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Objective: Describe the ear and hearing outcomes in Aboriginal infants in an Australian urban area. Design: Aboriginal infants enrolled in the Djaalinj Waakinj prospective cohort study had ear health screenings at ages 2-4, 6-8 and 12-18 months and audiological assessment at ∼12 months of age. Sociodemographic, environmental characteristics, otoscopy, otoacoustic emissions, tympanometry and visual reinforcement audiometry data were collected. Study Sample: 125 infants were enrolled in the study; 67 completed audiological assessment, 62, 54, and 58 of whom attended ear screenings at 2-4, 6-8 and 12-18 months. Results: Of the children that attended the audiological assessment, 36.5%, 50% and 64.3% of infants had otitis media (OM) at 2-4, 6-8 and 12-18 months. Using a 10 dB correction factor, 44.8% of infants had hearing loss (HL) (≥ 25 dB HL) at ∼ 12 months of age. More males (X2=5.4 (1df, p = 0.02)) and infants with OM at audiological assessment (X2=5.8 (1df, p = 0.02)) had HL. More infants that used a pacifier at 12-18 months of age had HL (X2=4.7 (1df, p = 0.03)). Conclusion: Aboriginal infants in an urban area have high rates of HL and OM, which requires early surveillance and timely treatment to reduce the medical and developmental impacts of OM and HL. [ABSTRACT FROM AUTHOR]

Access to hearing assessment is important for children, as poor auditory information can lead to poor speech and oral language development. This study aims to identify enablers and barriers to accessing hearing assessments for Australian children from the perspective of speech-language pathologists (SLPs), comparing access in metropolitan, regional, and rural areas. This is a sequential, explanatory mixed-methods study. Forty-nine participants completed the quantitative survey and 14 participated in semi-structured interviews. The study was undertaken online and included participants from metropolitan, regional, and rural parts of Australian states and territories. Similar accessibility issues were experienced across geographic locations and access to hearing assessment was related to the complexity of individual contexts. Speech-language pathologists felt that awareness and knowledge of hearing loss was low in parents and health professionals. Participants discussed barriers such as long wait times, complex criteria, and inefficient services that lead to compromised outcomes for clients. Barriers to hearing assessment are extensive and multifaceted. Future research might examine the accessibility of the health system in light of the barriers discussed in this research, and whether policies and procedures could be adapted to allow more easily accessible services. [ABSTRACT FROM AUTHOR]

This study compared the pre-employment median hearing threshold level (HTL) distribution from a population of coal miners from New South Wales (NSW), Australia, to an otologically normal, age-matched population described by the International Standards Organisation (ISO) ISO 7029:2019, to determine any differences. This was an observational, retrospective, repeated cross-sectional study. De-identified audiometric records of 59,601 male employees entering NSW coal mining in three representative five-year periods between 1991 and 2015 were utilised. The median HTL deviation of the mining population was statistically significantly different (p < 0.05) from the ISO population, for almost all analyses. Overall, the mining population cohorts have higher (worse) median HTLs compared to the ISO population. The greatest difference occurs at 4 kHz in older age groups, likely indicating noise-induced hearing loss. These findings indicate that some NSW coal mine workers commence their careers with evidence of pre-existing hearing loss (HL), in an industry with excessive noise exposures. These results provide Australian mining and other noisy industries with evidence to support a review of hearing conservation strategies to improve mitigation of hearing loss across the working lifespan. The coal mining industry in Australia typically employs 20,000–30,000 workers annually. These workers are potentially exposed to noise levels between 80 dB(A) and 120 dB(A) whilst at work, and thus at high risk of developing noise induced hearing loss (NIHL). NIHL is the most compensated, occupational disease for coal mining in Australia, costing the Australian State of New South Wales (NSW) up to $4 million each year. And yet: NIHL is entirely preventable. This is the second of two studies of Australian coal mining, analysing a database containing de-identified mandatory audiometric testing results. Evidence of hearing loss within this population was determined in the first study, and the aim of this follow-up study was to determine if there were differences in the median hearing threshold levels in the mining population compared to an otologically normal, international population (ISO7029). The results indicate that the mining population HTLs for males are significantly different (worse) compared to an age and gender matched otologically normal population, specifically at 4 kHz for older workers. Evidence of age-related hearing loss was also found. From a workplace perspective, employers need to consider appropriate workplace interventions to promote hearing loss prevention strategies across the workforce. This information can be used to inform future noise and hearing policies and procedures within this, as well as other noisy industries, to prevent and reduce further exposure of workers to excessive noise. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the relationship between speech perception, speech production, and vocabulary abilities in children with and without speech sound disorders (SSDs), analyzing the data both by group and continuously. Method: Sixty-one Australian English–speaking children aged 48–69 months participated in this study. Children’s speech production abilities ranged along the continuum from SSDs through to typical speech. Their vocabulary abilities ranged along the continuum from typical to above average (“lexically precocious”). Children completed routine speech and language assessments in addition to an experimental Australian English lexical and phonetic judgment task. Results: When analyzing data by group, there was no significant difference between the speech perception ability of children with SSDs and that of children without SSDs. Children with above-average vocabularies had significantly better speech perception ability than children with average vocabularies. When analyzing data continuously, speech production and vocabulary were both significant positive predictors of variance in speech perception ability, both individually in simple linear regression and when combined in multiple linear regression. There was also a significant positive correlation between perception and production of two of the four target phonemes tested (i.e., /k/ and /ʃ/) among children in the SSD group. Conclusions: Results from this study provide further insight into the complex relationship between speech perception, speech production, and vocabulary abilities in children. While there is a clinical and important need for categorical distinctions between SSDs and typically developing speech, findings further highlight the value of investigating speech production and vocabulary abilities continuously and categorically. By capturing the heterogeneity among children’s speech production and vocabulary abilities, we can advance our understanding of SSDs in children. [ABSTRACT FROM AUTHOR]

Purpose: This article examines the educational decision-making of hearing parents for their deaf children born during a period (1970–1990s) before the introduction of new-born hearing screening in New South Wales, where the study was conducted, and prior to the now near-universal adoption of cochlear implants in Australia. Design/methodology/approach: We present findings from an oral history study in which parents were invited to recall how they planned for the education of their deaf children. Findings: We propose that these oral histories shed light on how the concept, early intervention – a child development principle that became axiomatic from about the 1960s – significantly shaped the conduct of parents of deaf children, constituting both hope and burden, and intensifying a focus on early decision-making. They also illustrate ways in which parenting was shaped by two key structural shifts, one, being the increasing enrolment of deaf children in mainstream rather than separate classrooms and the other being the transformation of deafness itself by developments in hearing assistance technology. Originality/value: The paper contributes to a sociological/historical literature of "parenting for education" that almost entirely lacks deaf perspectives and a specialist literature of parental decision-making for deaf children that is almost entirely focussed on the post cochlear implant generation. The paper is distinctive in its treatment of the concept of "early intervention" as a historical phenomenon rather than a "common sense" truth, and proposes that parents of deaf children were at the leading edge of late-20th and early-21st century parenting intensification. [ABSTRACT FROM AUTHOR]

GJB2-associated hearing loss (GJB2-HL) is the most common genetic cause of hearing loss in children. However, little is known about the clinical characteristics and early language outcomes in population-oriented samples including children with different degrees of hearing loss. Insight into these characteristics are relevant for the counselling of parents. Our sample consisted of 66 children at approximately 2 years of age (17–32 months) with bilateral hearing loss due to GJB2 from three population-based cohorts in Austria, Australia and the Netherlands. Predictors of early vocabulary, including demographic, audiological, genetic and intervention variables and the role of medical comorbidities and nonverbal cognition were examined. The vocabulary scores of children with GJB2-HL were approximately 0.7 standard deviations (SDs) below the norms of children with typical hearing. Age at access to family-centered early intervention and first-born position among siblings predicted language outcomes, whereas the degree of hearing loss and genetic subtype were not significantly correlated with expressive vocabulary. In children with GJB2-HL, early access to family-centered early intervention significantly affected language outcomes at the age of two. [ABSTRACT FROM AUTHOR]

Background: A variety of outcome domains are currently measured for the assessment of hearing rehabilitation. To date, there is no consensus about which outcome domains should be measured, when they should be measured, and how they should be measured. In addition, most studies seeking to develop core outcome sets and measures for hearing rehabilitation services have primarily focussed on the opinions and expertise of researchers, and, to a lesser extent, clinicians, rather than also involving clients of those services. The principles of experience-based co-design suggest that health services, researchers, and policymakers should come together with clients and their families to design health services and define what metrics should be used for their success. Objectives: This study aimed to seek views and consensus from a range of key stakeholders to define which client-centred self-report outcome domains should be measured, when they should be measured, and how they should be measured, in a national publicly funded hearing rehabilitation scheme. In addition, the study aimed to identify current and future potential mechanisms and systems to standardise the collection of data and reporting of outcomes, to enable comparison across clients and hearing service providers. Methods: Two stakeholder groups participated in a three-round online Delphi process: (1) 79 professional stakeholders involved in the delivery of hearing services in Australia, and (2) 64 hearing rehabilitation services' clients identified by not-for-profit consumer organisations. An initial set of in-person workshops scoped the key issues upon which to develop the initial open-ended questions and subsequent Likert-scale statements addressing these issues. These statements were then distributed to both groups in an online survey. The respondent ratings were summarised, and the summary was returned to respondents along with a second round of the survey. This process was then repeated once more. The five most important outcome domains from both groups were then combined, and a consensus workshop of seven professionals and three client advocates agreed on the top four ranked domains. Results: A range of potential outcome domains were identified as relevant indicators of successful hearing rehabilitation. Communication ability, personal relationships, wellbeing, and participation restrictions were identified as a core outcome domain set that should be measured as a minimum for patients receiving hearing rehabilitation. There was little agreement on the preferred timepoints for collection of outcome measures, with respondents expressing the view that this should be established by research once a set of outcome measures has been selected. However, there was broad agreement that measurements of these domains should be collected at baseline (before the provision of hearing rehabilitation) and no earlier than 3 months following the completion of rehabilitation. Potential benefits and issues with the development of a national outcomes database/collection system were also identified and prioritised, with participants highlighting the importance of valid, high-quality, trustworthy, and comprehensive data collection. Conclusion: These results provide a Core Outcome Domain Set for the self-reported evaluation of hearing rehabilitation and provide important background information for the design of methods to implement them across hearing healthcare systems. However, the wide range of outcome domains identified as potentially providing important additional information and the lack of specific measures to address these domains strongly suggest that there is still more research to be done. Ongoing stakeholder engagement will continue to be vital for future implementation. In addition, further research is required to determine the optimal time following hearing rehabilitation to utilise any particular outcome measure. [ABSTRACT FROM AUTHOR]

To describe and analyse the linguistic structure of audiological diagnoses for infants, to determine ways to optimise the delivery of diagnostic information to parents during this typically emotive time. This study analysed the linguistic structure of audio-recorded infant diagnostic appointments. Nine appointments conducted by four experienced paediatric audiologists were analysed. Diagnoses of normal hearing were delivered explicitly and in a straightforward manner. Positive aspects of this outcome were highlighted, and audiologists used the pronoun "we," conveying a feeling of teamwork. In contrast, when a hearing loss was diagnosed, the diagnosis included disfluencies and the use of hedging, although positive aspects were also emphasised. In these cases, audiologists used the pronoun "I," thereby taking ownership of the results. Differences in the topics raised by audiologists and parents highlighted a mis-match between the information provided and the information requested. Topics addressed by audiologists were primarily medical and procedural, whereas parents were concerned with causes, treatments and experiential information. The use of the above linguistic strategies may serve to minimise the significance and impact of the diagnosis. Whilst the data are unable to be generalised to other contexts, the study has generated in-depth and nuanced information about diagnosis delivery. [ABSTRACT FROM AUTHOR]

This study investigated whether demographic variables, risk factor presence or absence and universal newborn hearing screening (UNHS) results can be used to predict permanent childhood hearing loss (PCHL) in infants referred from screening. Retrospective analysis of a UNHS database. Data were extracted from the state-wide UNHS database storing details of the 613,027 infants who were born in Queensland, Australia between 1 January 2007 and 31 December 2016 and participated in UNHS. This study included the 6735 children who were referred from the UNHS program for diagnostic audiology due to failing the screen in one or both ears or bypassing screening. Factors with a significant positive association with PCHL that were incorporated into a logistic regression model were: female gender, non-indigenous status, family history of PCHL, craniofacial anomalies and syndromes associated with PCHL, and a bilateral refer result on screening. Odds of PCHL vary among infants referred for diagnostic assessment from UNHS programs. When an infant refers on the newborn hearing screen, information about their gender, indigenous status, identified risk factors and specific screening outcome can be used to predict the likelihood of a congenital PCHL diagnosis. [ABSTRACT FROM AUTHOR]

This study examined the hearing threshold levels (HTL) of workers commencing employment in Australian coal mines in the State of New South Wales (NSW). The aim was to establish if some degree of hearing loss was identifiable in the mandatory pre-employment audiograms of workers. This was an observational, retrospective, repeated cross-sectional study. De-identified audiometric records of 64196 employees entering NSW coal mining in three representative five-year periods between 1991–2015 were utilised. Although HTLs were lower (better) in more recent years, the results showed clinically significant hearing loss (≥25dBHL) for older workers, 45–60 years. Pure tone average (PTA) hearing losses were greater at the higher frequencies associated with excessive noise exposure (3–6 kHz), than at the speech frequencies (0.5–4 kHz). Hearing loss in the left ears were higher compared to the right ears, with higher prevalence of audiometric notches in males. Almost a fifth (14.8–20.1%) of male workers commencing work in NSW coal mines presented with an audiometric notch at 4 kHz. Further research is required to determine if these notches represent true NIHL, and how the residual hearing of workers may be conserved. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare speech reception thresholds in noise measured with the Listening in Spatialised Noise – Universal test (LiSN-U; which requires no English knowledge) with those measured from the relevant conditions of the LiSN – Sentences test (LiSN-S; a test requiring knowledge of English) in Aboriginal and Torres Strait Islander children. A second aim was to compare the ability of the two tests to detect spatial processing disorder. Participants completed audiometry, the LiSN-S, and the LiSN-U. 90 Aboriginal and Torres Strait Islander children aged six to 14 years tested in a school setting. Strong correlations were found between speech reception thresholds in noise for the two tests. A moderate correlation was found between the difference scores that each test uses to detect spatial processing disorder. Consistent diagnoses of whether a child had spatial processing disorder or not on both tests were found for 72% of children. The moderate-to-strong relationships and agreement between diagnoses found for the LiSN-S and LiSN-U show promise for the LiSN-U being used as a tool to investigate spatial processing disorder in children, without requiring the test to use a language familiar to the children being tested. [ABSTRACT FROM AUTHOR]

Objective: To investigate the experiences of audiologists and audiometrists working in regional and remote areas of Australia. Design: A qualitative design, using telephone and videoconference semi‐structured interviews and thematic analysis. Setting: Regional and remote locations across Australia Participants: 5 audiologists and 2 audiometrists, 6 female and one male. Interventions: None. Main outcome measures: Insights into the experiences of audiologists and audiometrists working in rural Australia. Results: Core themes that emerged from analysis were (a) professional isolation and increased scope of practice, (b) the importance of social and professional networks, (c) variable access to professional support, (d) challenges in the recruitment and retention of clinicians, and (e) tensions between service provision and profitability. Conclusion: This study provides valuable insights into both the rewarding and challenging aspects of working as an audiologist or audiometrist in regional and remote areas. This study emphasised the need to address these challenges in order to attract more audiological professionals to work and stay in regional and remote areas of Australia. [ABSTRACT FROM AUTHOR]

In this paper, we draw on evidence to address the impact of earlier identification of congenital hearing loss through universal newborn hearing screening (UNHS) and the associated earlier access to interventions including cochlear implant (CI) technology on outcomes of children with hearing loss. Data from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study were analysed to examine the impact of UNHS and earlier intervention on language outcomes. The LOCHI study includes more than 450 deaf and hard of hearing Australian children whose hearing losses were identified variously through newborn hearing screening or later paths to confirmation and intervention. Seventy-two percent of the screened group received hearing aid fitting before 6 months of age, which more than doubled the 32% in the non-screened group. On average, children who received earlier intervention achieved language at age 5 years commensurate with their typically developing peers. Children who do not have disabilities in addition to hearing loss and received their first CIs before age 12 months achieved language scores within the range of typically developing peers. Newborn hearing screening led to earlier intervention. Children who received earlier intervention achieved better outcomes than those who received later intervention. [ABSTRACT FROM AUTHOR]

Objective: This study explored the feasibility of cortical automatic threshold estimation (CATE), a fully automated late auditory evoked potential (AEP) test, as an alternative to pure-tone audiometry for hearing threshold estimation for adults with dementia living in aged care. Design: A single group cross-sectional study was conducted. Participants' dementia severity was determined through the Clinical Dementia Rating scale. Hearing thresholds were obtained for four audiometric frequencies in at least one ear by using both pure-tone audiometry and CATE. Study sample: Sixteen participants enrolled in the study, of which 14 completed at least one of the hearing tests. Twelve ears, from six participants, were included in the final correlation analysis. Results: Pearson correlation coefficients were significant between CATE and pure-tone audiometry for all frequencies: r2 = 0.52 (p = 0.008) for 500 Hz, r2 = 0.79 (p = 0.0001) for 1000 Hz, r2 = 0.71 (p = 0.0005) for 2000 Hz, and r2 = 0.92 (p < 0.0001) for 4000 Hz. Cortical thresholds were within 10 dB of behavioural thresholds for all four frequencies. Conclusions: Findings are encouraging for the feasibility of CATE as an alternative diagnostic test to pure-tone audiometry for adults living with dementia in aged care. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the hypothesis that hearing aid amplification reduces effort within conversation for both hearing aid wearers and their communication partners. Levels of effort, in the form of speech production modifications, required to maintain successful spoken communication in a range of acoustic environments are compared to earlier reported results measured in unaided conversation conditions. Design: Fifteen young adult normal-hearing participants and 15 older adult hearing-impaired participants were tested in pairs. Each pair consisted of one young normal-hearing participant and one older hearing-impaired participant. Hearing-impaired participants received directional hearing aid amplification, according to their audiogram, via a master hearing aid with gain provided according to the NAL-NL2 fitting formula. Pairs of participants were required to take part in naturalistic conversations through the use of a referential communication task. Each pair took part in five conversations, each of 5-min duration. During each conversation, participants were exposed to one of five different realistic acoustic environments presented through highly open headphones. The ordering of acoustic environments across experimental blocks was pseudorandomized. Resulting recordings of conversational speech were analyzed to determine the magnitude of speech modifications, in terms of vocal level and spectrum, produced by normal-hearing talkers as a function of both acoustic environment and the degree of high-frequency average hearing impairment of their conversation partner. Results: The magnitude of spectral modifications of speech produced by normal-hearing talkers during conversations with aided hearing-impaired interlocutors was smaller than the speech modifications observed during conversations between the same pairs of participants in the absence of hearing aid amplification. Conclusions: The provision of hearing aid amplification reduces the effort required to maintain communication in adverse conditions. This reduction in effort provides benefit to hearing-impaired individuals and also to the conversation partners of hearing-impaired individuals. By considering the impact of amplification on both sides of dyadic conversations, this approach contributes to an increased understanding of the likely impact of hearing impairment on everyday communication. [ABSTRACT FROM AUTHOR]

Purpose: The language processing of Mandarin-accented English (MAE) by older hearing-impaired (OHI), older normally hearing (NH), and younger NH listeners was explored. We examined whether OHI adults have more difficulty than NH listeners in recognizing and adapting to MAE speech productions after receiving brief training with the accent. Method: Talker-independent adaptation was evaluated in an exposure training study design. Listeners were trained either by four MAE talkers or four Australian English talkers (control group) before listening to sentences presented by a novel MAE talker. Speech recognition for both the training sentences and the experimental sentences were compared between listener groups and between the training accents. Results: Listeners in all three groups (OHI, older NH, younger NH) who had been trained by the MAE talkers showed higher odds of speech recognition than listeners trained by the Australian English talkers. The OHI listeners adapted to MAE to the same degree as the NH groups despite returning lower overall odds of recognizing MAE speech. Conclusions: Older listeners with mild-to-moderate hearing loss were able to benefit as much from brief exposure to MAE as did the NH groups. This encouraging result suggests that OHI listeners have access to and can exploit the information present in a relatively brief sample of accented speech and generalize their learning to a novel MAE talker. [ABSTRACT FROM AUTHOR]

Objective: Peripheral hearing, central auditory processing (CAP) and cognition are all important for comprehension of speech and deteriorate with increased age. This study aimed to examine the relation between hearing impairment and cognitive impairment by assessing both peripheral hearing impairment and CAP ability. Design: Cognition was measured using the CogState Brief Battery (CSBB). Peripheral hearing was measured across eight frequencies (250 Hz–8000 Hz) using pure tone audiometry, and CAP was measured using the Listening in Spatialised Noise-Sentences test (LiSN-S) and the Dichotic Digits Test. Data were analysed using correlation and regression analyses. Study sample: Around 85 adults aged 60.33–83.08 years who attended the Melbourne Audiology clinic and had no previous diagnosis of dementia were included in the study. Results: A significant association was found between degree of peripheral hearing impairment and the cognitive skills of attention and executive function as measured by the CSBB. Additionally, CAP abilities as assessed using the LiSN-S test were significantly correlated with at least one cognitive measure. Conclusions: This study adds to the knowledge that peripheral hearing and CAP ability both share an association with cognition, specifically identifying cognitive skills and measures of "hearing" that mediate this relationship. [ABSTRACT FROM AUTHOR]

Objective: Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia., Design: Prospective mixed method service evaluation study., Study Sample: Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis., Results: Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency., Conclusions: A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants.

Context: Rural residents can be exposed to high levels of agricultural machinery noise and are at risk of hearing loss.Aims: This study aimed to determine audiology service use and rates of hearing loss in a regional area of Australia, using both self-report and audiology testing.Setting and Design: A survey of randomly selected households was undertaken and 6432 participants were interviewed face to face about their health, hearing, and use of audiology services. A total of 1454 participants were randomly selected to undertake standard audiology testing.Material and Methods: Material Hearing was evaluated using conventional audiometry.Statistical Analysis Used: Independent t-tests, cChi-squared tests, and logistic regression were used to examine the association amongbetween hearing loss, use of audiology services, and demographic factors.Results: Hearing issues were present in 12.5% of the survey participants. The rate of hearing loss increased significantly with age. Males were significantly more likely to have hearing loss than females (9.5% vs. 5.2%, pP << 0.01). The majority of people who reported accessing audiology services in the past 12 months were satisfied with the care they received (85.2%), and experienced short waiting times for these services (68.2% waited ≤≤ 7 days).Conclusions: Males had higher rates of hearing issues than females in this rural area. Audiology services in the region were accessible within short waiting times, and clients were satisfied with the service. [ABSTRACT FROM AUTHOR]

Background: Associations between oral and aural problems among children have been explored, but not among adults with intellectual disability (ID), where often, oral and ear pain can be difficult to diagnose.Methods: Data included Special Smiles and Healthy Hearing screenings from two Special Olympics (SO) events held in Australia (2013-2014).Results: The SO athletes had poor oral health with a high prevalence (56.8%) of gingival signs and unmet dental needs (66.9%). Over one-third (33.9%) had partially/completely blocked ear canals, over one-fifth (20.7%) had possible middle ear problems, and almost one quarter (23.8%) had some hearing loss. No associations between oral and aural problems were found in the small sample (n = 130) of SO athletes.Conclusions: Although SO athletes have unmet needs for both oral and aural health, access to appropriate hygiene care is an important preventive factor that athletes, families, and carers should be made aware of. Regular oral and aural screenings are recommended to identify problems early, because ability to communicate pain and discomfort can be different for this population. A larger sample of SO athletes with tooth and sextant level data could clarify the association between oral and aural problems in people with ID. [ABSTRACT FROM AUTHOR]

Objective: It is important to detect children with difficulties distinguishing speech-in-noise early. Prompt identification may be assisted by an evoked potential. The aims of the present study were: 1) to evaluate the frequency-following response (FFR) as a measure of binaural processing and spatial listening and, 2) to investigate the relationship between the FFR and a behavioural measure of binaural processing and spatial listening. Design: A single group, repeated measures design. The FFR was recorded in two different spatial conditions and amplitudes compared to spatial listening ability. Study Sample: Thirty-two children (aged 6.0 to 13.1 years) with a range of spatial processing abilities as measured behaviourally using the Listening in Spatialised Noise Sentences test (LiSN-S). Results: FFR waveforms were elicited using speech-like stimuli in co-located and separated conditions. A significant (p≤0.005) spatial advantage effect was observed with larger amplitudes in the separated condition. No correlations were observed between FFR amplitude and LiSN-S results. Conclusions: The FFR shows promise as a measure of binaural processing and spatial listening, but could be measuring different processes to those measured by the LiSN-S. [ABSTRACT FROM AUTHOR]

Background: The types of reading difficulties experienced by children are highly heterogeneous in nature, which makes diagnosis and intervention difficult. Over the past 30 years, there has been much debate over the cause of dyslexia. The two most popular theories for phonological deficits in dyslexia are the rate-processing constraint hypothesis, which relates to short timescale processing, and the temporal sampling framework hypothesis, which relates to longer timescale processing. Purpose: To investigate the relationship between sublexical (i.e., nonword) reading skills and auditory spectral and temporal resolution patterns in children with reading difficulties using the Phoneme Identification Test (PIT) and the Parsing Syllable Envelopes Test (ParSE). These tests were developed to assess the rate-processing constraint and the temporal sampling framework hypotheses, respectively. We hypothesized that a proportion of children who have sublexical reading difficulties may have an underlying auditory-resolution deficit which may impact their ability to form letter-sound correspondences. We predicted that children's sublexical reading difficulties may not be explained by one theory, but instead that both theories may describe different types of reading difficulties found in different children. We also hypothesized that children with lexical (i.e., irregular word) reading difficulties but intact sublexical reading skills would not show atypical results on PIT or ParSE. Research Design: Behavioral experimental clinical study with children who have reading difficulties. Study Sample: Sixteen children with nonword, irregular word, or mixed reading difficulties diagnosed by the Castles and Coltheart Test 2. Data Collection and Analysis: Children completed a test battery consisting of a hearing screen and tests of reading, auditory resolution, phonological awareness, attention, spatial auditory processing, auditory memory, and intelligence. Categorization and correlational analyses were conducted. Results: All four children with a pure sublexical reading deficit also had an auditory-resolution deficit. Four of seven children with a mixed reading deficit had an auditory-resolution deficit. Only one of five children with a lexical reading deficit had an auditory-resolution deficit. Individual children's specific deficits were related to either rate processing (n = 5) or temporal sampling (n = 4), but never both. Children's nonword reading scores were strongly correlated with their performance on the PIT in noise, but not with the PIT in quiet or the ParSE. Children's irregular word scores were not significantly correlated with their performance on the PIT in quiet or in noise, or the ParSE, as hypothesized. Strong correlations were also found between children's nonword scores and their phonological awareness scores. Conclusions: The results of this study suggest that neither the rate-processing hypothesis nor the temporal sampling framework is the single cause of reading difficulties in children. Instead, both of these hypotheses are likely to account for different types of reading deficits found in children. This is an important finding as the specific mechanisms driving different reading impairments must be identified to create tools to better diagnose and treat different types of reading difficulties. Further investigation of the PIT and ParSE as potential diagnostic tools for specific auditory-resolution-based reading difficulties in a larger group of children is currently underway. [ABSTRACT FROM AUTHOR]

Objective: This study has two interconnected aims. The first was to better understand how audiology students co-construct hearing assessments with patients while supervised by a clinical educator. The second was to investigate how students' communication aligns with principles of patient-centred communication. Study Sample: Twenty-three final year audiology students from two Australian universities participated in the study. Results: The supervised student-patient hearing appointments were video-recorded and transcribed. Genre analysis, a form of discourse analysis, was carried out to identify the structure and communication patterns. The six-function model of medical communication was adopted as an analytical framework to map students' patient-centred communication. The findings showed generic structure of the hearing assessments were the main stages of taking a history, providing a diagnosis, and initiating management plans. For patient-centred communication functions, students demonstrated their ability to foster the relationship and gather information. The communication functions of decision-making, enablement, and responding to patients' emotions were rarely observed. A significant relationship was found between clinical educators' interjection as a function of students' patient-centred communication tendencies. Conclusion: To enhance students' patient-centred communication, teaching should include explaining and planning as well as addressing additional aspects of patient-centred communication. Support of clinical educators is needed to optimise students' communication skills learning. [ABSTRACT FROM AUTHOR]

To explore the factors influencing parents’ choice of communication mode during early education of their child with hearing loss. Qualitative descriptive analysis of semi-structured interviews with parents of children with hearing loss. Fourteen parents of children who participated in the Longitudinal Outcomes of Children with Hearing Impairment study. Four themes emerged from thematic analysis of the interview data: (1) parents draw on a variety of experiences and information to make decisions; (2) parents’ preferred outcomes for their children drive their choices; (3) child’s preference and proficiency drive parental choice; and (4) parents’ fears and worries influence decisions. The results reinforced the importance of parents receiving unbiased, descriptive information as well as evaluative information from professionals, so that they could consider all options in making a decision that met their needs. Parents also require continual support for implementation of their choices as they adjust to their children’s changing communication needs. Parent decisions around communication mode are rarely made in isolation, but occur within a larger decision-making matrix that include device choices, early intervention agency choices, and ‘future-proofing’ the child’s ongoing communication needs. [ABSTRACT FROM AUTHOR]

Objective: In a national study of Australian children aged 11-12 years old, we examined the (1) prevalence and characteristics of hearing loss, (2) its demographic risk factors and (3) evidence for secular increases since 1990.Methods: This is a cross-sectional CheckPoint wave within the Longitudinal Study of Australian Children. 1485 children (49.8% retention; 49.7% boys) underwent air-conduction audiometry. Aim 1: hearing loss (≥16 decibels hearing level (dB HL)) was defined in four ways to enable prior/future comparisons: high Fletcher Index (mean of 1, 2 and 4 kHz; primary outcome relevant to speech perception), four-frequency (1, 2, 4 and 8 kHz), lower frequency (1 and 2 kHz) and higher frequency (4 and 8 kHz); aim 2: logistic regression of hearing loss by age, gender and disadvantage index; and aim 3: P for trend examining CheckPoint and reported prevalence in studies arranged by date since 1990.Results: For high Fletcher Index, the prevalence of bilateral and unilateral hearing loss ≥16 dB HL was 9.3% and 13.3%, respectively. Slight losses (16-25 dB HL) were more prevalent than mild or greater (≥26 dB HL) losses (bilateral 8.5% vs 0.8%; unilateral 12.5% vs 0.9%), and lower frequency more prevalent than higher frequency losses (bilateral 11.0% vs 6.9%; unilateral 15.4% vs 11.5%). Demographic characteristics did not convincingly predict hearing loss. Prevalence of bilateral/unilateral lower and higher frequency losses ≥16 dB HL has risen since 1990 (all P for trend <0.001).Conclusions and Relevance: Childhood hearing loss is prevalent and has risen since 1990. Future research should investigate the causes, course and impact of these changes. [ABSTRACT FROM AUTHOR]

Objective: This study investigated clinical care delivered to musicians in Australia by audiologists and manufacturers of musicians’ hearing protectors (MHP).Design: Audiologists with experience treating musicians were invited to complete a survey on their service delivery. A second survey was administered to manufacturers of MHPs.Study sample: Four manufacturers of MHP and 31 audiologists completed the surveys. Post hoc analyses were performed comparing the responses of audiologists with more versus less clinical experience; and those with and without musical training.Results: There was considerable variation in the audiological care provided to musicians. Only one-third of audiologists performed pure-tone audiometry prior to MHP fitting, and there was little consistency across the sample in relation to impression taking, preferred attenuation or selection of canal length. There was also significant variation in the manufacturers’ approach to MHP, each of whom provided different recommendations regarding preferred impression techniques and material viscosity.Conclusions: The results of this study reveal lack of consistency across the hearing healthcare sector with respect to care of musicians’ hearing, with potential to impact upon the satisfaction with, and usage of, MHP. There is need for evidence-based, best practice guidelines and training to support clinical audiologists in providing optimal care. [ABSTRACT FROM AUTHOR]

Background Universal newborn hearing screening (UNHS) targets moderate or greater hearing loss. However, UNHS also frequently detects children with mild loss that results in many receiving early treatment. The benefits of this approach are not yet established. We aimed to (i) compare language and psychosocial outcomes between four hearing loss detection systems for children aged 5-8 years with congenital mild-moderate hearing loss; (ii) determine whether age of detection predicts outcomes; and (iii) compare outcomes between children identified via well-established UNHS and the general population. Methods Linear regression adjusted for potential confounding factors was used throughout. Via a quasi-experimental design, language and psychosocial outcomes were compared across four population-based Australian systems of hearing loss detection: opportunistic detection, born 1991-1993, n = 50; universal risk factor referral, born 2003-2005, n = 34; newly established UNHS, born 2003-2005, n = 41; and well-established UNHS, born 2007-2010, n = 21. In pooled analyses, we examined whether age of detection predicted outcomes. Outcomes were similarly compared between the current well-established UNHS system and typically developing children in the Early Language in Victoria Study, born 2003, n = 1217. Results Age at diagnosis and hearing aid fitting fell steadily across the four systems. For moderate losses, mean expressive language ( P for trend .05) and receptive vocabulary ( P for trend .06) improved across the four systems, but benefit was not obvious for mild losses. In pooled analyses, diagnosis before age six months predicted better language outcomes for moderate losses. Children with mild-moderate losses exposed to well-established UNHS continue to experience expressive language scores well below children in the general population (adjusted mean difference −8.9 points, 95% CI −14.7 to −3.1). Conclusions Treatment arising from UNHS appears to be clearly benefitting children with moderate hearing losses. However, rigorous trials are needed to quantify benefits, versus costs and potential harms, of early aiding of children with mild losses. [ABSTRACT FROM AUTHOR]

Nursing students typically do not undertake clinical training in school settings. However, they are well placed to have a role in providing health screening and education in schools or community health venues under supervision of qualified nurses. This study provides a description and outcomes of a vision and hearing screening programme delivered by university nursing students working out of a student-led clinic situated in an underserved, largely Aboriginal and Torres Strait Islander community in regional Australia. Screening and follow-up data collected from 741 elementary school children indicated some important population patterns and trends, with nearly 30% having identified problems. Anecdotal evidence suggested children who gained treatment had improved school performance. Challenges to follow-up and confounding variables are discussed and a suggestion for future research is offered. [ABSTRACT FROM PUBLISHER]

Purpose: High-quality orofacial somatosensory inputs are essential for achieving rapid and accurate motor outputs. Little somatosensory testing is currently being completed in clinical settings. The purpose of this study is to assess the feasibility and test–retest reliability of clinical assessment tools for orofacial somatosensory testing in healthy young adults. Method: A total of 45 healthy young adults (ages 20– 41 years) was recruited. Participants reported basic health information, completed pure-tone hearing thresholds, and were assessed using two-point discrimination discs and Von Frey hair detection and discrimination thresholds for bilateral lip and tongue. A subsample of participants (n = 18; 40%) returned to complete reliability testing. Results: Descriptive results are presented for the normative group as well as the reliability group. Difference scores between Tests 1 and 2 for each testing measure and location show high agreement. Conclusion: Two-point discrimination and Von Frey hair monofilament assessment for both detection- and discrimination-threshold estimates have high test–retest reliability in a healthy young population. These testing measures could be a way to easily complete objective somatosensory testing of the orofacial region in a clinical context. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe the auditory phenotype of a large cohort with Smith-Magenis syndrome (SMS), a rare disorder including physical anomalies, cognitive deficits, sleep disturbances, and a distinct behavioral phenotype. Method: Hearing-related data were collected for 133 individuals with SMS aged 1-49 years. Audiogram data (97 participants) were used for cross-sectional and longitudinal analyses. Caregivers completed a sound sensitivity survey for 98 individuals with SMS and a control group of 24 unaffected siblings. Results: Nearly 80% of participants with interpretable audiograms (n = 76) had hearing loss, which was typically slight to mild in degree. When hearing loss type could be determined (40 participants), sensorineural hearing loss (48.1%) occurred most often in participants aged 11-49 years. Conductive hearing loss (35.2%) was typically observed in children aged 1-10 years. A pattern of fluctuating and progressive hearing decline was documented. Hyperacusis was reported in 73.5% of participants with SMS compared with 12.5% of unaffected siblings. Conclusions: This study offers the most comprehensive characterization of the auditory phenotype of SMS to date. The auditory profile in SMS is multifaceted and can include a previously unreported manifestation of hyperacusis. Routine audiologic surveillance is recommended as part of standard clinical care. [ABSTRACT FROM AUTHOR]

Objective: To develop, in Australian English, the first mixed-gender, multi-talker matrix sentence test. Design: Speech material consisted of a 50-word base matrix whose elements can be combined to form sentences of identical syntax but unpredictable content. Ten voices (five female and five male) were recorded for editing and preliminary level equalization. Elements were presented as single-talker sentences-innoise during two perceptual tests: an optimization phase that provided the basis for further level correction, and an evaluation phase that perceptually validated those changes. Study sample: Ten listeners participated in the optimization phase; these and an additional 32 naïve listeners completed the evaluation test. All were fluent in English and all but one had lived in Australia for42 years. Results: Optimization reduced the standard deviation (SD) and speech reception threshold (SRT) range across all speech material (grand mean SRT=-10.6 dB signal-to-noise ratio, median=-10.8, SD =1.4, range =13.7, slope =19.3%/dB), yielding data consistent with cross-validated matrix tests in other languages. Intelligibility differences between experienced and naïve listeners were minimal. Conclusions: The Australian matrix corpus provides a robust set of test materials suitable for both clinical assessment and research into the dynamics of active listening in multi-talker environments. [ABSTRACT FROM AUTHOR]

Background: The Dichotic Digits difference Test (DDdT) was developed to investigate the relationship between dichotic processing and cognitive abilities and, through the use of differential test scores, to provide professionals with a clinical tool that could aid in differentiation of clients with genuine dichotic deficits from those where cognitive disorders affect test performance. The DDdT consists of four subtests: dichotic free recall (FR), dichotic directed left ear, dichotic directed right ear, and diotic. Scores are calculated for six conditions: FR left ear (LE), right ear (RE), and total, as well as the directed left ear, directed right ear, and diotic, and four difference measures: dichotic advantage, RE advantage FR, RE advantage directed, and attention advantage. Purpose: To investigate the role of cognitive abilities on DDdT test performance. Research Design: Correlational analysis between the various DDdT conditions and difference measures, as well as between dichotic, diotic, and cognitive factors (memory, intelligence, and attention). Study Sample: Fifty typically developing children (aged 7 yr 0 mo to 12yr 1 mo, mean = 9yr2mo) and ten children recruited from the Australian Flearing CAPD Service who were diagnosed with a memory or dichotic deficit (aged 7 yr 0 mo to 15 yr 0 mo, mean = 9 yr 5 mo) took part in the study. Data Collection and Analysis: The Pearson product moment correlations were used to determine the strength of relationships between DDdT conditions as well as relationships between scores on these conditions and performance on the various cognitive assessment tools, which included the number memory forward and reversed subtests of the Test of Auditory Processing Skills-Third Edition, IVA + Plus Continuous Performance Test, and the Test of Non-Verbal Intelligence-4 (TONI-4). A parent questionnaire (Fisher's Auditory Checklist) and a participant questionnaire (Listening Inventory for Education) were also administered. Results: Diotic performance was significantly correlated with performance on all the DDdT dichotic FR conditions (r = 0.6-0.8; p < 0.00001). Further, significant correlations were found between the FR LE, total, and diotic conditions, and the cognitive measures of attention and memory, with r ranging from 0.4 to 0.5 (p < 0.01-0.001). Right-ear performance was not significantly correlated to any cognitive measure, except for FR RE and number memory forward (r = 0.35; p = 0.006). The DDdT dichotic advantage measure was investigated in a subset of clinical children and found to aid in differentiating true dichotic from spurious results. Conclusions: As found in the DDdT normative data study that precedes in the companion paper (DDdT Study Part 1; Cameron et al, 2016), the high correlation between dichotic and diotic performances by the clinical and typically developing participants suggests that factors other than dichotic performance play a substantial role in a child's ability to perform a dichotic listening task. Indeed, 61% of the variance in FR total scores for the children in this study was accounted for by factors that do not involve the perception of dichotic stimuli. This view is supported by the correlations between measures of attention and memory and dichotic scores. This result has wide-spread implications in respect to interpretation of central auditory processing disorder test results and further investigation of the use of the DDdT in a clinical population is warranted. [ABSTRACT FROM AUTHOR]

Background: The dichotic digits test is one of the most widely used assessment tools for central auditory processing disorder. However, questions remain concerning the impact of cognitive factors on test results. Purpose: To develop the Dichotic Digits difference Test (DDdT), an assessment tool that could differentiate children with cognitive deficits from children with genuine dichotic deficits based on differential test results. The DDdT consists of four subtests: dichotic free recall (FR), dichotic directed left ear (DLE), dichotic directed right ear (DRE), and diotic. Scores for six conditions are calculated (FR left ear [LE], FR right ear [RE], and FR total, as well as DLE, DRE, and diotic). Scores for four difference measures are also calculated: dichotic advantage, right-ear advantage (REA) FR, REA directed, and attention advantage. Research Design: Experiment 1 involved development of the DDdT, including error rate analysis. Experiment 2 involved collection of normative and test-retest reliability data. Study Sample: Twenty adults (aged 25 yr 10 mo to 50 yr 7 mo, mean 36 yr 4 mo) took part in the development study; 62 normal-hearing, typically developing, primary-school children (aged 7 yr 1 mo to 11 yr 11 mo, mean 9 yr 4 mo) and 10 adults (aged 25 yr 0 mo to 51 yr 6 mo, mean 34 yr 10 mo) took part in the normative and test-retest reliability study. Data Collection and Analysis: In Experiment 1, error rate analysis was conducted on the 36 digit-pair combinations of the DDdT. Normative data collected in Experiment 2 were arcsine transformed to achieve a distribution that was closer to a normal distribution and z-scores calculated. Pearson product-moment correlations were used to determine the strength of relationships between DDdT conditions. Results: The development study revealed no significant differences in the adult population between test and retestonany DDdT condition. Error rates on 36 digit pairs ranged from 1.5% to 16.7%. The most and the least error-prone digits were removed before commencement of the normative data study, leaving 25 unique digit pairs. Average z-scores calculated from the arcsine-transformed data collected from the 62 children who took part in the normative data study revealed that FR dichotic processing (LE, RE, and total) was highly correlated with diotic processing (/"ranging from 0.5 to 0.6; p < 0.0001). Significant improvements in performance on retest occurred for the FR LE, RE, total, and diotic conditions (p ranging from 0.05 to 0.0004), the conditions that would be expected to improve with practice if the participant's response strategies are better the second time around. Conclusions: The addition of a diotic control task--that shares many response demands with the usual dichotic tasks--opens up the possibility of differentiating children who perform below expectations because of poor dichotic processing skills from those who perform poorly because of impaired attention, memory, or other cognitive abilities. The high correlation between dichotic and diotic performance suggests that factors other than dichotic performance play a substantial role in a child's ability to perform a dichotic listening task. This hypothesis is investigated further in the cognitive correlation study that follows in the companion paper (DDdT Study Part 2; Cameron et al, 2016). [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to estimate the expected years lived with hearing impairment, vision impairment, and dual sensory impairment among older adults.Methods: A total of 4,160 adults (45.1% men) from two Australian community based studies were followed for up to 16 years (average 8.9 years). Hearing impairment was defined by a pure-tone average (500-4000 Hz) greater than 25 dB in the better ear. Vision impairment was defined by presenting distance visual acuity worse than 6/12 (20/40). Postliminary analyses were also conducted for moderate levels of sensory impairment. Dual sensory impairment was defined by concurrent hearing and vision impairment. Multistate Markov models were used to calculate sensory life expectancies based on transition probabilities between health states (no sensory impairment, sensory impairment, and death).Results: Based on thresholds for mild impairment, men aged 65 had a total life expectancy of 19.4 years, and were estimated to live for 10.4 years (95% confidence interval [CI]: 9.1, 11.7) with hearing impairment, 2.8 years (95% CI: 2.4, 3.2) with vision impairment, and 2.2 years (95% CI: 1.8, 2.6) with dual sensory impairment. Women aged 65 had a total life expectancy of 23.2 years, and were estimated to live for 12.9 years (95% CI: 11.9, 13.9) with hearing impairment, 3.9 years (95% CI: 3.4, 4.4) with vision impairment, and 3.2 years (95% CI: 2.7, 3.7) with dual sensory impairment.Conclusions: In addition to being highly prevalent, hearing and vision impairment affect older adults for substantial periods of their remaining life. Given their broad ranging impacts on health and well-being, sensory impairments are ideal targets for strategies to compress morbidity in late life. [ABSTRACT FROM AUTHOR]

Aim: To characterise usage and monitoring of intravenous tobramycin in cystic fibrosis ( CF) patients in Australia and the UK. Methods: An anonymous, online survey of healthcare professionals caring for CF patients was conducted. Survey questions were designed to obtain information on tobramycin dosing, therapeutic drug monitoring and toxicity monitoring. Results: The survey was sent to pharmacists and clinicians in 73 CF centres. Responses were received from 32 and 40 healthcare professionals, from Australia and the UK, respectively. Once-daily dosing of tobramycin was the preferred administration regimen for 93.8 and 67.5% of participants in Australia and the UK, respectively. Among them 68.8% of Australian and 55% of UK participants initiated tobramycin therapy at a dose of 10 mg/kg/day or greater. Australian participants most commonly adjusted tobramycin dosage using log-linear regression analysis (40.6%) or trough measurements (28.1%). UK participants most commonly adjusted tobramycin dosage using trough (55%) or peak and trough measurements (37.5%). In 90.6% of Australian and 95% of UK participants practices, serum creatinine was routinely monitored during admission. Standard pure tone audiometry was performed by 15.6% of Australian and 17.5% of UK participants and high-frequency pure tone audiometry was performed by 15.6% of Australian and 10% of UK participants, once or twice a year. Conclusions: Many discrepancies exist between Australia and the UK and within each country with respect to monitoring of intravenous tobramycin in CF patients. Greater ototoxicity monitoring is likely necessary in both countries. Further education of health professionals about the existence of national guidelines and guidance on how they can be applied in practice is likely required. [ABSTRACT FROM AUTHOR]

Objective: This article describes the background and the design of the longitudinal outcomes of children with hearing impairment (LOCHI) study, and the characteristics of the study cohort. Design: Children born between 2002 and 2007 who were identified with hearing loss and received audiological intervention by 3 years of age in Australia enrolled in the study. Their demographic characteristics are described. Study sample: Four hundred and fifty-one children in New South Wales, Victoria, and Southern Queensland. Results: Data on age at first hearing-aid fitting for different degrees of hearing loss are reported together with demographic characteristics of the cohort. Conclusion: A unique environment in Australia where all children with varied access to universal newborn hearing screening received the same consistent hearing services from a national hearing service provider makes it possible to investigate the effects of access to early auditory intervention on children's outcomes at a population level. [ABSTRACT FROM AUTHOR]

Among orchestral musicians, horn players are one of the most at-risk groups for noise-induced hearing loss (NIHL). To investigate this group further, pure tone audiometry and a 14-item questionnaire were used to assess the hearing health, as well as attitudes and practices regarding hearing conservation, among 142 French horn players attending an international horn conference in Brisbane, Australia. Of this study's French horn players, 11.1% to 22.2%, and 17.7% to 32.9% of those aged ≤40 years, showed some form of hearing loss (corrected for age and gender) typical of NIHL, using conservative versus lenient criteria, respectively. Stepwise multiple regression analyses showed no obvious predictor of hearing loss in this study's participants. Of the 18% of participants who reported using hearing protection, 81% used this protection “sometimes” and 50% used generic, foam, or other inferior forms of protection. Continued efforts to better manage the hearing health of horn players is warranted particularly as any hearing loss will affect a horn player's ability to perform and therefore his or her livelihood. Managing the hearing health of horn players will be challenging, however, with no simple predictor of NIHL loss being identified in this study's sample. [ABSTRACT FROM AUTHOR]

Objectives: We sought to assess the postoperative hearing gains at individual frequencies after stapes surgery with piston reconstruction for clinical otosclerosis. Methods: We analyzed the air conduction (AC) hearing gains at various audiometric frequencies in a sample of 1,168 stapes procedures with piston reconstruction performed on 911 strictly consecutive patients by one surgeon between 1963 and 1979. Assiduous follow-up of patients was attempted for at least 10 years. The audiometric results over time were stored for computer analysis. Results: The mean AC gain over the speech frequencies (0.5,1,2, and 3 kHz) was 35.5 dB at 1 year after operation, and the rate of deterioration over the next 19 years was 0.58 dB/y. Conclusions: The picture to emerge from the analysis is clear. The mean AC gain is maximal at nearly 40 dB for the audiometric frequencies of 0.25,0.5, and 1 kHz. The mean AC gain at any given time after operation decreases with increasing frequency, at least for frequencies of ≥1 kHz. For any frequency there is, with few exceptions, a significant decrease in the AC gain from one time period to the next. [ABSTRACT FROM AUTHOR]