrections up to ± 3 dB. Subsequently, the YUEmatrix test was evaluated in five aspects: training effect, test-list equivalence, test-retest reliability, establishment of reference data for normal-hearing Cantonese-speakers, and comparison with the Cantonese-Hearing-In-Noise-Test., Study Sample: Overall, 64 normal-hearing native Cantonese-speaking listeners., Results: SRT measurements with adaptive procedures resulted in a reference SRT of -9.7 ± 0.7 dB SNR for open-set and -11.1 ± 1.2 dB SNR for the closed-set response format. Fixed SNR measurements suggested a test-specific speech intelligibility function slope of 15.5 ± 0.7%/dB. Seventeen 10-sentences base test lists were confirmed to be equivalent with respect to speech intelligibility. Training effect was not observed after two measurements of 20-sentences lists., Conclusions: The YUEmatrix yields comparable results to matrix tests in other languages including Mandarin. Level adjustments to homogenise sentences appear to be less effective for tonal languages than for most other languages developed so far.

Objective: The aim of this study was to provide estimates of interaural attenuation (IA) in children, under clinical test conditions for supra-aural and insert earphones., Design: This was a retrospective review of clinical audiograms for children aged 8 months to 16 years., Study Sample: There were between 2 and 21 subjects, depending on the transducer and stimulus frequency., Results: For insert earphones, younger age groups had smaller IA estimates (mean 60 dB, minimum 40 dB) compared to older children (mean 78 dB, minimum 60 dB). The insert IA estimates for older children were similar to published adult IA data. There was no significant effect of age on the children's estimated IA for supra-aural earphones., Conclusions: Under the clinical conditions of this study, cross-hearing should be considered when the difference between the better ear and poorer ear not-masked air conduction thresholds are ≥ 40 dB for inserts with foam tips in children under 13 years. Smaller estimates of IA in younger children compared to older children may be due to difficulties achieving deep insertion of foam tips in smaller ears and less cooperative subjects under these conditions. Limitations of the study, including lack of bone conduction threshold data, are discussed.

Objective: To examine the association between individual and cumulative leisure noise exposure in addition to acceptable yearly exposure (AYE) and hearing outcomes among a nationally representative sample of Canadians., Design: Audiometry, distortion-product otoacoustic emissions (DPOAEs) and in-person questionnaires were used to evaluate hearing and leisure noise exposure across age, sex, and household income/education level. High-risk cumulative leisure noise exposure was defined as 85 dBA or greater for 40 h or more per week, with AYE calculations also based on this occupational limit., Study Sample: A randomised sample of 10,460 respondents, aged 6-79, completed questionnaires and hearing evaluations between 2012 and 2015., Results: Among 50-79 year olds, high-risk cumulative leisure noise was associated with increased odds of a notch while high exposure to farming/construction equipment noise was associated with hearing loss, notches and absent DPOAEs. No associations with hearing loss were found however, non-significant tendencies observed included higher mean hearing thresholds, notches and hearing loss odds., Conclusion: Educational outreach and monitoring of hearing among young and middle-aged populations exposed to hazardous leisure noise would be beneficial.

Objective: User-operated audiometry faces multiple barriers. One of these is the concern of audiologists that patients (non-experts) placing headphones by themselves results in invalid hearing thresholds due to greater placement variability., Design: Comparative study. Participants took the AMTAS pure-tone air-conduction audiometry under two different conditions, expert and non-expert circumaural headphone placement for five frequencies within the range 250-8000 Hz. Questionnaires were also used to gain insight into the usability of the user-operated audiometry system - as well as the participants' perceived handling of the audiometry headphones., Study Sample: Thirty participants (mean age 67.5 years)., Results: No statistically significant mean differences in hearing thresholds between the expert and non-expert conditions were found. The mean system usability scale score was 84.5. Handling the headphones was also rated as being easy (30%) or very easy (60%) by most non-experts., Conclusion: The conclusion of the study is that non-experts can be trusted to properly equip a pair of circumaural audiometry headphones for the correct conduction of pure-tone audiometry with only a few digital instructions.

Objective: This study aimed to identify the characteristics of distortion product otoacoustic emissions (DPOAEs) that can be used to differentiate noise-induced hearing loss (NIHL) from age-related hearing loss. A potential index to detect NIHL was defined in terms of its susceptibility to cumulative noise exposure but not to age., Design: In this cross-sectional cohort study, a job-exposure matrix was used to calculate the cumulative noise exposure. Multivariate linear regression models were used to examine how age and cumulative noise exposure associated with DPOAEs at individual frequencies after adjusting for hypertension, dyslipidaemia, tobacco use and alcohol consumption., Study Sample: The pure-tone audiometry and DPOAEs data collected from 239 male workers in a steel factory., Results: DPOAEs and DPOAE signal-to-noise ratios (SNRs) at all frequencies were found to be correlated with age, and those at 2, 3, 4 and 6 kHz were correlated with both age and noise exposure. The difference between DPOAE SNR at 1 and 3 kHz showed significant correlation with noise exposure but not with age., Conclusions: The results showed that this DPOAE index, the DPOAE SNR at 1 kHz minus the DPOAE SNR at 3 kHz, could add values to audiometric evaluation of NIHL.

Objective: The objectives of this study were (1) to re-calculate hearing threshold levels (HTLs) for pure tones as described in an international standard, ISO 7029:2017, and (2) to explain the procedure of how HTLs in the standard had been derived., Design: Pure-tone hearing threshold data used for developing ISO 7029:2017 and additional data sets were combined to re-estimate median HTLs and the distribution of individual HTLs around the median. The calculation was done for audiometric frequencies from 125 Hz to 8000 Hz and extended high frequencies from 9000 Hz to 12,500 Hz for ages from 18 to 80 years., Study Sample: Approximately 9000 men and 20,000 women employed in 15 studies in nine countries. They had been rigorously screened for hearing abnormalities., Results: A new set of median HTLs and distribution around the median was obtained as a function of age for males and females separately and compared with the estimates in ISO 7029. The differences among these threshold values were discussed., Conclusions: The calculation procedure described would help understand how the normative HTLs in ISO 7029:2017 had been obtained. Re-calculated HTLs could serve as a basis for the next edition of the standard that covers a wider range of population.

Objective: To examine associations between non-otologic medical conditions and auditory dysfunction., Design: Cross-sectional analysis of baseline data from the Noise Outcomes in Service members Epidemiology (NOISE) study. Logistic regression was used to estimate the association between medical conditions (0, 1, and 2 or more conditions) and auditory dysfunction (hearing loss pure tone average ≥20 dB HL and tinnitus), adjusting for key confounders including noise exposure. Secondarily, the association between specific medical conditions and auditory dysfunction was examined. All variables were self-reported., Study Sample: United States military Veterans (n = 580) with mean age 34.1 years (standard deviation = 9.2), who were within approximately 2.5 years of separation from service., Results: Compared to Veterans reporting no medical conditions, Veterans reporting two or more had increased odds on low-frequency hearing loss and on tinnitus but not on high or extended-high frequency hearing loss. Furthermore, specific conditions sleep disorder and arthritis were associated with auditory dysfunction., Conclusions: Non-otologic medical conditions were associated with low-frequency hearing loss and tinnitus in this sample of young Veterans. This suggests medical conditions may play a role in Veterans' hearing health. Whether management of medical conditions earlier in life reduces the risk of hearing loss and tinnitus requires further study.

Objective: Evaluate the conceptual framework that age effects on the electrophysiological binaural masking level difference (MLD) are partially mediated by age-related hearing loss and/or global cognitive function via mediation analysis., Design: Participants underwent a series of audiometric tests. The MLD was measured via cortical auditory evoked potentials using a speech stimulus (/ɑ/) in speech-weighted background noise. We used mediation analyses to determine the total effect, natural direct effects, and natural indirect effects, which are displayed as regression coefficients ([95% CI]; p value)., Study Sample: Twenty-eight individuals aged 19-87 years (mean [SD]: 53.3 [25.2]), recruited from the community., Results: Older age had a significant total effect on the MLD (-0.69 [95% CI: -0.96, -0.45]; p  < 0.01). Neither pure tone average (-0.11 [95% CI: -0.43, 0.24; p  = 0.54] nor global cognitive function (-0.02 [95% CI: -0.13, 0.02]; p  = 0.55) mediated the relationship of age and the MLD and effect sizes were small. Results were insensitive to use of alternative hearing measures or inclusion of interaction terms., Conclusions: The electrophysiological MLD may be an age-sensitive measure of binaural temporal processing that is minimally affected by age-related hearing loss and global cognitive function.

Objective: To investigate the effect of tinnitus and/or hyperacusis on distortion product otoacoustic emission (DPOAE) measures in adults with normal hearing thresholds from 0.25 to 8 kHz, while accounting for extended high-frequency (EHF) thresholds., Design: A behavioural study consisted of comprehensive audiological assessment, validated tinnitus and hyperacusis questionnaires, DPOAE amplitudes and input/output (I/O) functions., Study Sample: Data of 56 participants with normal hearing were included for the analysis. Participants were categorised into four groups: (1) without tinnitus or hyperacusis, (2) with tinnitus only, (3) with hyperacusis only, and (4) with both tinnitus and hyperacusis., Results: The groups with tinnitus showed elevated EHF thresholds compared with those without tinnitus. DPOAE amplitudes were not significantly affected by tinnitus and/or hyperacusis status; however, they were significantly affected by EHF thresholds. Further, no appreciable differences in DPOAE I/O functions were found across groups., Conclusions: The reported non-significant differences in DPOAEs in individuals with tinnitus and/or hyperacusis do not support a peripheral mechanism or an interaction between peripheral and central mechanisms underlying tinnitus or hyperacusis. Our findings, however, suggest the need to assess basal cochlear function (e.g. EHF thresholds) for a better understanding of differences in DPOAE measures in tinnitus and/or hyperacusis.

Objective: The primary objective of the current study was the validation of a cloud-centralized audiometry system for clinical practice., Design: A cross-sectional study design was used., Study Sample: A convenience sample of patients (>10 years old) booked for follow-up appointments were invited to participate. Participants completed both conventional and online digital audiometry in a standard sound treated clinic space during a single clinic visit; tests were completed in random order. Data for both ears were included. Patients were from one of three audiological practices., Results: A total of 41 participants completed both audiometric tests. Validation study results showed that the mean difference between the two audiometric test results remained within 5 dB HL for both air and bone conduction thresholds at all tested frequencies., Conclusions: Online digital audiometry has been demonstrated as a clinically accurate method for hearing assessment.

Objectives: The risk of noise injury from recreational firearm use is well known. Despite preventive measures it is uncertain whether it has become less harmful. We assessed whether the association between recreational firearm use and hearing has changed during the last two decades., Design: We used a repeated cross-sectional design and determined hearing thresholds by pure-tone audiometry. Frequency-specific associations between recreational firearm use and hearing thresholds were assessed by multivariate linear regression stratified by sex and adjusted for age and other covariates., Study Sample: Two cross-sectional population-based cohorts 20 years apart (1998 and 2018) comprised 27,580 (53% women, mean age 53 years) and 26,606 individuals (56% women, mean age 54 years), respectively., Results: Recreational firearm use was reported by 28% in 1998 and 30% in 2018. The proportion that reported wearing hearing protection increased. Exposure to recreational firearms was associated with elevated thresholds at 3-6 kHz in both cohorts. The association increased with the number of lifetime shots. The associations increased by age and were substantially smaller in the most recent cohort., Conclusions: Analyses of two cohorts revealed a reduction in the association between recreational firearm use and hearing over 20 years, coinciding with the introduction of hearing preservation measures.

Objective: To elucidate D-methionine's (D-met) dose and time rescue parameters from steady-state or impulse noise-induced permanent threshold shift (PTS) and determine D-met rescue's influence on serum and cochlear antioxidant levels., Design: Five D-met doses at 0, 50, 100, or 200 mg/kg/dose administered starting at 1, 24, or 36 hours post steady-state or impulse noise exposure. Auditory brainstem responses at baseline and 21 days post-noise measured PTS. Serum (superoxide dismutase [SOD], catalase [CAT],, glutathione reductaseand glutathione peroxidase [GPx]) and cochlear (Glutathione [GSH] and glutathione disulphide [GSSG]) antioxidant levels measured physiological impact., Study Sample: Chinchillas (10/study group; 6-8/confirmatory groups)., Results: D-met significantly reduced PTS for impulse noise (100 mg [2, 6, 14 and 20 kHz]; 200 mg [2, 14 and 20 kHz]) and steady-state noise (all dosing groups, time parameters and tested frequencies). PTS reduction did not significantly vary by rescue time. D-met significantly increased serum SOD (100 and 200 mg for 24 hour rescue) and GPx (50 mg/kg at 24 hour rescue) at 21 days post-noise. Cochlear GSH and GSSG levels were unaffected relative to control., Conclusion: D-met rescues from steady-state and impulse noise-induced PTS even when administered up to 36 hours post-noise and dose-dependently influences serum antioxidant levels even 21 days post-noise. D-met's broad and effective dose/time window renders it a promising antioxidant rescue agent.

Objective: To monitor ototoxicity, air conduction (AC) extended high frequency (EHF) thresholds can be measured up to 16 kHz. However, conductive hearing loss might influence these results. This is unfortunate because the EHF thresholds are important to follow the impact of ototoxic medication during therapy. Therefore a suitable bone conduction (BC) transducer and norm values for EHF BC measurements are needed., Design: In this study three different BC transducers were used: the B71 (Radioear), the KH70 (Präcitronic), and the KLH96 (Westra). Hearing thresholds were measured from 0.125 to 16 kHz using AC transducers (Telephonics TDH39, Sennheiser HDA200), and BC thresholds from 0.25 to 8 kHz with the B71, and from 0.25 to 16 kHz with the KLH96 and KH70., Study Sample: 60 ears of 30 normal hearing subjects were measured., Results: The KLH96 showed the highest output for the high frequencies, and distortion measurements were similar to the KH70. The results show that EHF measurements are possible using the KLH96 and KH70 bone conductors., Conclusion: EHF BC measurements are reliable when using the KLH96 and KH70 bone conductors. The extended force sensitivity of the used artificial mastoid should be determined for a proper EHF BC calibration.

Objective: The primary objective of this experiment was to measure the temporal and spatial processing capabilities of older individuals and use statistical models to identify the individual contributions of these temporal and spatial processing capabilities to spatial release from masking (SRM)., Design: Repeated measures., Study Sample: Twenty-five older listeners with varying degrees of hearing loss participated in this experiment. SRM using the coordinate response measure, gap detection thresholds and localisation acuity for 1/3-octave-wide Gaussian noise bands centred at 500 and 4000 Hz were measured for all the listeners., Results: Older listeners had better speech recognition thresholds when target and maskers were spatially separated as compared to when they were co-located. In addition, hearing loss and localisation acuity at 500 Hz were significant predictors in a multiple regression model predicting SRM. However, gap detection thresholds did not significantly contribute to the multiple regression model predicting SRM., Conclusion: Based on our data, we conclude that SRM at 30° spatial separation between the target and symmetric maskers is driven by the ability of the individuals to use interaural time difference cues.

Objective: The objective of this study was to assess the association of self-reported noise exposure and audiograms processed with ten algorithms proposed to quantify noise-induced hearing loss using receiver operating characteristic (ROC) curves., Design: Participants were placed into groups based on self-reported noise exposure. Self-reported noise exposure served as a predictor for noise-induced hearing loss (NIHL). Audiograms were analysed with ten algorithms: The Guidelines, Brewster's Rules, two versions of military Noise-induced Hearing Loss, the Bulge Depth, the age-adjusted 8 kHz threshold and four versions of a new algorithm called the Adjusted Notch Depth (AND). The area under the ROC curves were calculated for each algorithm., Study Sample: Data were collected from three cycles of the National Health and Nutrition Examination Survey., Results: Only one version the AND significantly identified those with self-reported noise exposure with an area under the curve of 0.562., Conclusions: The association between the AND and self-reported noise exposure was marginally better than the previous algorithms in identifying those with self-reported noise exposure. These findings do not support using puretone thresholds for identifying those with NIHL in a cross-sectional research study without stratifying the participants. More research is needed to determine how the AND can be applied to stratified designs.

Objective: To undertake calibration and preliminary validation of a custom-designed computer-based screening audiometer connected to consumer insert phone-earmuff combination for adult pure tone audiometry., Design: Part 1 involved electroacoustic measurement and biological calibration of a laptop-earphone pair used for the computer-based audiometry (CBA). Part 2 compared CBA thresholds obtained without a sound booth with those measured using the gold-standard clinical audiometry., Study Sample: 17 young normal-hearing volunteers (Part 1) and 43 normal and hearing loss subjects (Part 2) recruited from an audiology clinic via convenience sampling., Results: The transducer-device combination produced outputs suitable for measuring thresholds down to 0 dB HL. Threshold pairs obtained from the CBA and clinical audiometry were highly correlated (Spearman's correlation coefficient, ρ  = 0.92, p  < 0.0001) and had a good degree of agreement (mean difference of -1.06 ± 7.63 dB). Also, the CBA showed about 90% sensitivity and 80% specificity for detecting hearing loss based on low (0.5, 1, 2 kHz) and high frequency (4, 8 kHz) pure tone averages of >25 dB HL., Conclusions: The use of a computer-based audiometer application with consumer insert phone-earmuff combination can offer a cost-effective solution for boothless screening audiometry.

Objective: To study the impact of cardiovascular diseases (CVDs) on hearing deterioration among ageing adults in a longitudinal setting. Furthermore, to describe the pure tone threshold changes at the 0.125-8 kHz frequency range over 13 years., Design: A population-based follow-up study., Study Sample: A random sample of 850 adults, of whom 559 participated in the follow-up study. Otological examination, a structured interview, and pure tone audiometry were conducted. Multivariate regression models were used to estimate the effect of CVD (participants had at least one cardiovascular condition) on hearing deterioration of the better ear hearing level (BEHL), defined as a change in the pure-tone average (PTA) of the frequencies 0.5, 1, 2, and 4 kHz and separately at the lower (0.125, 0.25, and 0.5 kHz) and higher (4, 6, and 8 kHz) frequencies., Results: In the multivariable-adjusted analysis, the BEHL change at 13 years was 0.7 dB greater among participants with CVD ( p  = 0.3). The mean BEHL change during the 13-year follow-up was 12.0 dB (95% CI 11.4-12.6) among all participants., Conclusions: No significant association between CVD and hearing threshold changes was found.

Objective: This exploratory Phase 2 clinical trial is the first determining safety and efficacy of oral D-methionine (D-met) in reducing cisplatin-induced ototoxicity. Design: Randomised parallel double-blind placebo-controlled exploratory Phase 2 study. Study samples: Fifty adult cancer patients received oral D-met or placebo before each cisplatin dose. Physical examination, blood collection and audiometry occurred at baseline and subsequent visits plus post-treatment audiometry. After attrition, final analysis included 27 patients. Results: Significant treatment group by ear and time (baseline vs. post-treatment) interactions occurred at 10 kHz and 11.2 kHz. Placebo and D-met groups differed in threshold shift for left ear at 11.2 kHz (mean difference = 22.97 dB [9.59, 36.35]). Averaging across ears, placebo group showed significant threshold shifts from baseline to post-treatment at 10 kHz (mean shift= -13.65 dB [-21.32,-5.98]), 11.2 kHz (-16.15 dB [-25.19,-7.12]), and 12.5 kHz (-11.46 dB [-19.18,-3.74]) but not 8 kHz (-8.65 dB [-17.86, 0.55]). The D-met group showed no significant threshold shifts (8 kHz: -1.25 dB [-7.75, 5.25]; 10 kHz:-3.93 dB [-8.89, 1.03]; 11.2 kHz:-4.82 dB [-11.21, 1.57]; 12.5 kHz:-3.68 dB [-11.57, 4.21]). Side effects did not significantly differ between groups. Conclusion: Oral D-met reduces cisplatin-induced ototoxicity in humans.

Objective: To estimate the equivalent threshold sound pressure levels (ETSPLs) for nine stimuli used today and in the future for universal newborn hearing screening and diagnostics delivered by the Interacoustics SnapPROBE™., Design: The Click and eight variants of the CE-Chirp ® were included to establish ETSPLs when delivered by the SnapPROBE™. The short duration stimuli were presented at a 20/s repetition rate for about 1-2 s following the international standards for establishing ETSPLs., Study Sample: 50 ears from a total of 27 normal hearing young adult subjects (female/male = 16/11; age = 21-25 years, mean age = 23.1 years)., Results: Peak-to-peak equivalent signal levels and root mean square signal levels (at 20/s repetition rate) for the nine stimuli are stated., Conclusions: The ETSPLs are in alignment overall with those found in previous studies, while some levels are about 2-6 dB higher for this study compared to the Interacoustics Titan IOW probe and the ER-3A insert earphone. The results are relevant for present and future universal newborn hearing screening and diagnostics carried out with the SnapPROBE™ to ensure that correct stimulation levels are applied.

Objective: Free-field correction values were measured for RadioEar DD65v2 audiometric headphones., Design: Free-field correction values, that is, the difference G F - G C between the free-field sensitivity level G F and the ear simulator sensitivity level G C , were determined by loudness level comparisons between the headphone and a plane progressive wave in a free sound field., Study Sample: The study was based on 17 otologically normal test subjects., Results: Frequency-dependent free-field correction values are provided. The free-field correction of the speech level was determined to be 3.2 dB., Conclusions: Free-field correction values were determined for RadioEar DD65v2 audiometric headphones with an expanded measurement uncertainty.

Objective: Upon calibration of a specific commercially available immittance device, an artifact was consistently measured in a calibration cavity when in ipsilateral acoustic reflex mode. These results were replicated in a controlled fashion, raising concerns about how clinical results might potentially be misinterpreted., Design: Responses were measured from an Interacoustics Titan and Grason-Stadler Tympstar Pro immittance device coupled to a 0.2 cc and, separately, to a 1.0 cc calibration cavity when in ipsilateral acoustic reflex mode. The procedure was repeated with the same outcomes., Results: Clinically significant responses ordinarily associated with presence of an ipsilateral acoustic reflex were obtained in a 0.2 cc and 1 cc coupler with stimuli presented at 0.5 kHz, 1 kHz, and 2 kHz with one of the Interacoustics Titan, but were not obtained in the same conditions with the Grason-Stadler Tympstar Pro., Conclusions: A commercially available immittance device yielded clinically-significant responses to ipsilateral acoustic reflex stimuli within calibration cavities of various sizes. Results suggest that false-positive responses may be obtained when certain immittance devices are used clinically, producing possible misleading or incorrect clinical impressions and assessment.

Objective: Two consecutive studies sought to determine the (1) Equivalent Threshold Sound Pressure Levels (ETSPLs) and, (2) real ear attenuation thresholds (REAT) for the KUDUwave earcup configured with an insert earphone using a typical immittance probe tip (TPT)., Design: (1) Hearing thresholds were measured for frequencies 125 to 8000 Hz using the TPT. ETSPLs were calculated in an IEC 60318-4 occluded ear simulator. (2) REAT were obtained by measuring sound field thresholds with ears uncovered and covered with the investigational transducer. The attenuation values were used to determine the maximum permissible ambient noise levels (MPANLs)., Study Sample: (1) Study 1 included twenty-five adult participants with no otologic diseases (8 females; 18 - 33 years). (2) Study 2 included fifteen normal hearing participants aged 21-31 years., Results: Established ETSPLs, REAT, and MPANLs for the TPT are presented in this paper. The determined TPT ETSPLs differed from the ER-3A foam tip insert earphone's RETSPLs reported in ISO 389-2., Conclusions: The investigational transducer can be used for pure-tone audiometry provided the reported MPANLs are adhered to, and ETSPL values are employed for calibration purposes. The advantage is to achieve a cost-effective one-probe tip solution for pure tone audiometry and immittance measurement.

Objective: A model-based determination of the average supra-threshold ("distortion") component of hearing impairment which limits the benefit of hearing aid amplification., Design: Published speech recognition thresholds (SRTs) were predicted with the framework for auditory discrimination experiments (FADE), which simulates recognition processes, the speech intelligibility index (SII), which exploits frequency-dependent signal-to-noise ratios (SNR), and a modified SII with a hearing-loss-dependent band importance function (PAV). Their attenuation-component-based prediction errors were interpreted as estimates of the distortion component., Study Sample: Unaided SRTs of 315 hearing-impaired ears measured with the German matrix sentence test in stationary noise., Results: Overall, the models showed root-mean-square errors (RMSEs) of 7 dB, but for steeply sloping hearing loss FADE and PAV were more accurate (RMSE = 9 dB) than the SII (RMSE = 23 dB). Prediction errors of FADE and PAV increased linearly with the average hearing loss. The consideration of the distortion component estimate significantly improved the accuracy of FADE's and PAV's predictions., Conclusions: The supra-threshold distortion component-estimated by prediction errors of FADE and PAV-seems to increase with the average hearing loss. Accounting for a distortion component improves the model predictions and implies a need for effective compensation strategies for supra-threshold processing deficits with increasing audibility loss.

Objective: To assess the accuracy and reliability of a machine learning (ML) algorithm for predicting the full audiograms of hearing-impaired children relative to the common approach (CA)., Design: Retrospective study., Study Sample: There were 206 audiograms included from 206 children with sensorineural hearing loss. Nested cross-validation was used for evaluating the performance of the CA and ML. Six audiogram prediction simulations were performed in which either one or two thresholds across 0.5-4 kHz from complete audiograms in the dataset were labelled. Missing thresholds at the remaining frequencies were then predicted using the CA and ML in each simulation. The accuracy of the ML algorithm was determined by comparing the median average absolute threshold differences between the CA and ML using Wilcoxon signed-rank test. The reliability between runs of the ML was also assessed with Cronbach's alphas., Results: The median average absolute threshold differences in ML (5-8 dBHL) were statistically significantly lower than those in CA (6.25-10 dBHL) in all six simulations ( p value < 0.05). The ML algorithm was also found to be reliable to predict the audiograms in all six simulations ( α  > 0.9)., Conclusion: Using the ML to predict the children's audiograms was reliable and more accurate than using the CA.

Objectives: To compare the loudness functions (loudness ratings as a function of sound level) obtained from patients diagnosed as having functional hearing loss (FHL) with those for patients with sensorineural hearing loss (SNHL) and healthy volunteers., Design: Loudness functions for a 1000 Hz tone for patients with FHL and SNHL were assessed based on the categorical loudness scaling method. The data were compared with control data obtained in our facilities., Study Sample: 18 patients (33 ears) with FHL and 10 patients (19 ears) with SNHL., Results: For patients with SNHL and healthy volunteers, loudness increased progressively with increasing sound level above the audiometric threshold, with no exceptions. However, for about 70% of the patients with FHL, a different type of loudness function was obtained; the thresholds determined from the loudness function, which were defined as the minimum sound levels at which loudness could be judged, were 10 dB or more lower than the audiometric threshold (>10 dB), and/or the loudness ratings were elevated for a sound at the audiometric threshold., Conclusions: The results support the hypothesis that patients with FHL often make threshold judgments based on a certain loudness.

Objective: Telecommunication can be difficult in the presence of noise or hearing loss. The purpose of this study was to systematically review evidence regarding the effects of text supplementation (e.g. captions, subtitles) of auditory or auditory-visual signals on speech intelligibility for listeners with normal or impaired hearing., Design: Three databases were searched. Articles were evaluated for inclusion based on the Population Intervention Comparison Outcome framework. The Effective Public Health Practice Project instrument was used to evaluate the quality of the identified articles., Study Sample: After duplicates were removed, the titles and abstracts of 2019 articles were screened. Forty-six full texts were reviewed; ten met inclusion criteria., Results: The quality of all ten articles was moderate or strong. The articles demonstrated that text added to auditory (or auditory-visual) signals improved speech intelligibility and that the benefits were largest when auditory signal integrity was low, accuracy of the text was high, and the auditory signal and text were synchronous. Age and hearing loss did not affect benefits from the addition of text., Conclusions: Although only based on ten studies, these data support the use of text as a supplement during telecommunication, such as while watching television or during telehealth appointments.

Objectives: The aims of this study were to investigate auditory habits and binaural interaction among pilot and non-pilot military personnel from the Brazilian Air Force., Design: A cross-sectional study using (1) an auditory habits questionnaire to outline the groups auditory profile and (2) the masking level difference test (MLD, Auditec, Saint Louis®) to evaluate and compare the groups., Study Sample: Forty military male personnel aged between 30-40 years old, all with normal hearing, comprising 20 pilots in the study group (SG), and 20 non-pilots, not exposed to noise, in the control group (CG)., Results: There was no significant difference between groups regarding auditory habits. In the MLD test, a significantly better performance under the homophasic condition (S0N0) was found in the SG. Under the antiphasic condition (SπN0) there were no differences between groups. This combination resulted in a significantly lower MLD in the SG compared to the CG., Conclusions: Repeated exposure to conditions where active pilots have to learn to recognise speech in noisy backgrounds may lead to a better performance in the MLD's homophasic condition (S0N0).

Objective: Previous studies at conventional audiometric frequencies found associations between the ripple depth seen in audiogram fine structure (AFS) and amplitudes of both transient evoked otoacoustic emissions (TEOAEs) and overall hearing threshold levels (HTLs). These associations are explained by the cochlear mechanical theory of multiple coherent reflections of the travelling wave apically by reflections sites on the basilar membrane and basally by the stapes., Design: The aim was to investigate whether a similar relationship is seen in the extended high-frequency (EHF) range from 8-16 kHz. Measurements from 8-16 kHz were obtained in normal-hearing subjects comprising EHF HTLs, EHF TEOAEs using a double evoked paradigm, and Bekesy audiometry to assess AFS ripple depth and spectral periodicity., Study Sample: Twenty eight normal-hearing subjects participated., Results: Results showed no significant correlation between AFS ripple depth and either frequency-averaged EHF HTLs or EHF TEOAE amplitudes. The amplitude of AFS ripple depth was also lower than that seen in the conventional frequency region and spectral periodicity in the ripple more difficult to discern., Conclusion: The results suggest a weaker interference pattern between forward and reverse cochlear travelling waves in the most basal region compared to more apical regions, or a difference in cochlear mechanical properties.

Objective: Distortion product otoacoustic emission (DPOAE) levels plotted as a function of stimulus frequency ratio demonstrate a bandpass shape. This bandpass shape is narrower at higher frequencies compared to lower frequencies and thus has been thought to be related to cochlear mechanical tuning. Design: However, the frequency- and level-dependence of these functions above 8 kHz is largely unknown. Furthermore, how tuning estimates from these functions are related to behavioural tuning is not fully understood. Study Sample: From experiment 1, we report DPOAE level ratio functions (LRF) from seven normal-hearing, young-adults for f 2 = 0.75-16 kHz and two stimulus levels of 62/52 and 52/37 dB FPL. We found that LRFs became narrower as a function of increasing frequency and decreasing level. Results: Tuning estimates from these functions increased as expected from 1-8 kHz. In experiment 2, we compared tuning estimates from DPOAE LRF to behavioural tuning in 24 normal-hearing, young adults for 1 and 4 kHz and found that behavioural tuning generally predicted DPOAE LRF estimated tuning. Conclusions: Our findings suggest that DPOAE LRFs generally reflect the tuning profile consistent with basilar membrane, neural, and behavioural tuning. However, further investigations are warranted to fully determine the use of DPOAE LRF as a clinical measure of cochlear tuning.