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Background: As part of their professional responsibilities, speech-language therapists and audiologists are required to deliver bad news. Aims: The aim of this qualitative study is to describe and characterize the subjective experience of speech-language therapists and audiologists when delivering bad news to clients or their family members. Methods & Procedures: A group of 156 speech-language therapists and audiologists replied in writing to an open question asking them to describe a clinical encounter in which they delivered bad news. The texts that were generated in response to this question served as a data base. Qualitative content analysis was used to analyse data and generate themes. Outcomes & Results: Thematic analysis of participants' texts revealed the challenges inherent to the delivery of bad news. Four main themes emerged from text analysis: difficulty in phrasing the news; the deliverer's emotional experience; the receiver's reaction; and being alone or in companion with another healthcare provider during the delivery of the bad news. Conclusions & Implications: Speech-language therapists and audiologists experience difficulties similar to those experienced by other healthcare professionals when delivering bad news. Nevertheless, speech-language therapists and audiologists seem to perceive the delivery of bad news situation in a broader sense than the conventional definition given to this term in the medical arena.

Purpose: We aimed to develop and validate the Musicians' Hearing Handicap Index (MHHI), a new self-evaluation tool for quantifying occupation-related auditory difficulties in music professionals. Although pure-tone audiometry is often considered the "gold standard" and is usually employed as the main instrument for hearing assessment, it cannot fully describe the impact of hearing dysfunction. The MHHI is an attempt to complement the hearing impairment assessment toolbox and is based on a unique approach to quantify the effects of hearing-related symptoms or hearing loss on the performance of musicians and other music industry professionals. Method: An initial set of 143 questionnaire items was successively refined through a series of critical appraisals, modifications, and suggestions. This yielded an intermediate questionnaire consisting of 43 items, which was administered to 204 musicians and sound engineers. After exploratory factor analysis, the final form of the MHHI questionnaire was obtained, consisting of 29 items. The questionnaire's test-retest reliability, internal consistency, discriminating power, content validity, criterion validity, and aspects of construct validity and inherent conceptual structure were assessed. Results: Exploratory factor analysis revealed a combination of four common factors for the 29 validated questionnaire items. They were named "impact on social and working lives," "difficulties in performance and sound perception," "communication difficulties," and "emotional distress." The MHHI was shown to be a valid and reliable instrument to assess musicians' and sound engineers' occupational difficulties due to hearing impairment and related symptoms. Conclusion: The ability of the MHHI to discriminate between groups of music professionals with different auditory symptoms or pure-tone audiometry thresholds suggests that auditory symptoms might influence a professional's performance to an extent that cannot be assessed by a pure-tone audiogram.

Purpose: The aim of the study was to investigate the achieved audibility with clinically available, modern, high-end, behind-the-ear hearing aids fitted using the Desired Sensation Level v5.0 child prescription for a clinical sample of children with hearing impairment and the effect of the extended bandwidth provided by the hearing aids on several outcome measures. Method: The achieved audibility was measured using the maximum audible output frequency method. Twenty-eight children (7-17 years old) with mild to severe hearing losses completed this study. Two hearing aid conditions were fitted for each participant: an extended bandwidth condition, which was fitted to targets as closely as possible, and a restricted bandwidth condition, for which aided output was restricted above 4.5 kHz. Consonant discrimination in noise, subjective preference, aided loudness growth, and preferred listening levels were evaluated in both conditions. Results: The extended bandwidth hearing aid fittings provided speech audibility above 4.5 kHz for all children, with an average maximum audible output frequency of 7376 Hz (SD = 1669 Hz). When compared to a restricted bandwidth, the extended bandwidth condition led to an improvement of 5.4% for consonant discrimination in noise scores, mostly attributable to /s/, /z/, and /t/ phoneme perception. Aided loudness results and preferred listening levels were not significantly different across bandwidth conditions; however, 65% of the children indicated a subjective preference for the extended bandwidth. Conclusion: The study suggests that providing the full bandwidth available, with modern, behind-the-ear hearing aids, leads to improved audibility, when compared to restricted bandwidth hearing aids, and that it leads to beneficial outcomes for children who use hearing aids, fitted to the Desired Sensation Level v5.0 child prescription, without causing significant increases in their loudness perception.

Purpose: The goal of this study was to examine the effects of cognitive and linguistic skills on masked speech recognition for children with normal hearing in three different masking conditions: (a) speech-shaped noise (SSN), (b) amplitude-modulated SSN (AMSSN), and (c) two-talker speech (TTS). We hypothesized that children with better working memory and language skills would have better masked speech recognition than peers with poorer skills in these areas. Selective attention was predicted to affect performance in the TTS masker due to increased cognitive demands from informational masking. Method: A group of 60 children in two age groups (5- to 6-year-olds and 9- to 10-year-olds) with normal hearing completed sentence recognition in SSN, AMSSN, and TTS masker conditions. Speech recognition thresholds for 50% correct were measured. Children also completed standardized measures of language, memory, and executive function. Results: Children's speech recognition was poorer in the TTS relative to the SSN and AMSSN maskers. Older children had lower speech recognition thresholds than younger children for all masker conditions. Greater language abilities were associated with better sentence recognition for the younger children in all masker conditions, but there was no effect of language for older children. Better working memory and selective attention skills were associated with better masked sentence recognition for both age groups, but only in the TTS masker condition. Conclusions: The decreasing influence of vocabulary on masked speech recognition for older children supports the idea that this relationship depends on an interaction between the language level of the stimuli and the listener's vocabulary. Increased cognitive demands associated with perceptually isolating the target talker and two competing masker talkers with a TTS masker may result in the recruitment of working memory and selective attention skills, effects that were not observed in SSN or AMSSN maskers. Future research should evaluate these effects across a broader range of stimuli or with children who have hearing loss.

The goal of this study was to explore the evidence-based practice (EBP) pattern among speech-language pathologists (SLPs) and audiologists in Saudi Arabia. A total of 48 clinicians working in Saudi Arabia completed a questionnaire that investigated patterns, attitudes, skills, and time and resources at the workplace related to EBP. The results showed that SLPs and audiologists held favorable attitudes toward EBP, and the use of research studies to guide clinical decision making was increased among the participants with previous EBP training. Also, the study found that skills and knowledge related to EBP need to be enhanced, but they were not major barriers to EBP implementation. Limited resources appeared to impose some hindrances, whereas insufficient time at the workplace was found to be a major challenge for EBP implementation. Overall, the findings from this study highlight the importance of increasing the continuing education and professional time for EBP activities in the workplace.

Purpose: The purpose was to examine and determine effect size distributions reported in published audiology and speech-language pathology research in order to provide researchers and clinicians with more relevant guidelines for the interpretation of potentially clinically meaningful findings. Method: Cohen's d, Hedges' g, Pearson r, and sample sizes (n = 1,387) were extracted from 32 meta-analyses in journals in speech-language pathology and audiology. Percentile ranks (25th, 50th, 75th) were calculated to determine estimates for small, medium, and large effect sizes, respectively. The median sample size was also used to explore statistical power for small, medium, and large effect sizes. Results: For individual differences research, effect sizes of Pearson r = 0.24, 0.41, and 0.64 were found. For group differences, Cohen's d/Hedges' g = 0.25, 0.55, and 0.93. These values can be interpreted as small, medium, and large effect sizes in speech-language pathology and audiology. The majority of published research was inadequately powered to detect a medium effect size. Conclusions: Effect size interpretations from published research in audiology and speech-language pathology were found to be underestimated based on Cohen's (1988, 1992) guidelines. Researchers in the field should consider using Pearson r = 0.25, 0.40, and 0.65 and Cohen's d/Hedges' g = 0.25, 0.55, and 0.95 as small, medium, and large effect sizes, respectively, and collect larger sample sizes to ensure that both significant and nonsignificant findings are robust and replicable.

Purpose: School-aged children with hearing loss are best served by a multidisciplinary team of professionals. The purpose of this research was to assess school-based speech-language pathologists' (SLPs) perceptions of their access to, involvement of, and working relationships with educational audiologists in their current work setting. Method: An online survey was developed and distributed to school-based SLPs in North Carolina. Results: A significant difference in access to and involvement of educational audiologists across the state was found. Conclusions: This research contributes to professional knowledge by providing information about current perceptions in the field about interprofessional practice in a school-based setting. Overall, SLPs reported positive feelings about their working relationship with educational audiologists and feel the workload is distributed fairly.

Purpose: In a previous paper (Souza, Wright, Blackburn, Tatman, & Gallun, 2015), we explored the extent to which individuals with sensorineural hearing loss used different cues for speech identification when multiple cues were available. Specifically, some listeners placed the greatest weight on spectral cues (spectral shape and/or formant transition), whereas others relied on the temporal envelope. In the current study, we aimed to determine whether listeners who relied on temporal envelope did so because they were unable to discriminate the formant information at a level sufficient to use it for identification and the extent to which a brief discrimination test could predict cue weighting patterns. Method: Participants were 30 older adults with bilateral sensorineural hearing loss. The first task was to label synthetic speech tokens based on the combined percept of temporal envelope rise time and formant transitions. An individual profile was derived from linear discriminant analysis of the identification responses. The second task was to discriminate differences in either temporal envelope rise time or formant transitions. The third task was to discriminate spectrotemporal modulation in a nonspeech stimulus. Results: All listeners were able to discriminate temporal envelope rise time at levels sufficient for the identification task. There was wide variability in the ability to discriminate formant transitions, and that ability predicted approximately one third of the variance in the identification task. There was no relationship between performance in the identification task and either amount of hearing loss or ability to discriminate nonspeech spectrotemporal modulation. Conclusions: The data suggest that listeners who rely to a greater extent on temporal cues lack the ability to discriminate fine-grained spectral information. The fact that the amount of hearing loss was not associated with the cue profile underscores the need to characterize individual abilities in a more nuanced way than can be captured by the pure-tone audiogram.

Purpose: Alterations in primary auditory functioning have been reported in patients with Parkinson's disease (PD). Despite the current findings, the pathophysiological mechanisms underlying these alterations remain unclear, and the effect of dopaminergic medication on auditory functioning in PD has been explored insufficiently. Therefore, this study aimed to systematically investigate primary auditory functioning in patients with PD by using both subjective and objective audiological measurements. Method: In this case-control study, 25 patients with PD and 25 age-, gender-, and education-matched healthy controls underwent an audiological test battery consisting of tonal audiometry, short increment sensitivity index, otoacoustic emissions (OAEs), and speech audiometry. Patients with PD were tested in the on- and off-medication states. Results: Increased OAE amplitudes were found when patients with PD were tested without dopaminergic medication. In addition, speech audiometry in silence and multitalker babble noise demonstrated higher phoneme scores for patients with PD in the off-medication condition. The results showed no differences in auditory functioning between patients with PD in the on-medication condition and healthy controls. No effect of disease stage or motor score was evident. Conclusions: This study provides evidence for a top-down involvement in auditory processing in PD at both central and peripheral levels. Most important, the increase in OAE amplitude in the off-medication condition in PD is hypothesized to be linked to a dysfunction of the olivocochlear efferent system, which is known to have an inhibitory effect on outer hair cell functioning. Future studies may clarify whether OAEs may facilitate an early diagnosis of PD.

Purpose: Null hypothesis significance testing is commonly used in audiology research to determine the presence of an effect. Knowledge of study outcomes, including nonsignificant findings, is important for evidence-based practice. Nonsignificant "p" values obtained from null hypothesis significance testing cannot differentiate between true null effects or underpowered studies. Bayes factors (BFs) are a statistical technique that can distinguish between conclusive and inconclusive nonsignificant results, and quantify the strength of evidence in favor of 1 hypothesis over another. This study aimed to investigate the prevalence of BFs in nonsignificant results in audiology research and the strength of evidence in favor of the null hypothesis in these results. Method: Nonsignificant results mentioned in abstracts of articles published in 2018 volumes of 4 prominent audiology journals were extracted (N = 108) and categorized based on whether BFs were calculated. BFs were calculated from nonsignificant "t" tests within this sample to determine how frequently the null hypothesis was strongly supported. Results: Nonsignificant results were not directly tested with BFs in any study. Bayesian re-analysis of 93 nonsignificant "t" tests found that only 40.86% of findings provided moderate evidence in favor of the null hypothesis, and none provided strong evidence. Conclusion: BFs are underutilized in audiology research, and a large proportion of null findings were deemed inconclusive when re-analyzed with BFs. Researchers are encouraged to use BFs to test the validity and strength of evidence of nonsignificant results and ensure that sufficient sample sizes are used so that conclusive findings (significant or not) are observed more frequently.

Purpose: Evidence-based data analysis methods are important in clinical research fields, including speech-language pathology and audiology. Although commonly used, null hypothesis significance testing (NHST) has several limitations with regard to the conclusions that can be drawn from results, particularly nonsignificant findings. Bayes factors (BFs) can be used to complement NHST and quantify the strength of evidence in favor of 1 hypothesis over another, given the data: commonly, either the alternate hypothesis over the null or the null hypothesis over the alternate. This article provides an introduction to BFs through JASP, a free, open-source, graphics-based statistics package that allows researchers to easily conduct both NHST and Bayesian analyses in a clear and reproducible manner. Method and Results: Both traditional NHST analyses and Bayesian equivalents for correlations, "t" tests, and analyses of variance were conducted in JASP using simulated data, with explanations of analysis options, statistical output, and figures provided. These examples also demonstrate what NHST and BFs can and cannot infer about a data set. Additionally, BFs were calculated from the summary statistics of published nonsignificant results to illustrate how JASP may be useful to consumers of research who only have access to statistics provided in a published study. Conclusions: Bayesian analyses are underutilized in speech, language, and hearing research. By complementing traditional NHST analyses with BFs, researchers can directly test for and quantify the strength of evidence during hypothesis testing, thereby drawing stronger conclusions from their research and providing more relevant information for clinicians and researchers in the field.

This critical review addresses the implications of the Curriculum and Assessment Plan Statement (CAPS) for collaboration between teachers and speech-language therapists (SLTs) in schools. A historical perspective on changes in the roles and responsibilities of SLTs is provided, reflecting a shift from supporting the child to supporting the teacher. Based on the role of SLTs and audiologists in schools, an innovative approach to the support of teachers is conceptualized. The curriculum content and methods support learners who experience challenges and barriers to learning in main stream classrooms. The implementation of the curriculum necessitates close collaboration between teachers and SLTs in order to ensure the best possible outcomes for all learners. This collaboration is reviewed by identifying the benefits of, and barriers to, the process, as well as crucial areas of collaboration. Inclusive education is mandated by White Paper 6, and collaborative support of teachers by SLTs is presented from the learners' perspective within the context of the curriculum. An example of teacher support through the response to intervention (RTI) approach is described.

Teachers and parents have long believed that children with hearing loss (CHL) are at increased risk for fatigue. CHL may be physically and mentally "worn out" as a result of focusing so intently on a teacher's speech and on conversations with other students. Moreover, increased listening effort, stress, and subsequent fatigue could compromise a child's ability to learn in a noisy classroom environment. Only recently, however, have we begun to see empirical studies supporting the notion that some CHL experience more fatigue than children with normal hearing (CNH). The purpose of this paper is to enhance the awareness of fatigue in school-age CHL among educational audiologists. To this end, an overview on the topic of fatigue in CHL is provided including its importance, definitions, consequences, and preliminary findings from a large-scale study at Vanderbilt University. In addition, we discuss the role of the educational audiologist in the identification and management of CHL who are fatigued. Research on fatigue in CHL is lacking and the importance of, and need for, scientific exploration in this area is emphasized.

The sense of hearing is very important in our need and ability to communicate with others, and for our safety. An audiologist describes features of the role of an audiologist and outlines training routes. Understanding how the ear works is the starting point, followed by basic details of some causes of hearing problems and management options for those with hearing difficulties.

This paper focuses on the potential benefits of integrating physics demonstrations as a mediator for learning the physics of sound, acoustics and psychoacoustics in an undergraduate audiology classroom. The participants of this study were 54 first-year audiology students enrolled in the Physics of Sound and Acoustics course. According to the results, students' physics achievement in a paper-pencil test (midterm exam) was found to be a good predictor for the good understanding of psychoacoustics. However, the results of a multiple regression analysis showed that student's performance in physics demonstrations also mediate the process of learning in this course.

Purpose: The purposes of the current study were to examine the effect of age on Spanish-English bilinguals' speech recognition performance and to identify differences in speech recognition performance between Spanish and English bilinguals' 1st and 2nd languages. Method: Fifteen younger adult Spanish-English bilinguals, 15 older adult Spanish-English bilinguals, 15 younger adult English monolinguals, and 15 older adult English monolinguals participated in this study. Bilingual participants had learned Spanish from birth and began learning English by the age of 4 years (SD = 2.7). Speech recognition performance was measured using the Spanish and English versions of the Hearing in Noise Test (HINT; Nilsson, Soli, & Sullivan, 1994) presented in quiet and in a speech-shaped background noise. Participants also completed a self-assessment of the listening effort they expended on the HINT in background noise. Results: There were no significant differences in performance within or between the participant groups for the HINT in quiet. In background noise, Spanish-English bilinguals performed significantly poorer and had increased listening effort on the English HINT than English monolinguals, with the most significant effects evidenced for the older Spanish-English bilingual group. Overall, the bilingual participants performed significantly better and expended less listening effort on the Spanish than on the English HINT in background noise, despite learning both languages at an early age. Conclusions: Older Spanish-English bilinguals are at an increased disadvantage in understanding English in background noise compared to older English monolinguals. This suggests that current clinical audiological evaluation and treatment procedures may need to be modified to better serve an older bilingual population.

Objective: The purpose of this systematic review is to evaluate the published research in auditory training (AT) for pediatric cochlear implant (CI) recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language development, cognition, and/or quality of life and whether improvements, if any, remain over time post AT intervention. Method: A systematic search of 7 databases identified 96 review articles published up until January 2017, 9 of which met the inclusion criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICOS (participants, intervention, control, outcomes, and study) framework. Results: All studies reported improvements in trained AT tasks, including speech discrimination/identification and working memory. Retention of improvements over time was found whenever it was assessed. Transfer of learning was measured in 4 of 6 studies, which assessed generalization. Quality of life was not assessed. Overall, evidence for the included studies was deemed to be of low quality. Conclusion: Benefits of AT were illustrated through the improvement in trained tasks, and this was observed in all reviewed studies. Transfer of improvement to other domains and also retention of benefits post AT were evident when assessed, although rarely done. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed.

Purpose: Older adults seeking audiologic rehabilitation often present with medical comorbidities, yet these realities of practice are poorly understood. Study aims were to examine (a) the frequency of identification of selected comorbidities in clients of a geriatric audiology clinic, (b) the influence of comorbidities on audiology practice, and (c) the effect of comorbidities on rehabilitation outcomes. Method: The records of 135 clients (Mage = 86 years) were examined. Information about comorbidities came from audiology charts (physical paper files) and hospital electronic health records (EHRs). Data about rehabilitation recommendations and outcomes came from the charts. Focus groups with audiologists probed their views of how comorbidities influenced their practice. Results: The frequency of identification was 68% for visual, 50% for cognitive, and 42% for manual dexterity issues; 84% had more than one comorbidity. Also noted were hypertension (43%), falls (33%), diabetes (13%), and depression (16%). Integrating information from the audiology chart and EHR provided a more complete understanding of comorbidities. Information about hearing in the EHR included logs of outpatient audiology visits (75% of 135 cases), audiologists' care notes for inpatients and long-term care residents (25%), and entries by other health professionals (60%). Modifications to audiology practice were common and varied depending on comorbidity. High rates of success were achieved regardless of comorbidities. Conclusions: In this clinic, successful outcomes were achieved by modifying audiology practice for clients with comorbidities. Increased interprofessional communication among clinicians in the circle of care could improve care planning and outcomes for older adults with hearing loss.

Purpose: This article presents a basic exploration of Bayesian inference to inform researchers unfamiliar to this type of analysis of the many advantages this readily available approach provides. Method: First, we demonstrate the development of Bayes' theorem, the cornerstone of Bayesian statistics, into an iterative process of updating priors. Working with a few assumptions, including normalcy and conjugacy of prior distribution, we express how one would calculate the posterior distribution using the prior distribution and the likelihood of the parameter. Next, we move to an example in auditory research by considering the effect of sound therapy for reducing the perceived loudness of tinnitus. In this case, as well as most real-world settings, we turn to Markov chain simulations because the assumptions allowing for easy calculations no longer hold. Using Markov chain Monte Carlo methods, we can illustrate several analysis solutions given by a straight forward Bayesian approach. Conclusion: Bayesian methods are widely applicable and can help scientists overcome analysis problems, including how to include existing information, run interim analysis, achieve consensus through measurement, and, most importantly, interpret results correctly.

Purpose: The purpose of the study was to examine the effect of short-term noise exposure on audiometric thresholds, distortion product otoacoustic emissions (DPOAEs), and electrocochleography (ECochG) as a function of ear and sex. Method: Preexposure and postexposure measures of audiometric thresholds, DPOAEs, and ECochG indices were examined. Sixteen male and 16 female adults participated. Participants were exposed to a 2000-Hz narrowband noise presented at 105 dBA for 10 min. Results: Following noise exposure, significantly ( p < 0.0001) larger auditory threshold differences were observed for left ears. Larger auditory threshold differences were also observed for 3000 and 4000 Hz versus 2000 and 6000 Hz. DPOAE absolute amplitude differences increased with decreasing L[subscript 1], L[subscript 2] level ( p < 0.0001). DPOAE absolute amplitude differences also significantly rose with increasing f 2 frequencies ( p < 0.0001). Females generally had larger DPOAE absolute amplitude differences than males ( p < 0.05). Summating potential amplitudes were significantly larger for female left ears following noise exposure ( p = 0.03). Left-ear summating potential/action potential amplitude ratios and summating potential/action potential area ratios were increased following noise exposure ( p < 0.05). Conclusions: Utilizing a test battery to examine the effects of short-term noise exposure can reveal the functional status of different structures in the cochlea. There appears to be a susceptibility of the left ear to short-term loud noise exposure. Findings with respect to a sex susceptibility to short-term loud noise exposure were not strong, as sex differences were only observed for a subset of the conditions.

Purpose: Children with hearing loss may not reach the same level of reading proficiency as their peers with typical development. Audiologists and speech-language pathologists (SLPs) have important roles to play in preventing this problem early in children's development. In this tutorial, we aim to communicate how the habilitation practices of audiologists and intervention services of SLPs can support early literacy skill development in children with hearing loss. Method: We describe key findings from peer-reviewed research articles to provide a review of early literacy skill development, to explain the relationship between early literacy skills and conventional reading skills, and to highlight findings from early literacy skill intervention studies that included children with hearing loss who use spoken language. We conclude with a hypothetical case study to illustrate how audiologists and SLPs can support early literacy acquisition in children with hearing loss. Conclusion: Findings from studies of young children with hearing loss suggest that a promising approach to improving reading outcomes is to provide explicit early literacy instruction and intervention.

Effective teaching strategies to modify classroom instruction for students who are deaf or hard of hearing are presented. The authors share principles that guide these instructional strategies and complement current pedagogy. Examples of applying instructional modifications using real classroom scenarios are included under each principle.

Efforts to improve cultural competence in pediatric hearing loss services should be informed by evidence of how culture can affect services, yet there is a paucity of research in the field of audiology. The aim of this study was to gain insight into practitioners' experiences with offering early hearing loss services to minority culture families. Specifically, the objective was to examine possible barriers and facilitators to improving cultural competence in early hearing loss services by exploring the perspectives of the providers of care from across Canada. A survey, informed by our previous studies, was disseminated to practitioners providing hearing loss services. Responses to all survey questions were analyzed descriptively. Open-ended questions were analyzed with simple content analysis. Results indicate practitioners reported barriers at each stage of service delivery: during diagnoses, amplification discussions, language assessments, and interventions. Practitioners also described various strategies used to facilitate culturally competent care. Findings stemming from this study can be used to inform practitioners seeking to provide culturally competent care.

The main purpose of the present study was to assess special needs for students with hearing impairment. The sample of the study consisted of 231 students enrolled at schools for deaf children in Jordan, 113 males and 118 females. A special needs scale was developed and used in assessing special needs for students. The reliability and validity of the scale were established. The investigator used the t-test and ANOVA to answer the research questions. The results indicated that the differences between all pairs of means for both male and female respondents were statistically non-significant. Also, findings showed that the hearing-impaired students who have 55-69 dB hearing loss were more affected by communication needs, audiological rehabilitation needs, and learning style needs than hearing-impaired students who have 90 dB hearing loss and beyond hearing loss. In addition to, findings revealed that the grade groups of 2-5 and 6-8 were more affected than grade group of 9-11 for the following dependent variables: communication needs, social and emotional needs, personal needs, behavioral needs, and academic needs. Also, the grade group of 6-8 was more affected than the grade groups of 2-5 and 9-11 with respect to the dependent variable of learning style needs. Differences between mean scores of students who used sign language and total communication were in favor of students who used total communication on the dimensions of communication needs, audiological rehabilitation needs, behavioral needs, and learning style needs. The study recommended on meeting the needs of students with hearing impairment throughout planned programs.

Relative to Early Hearing Detection and Intervention (EHDI), New Mexico struggles with multiple points of referral into early intervention in the same way most states do. Referrals are not systematized through a single point of entry. The Step*Hi (statewide Parent-Infant) Program of the New Mexico School for the Deaf (NMSD) receives referrals from sources such as hospitals, doctors, audiologists, Part C programs, the Department of Health, parents self-referring, and audiologists. Babies may or may not receive timely early intervention based upon the system they are moving through. Given these demographics, it is probably not surprising that the EHDI standards of screening by 1 month of age, diagnosis by 3 months, and entrance into early intervention specific to hearing loss by 6 months have not completely been met. What is surprising, amazing actually, is that, even given all of the barriers New Mexico faces, the average age of entry into early intervention is currently 11 months and continues to slowly decline. So how has New Mexico, with multiple barriers, continued to reduce the age at which children receive early intervention? New Mexico state agencies, as key stakeholders in the success of the EHDI system, do more than just "play nicely in the sandbox" together. There is a systemic commitment to decrease the number of children "lost to follow-up" and to decrease the age at which a child receives early intervention. This commitment has led to strategic interagency planning and implementation of these plans. This article describes some of the strategies that New Mexico has found to be successful.

In Indiana, families with newly identified deaf and hard of hearing children may have varying experiences in discovering the support systems available to them. Indiana has a Part C early intervention (EI) program, known as First Steps, that serves all children at risk or identified with a disability. This program, however, is not yet seamless in taking families from the newborn screening and identification stages through the EI and service delivery stages. Indiana School for the Deaf's (ISD) Outreach Department, mandated by Indiana Code 20-22-2 to serve as a statewide resource providing outreach services and consultation to public schools serving deaf and hard of hearing children, has taken a multifaceted approach to helping create a more fluid experience for families in need of EI services. A critical factor in ISD Outreach's ability to provide this support to families of newly identified deaf or hard of hearing children has been a strong relationship with other state agencies. When the Universal Newborn Hearing Screening (UNHS) mandate passed in 1999, it was crucial that First Steps, ISD Outreach, and the Indiana State Department of Health (ISDH) work together in the implementation of a statewide Early Hearing Detection and Intervention (EHDI) program. ISDH oversees early hearing detection programs in the state. First Steps had the funding for an appropriate intervention, but lacked the comprehensive specialized services that ISD Outreach had. All three agencies, working in tandem, have been able to make progress towards developing a more unified statewide system of EI service delivery. (Contains 1 resource.)

The Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) is used to assess auditory development in young children with hearing loss. Despite being widely used, previous research showed that its psychometric properties are not ideal. As a first step toward psychometric advancements of the IT-MAIS, this study aimed to create videos with strong content validity that can later be used to supplement the IT-MAIS questions and ultimately improve its reliability. Researchers first surveyed 10 pediatric audiologists to determine how representative 6 different video scripts were of their corresponding IT-MAIS questions. Researchers then filmed the top-rated scripts. Finally, researchers surveyed an additional 25 pediatric audiologists and 25 caregivers unfamiliar with the IT-MAIS to assess the videos' content validity. Analyses showed that the audiologists and caregivers agreed on which video best depicted each of the 10 ITMAIS questions, thus suggesting that the videos had strong content validity.

Purpose: To characterize preschool and school services for children who are hard of hearing (CHH), we described service setting, amount, and configuration and analyzed the relationship between service receipt and student hearing levels and language scores. Characteristics of professionals providing services were described and then used to predict level of comfort with skills supporting listening and spoken language. The amount of provider communication with children's audiologists was also investigated. Method: Participants included parents of CHH (preschool n = 174; school n = 155) and professionals (preschool n = 133; school n = 104) who completed interviews and questionnaires as part of a longitudinal study. Children's hearing, speech, and language data were collected from annual testing and analyzed in relation to service data. Results: A majority (81%) of preschool-age CHH received services. Children were more likely to be in a preschool for children who are deaf or hard of hearing (CDHH) or exceptional children than a general education preschool. By elementary school, 70% received services, nearly all in general education settings. Sessions averaged twice a week for a total of approximately 90 min. Children who no longer received services performed significantly better on speech/language measures than those who received services, regardless of service setting. Professionals were primarily speech-language pathologists (SLPs) and teachers of CDHH. SLPs reported significantly less comfort with skills involving auditory development and hearing technologies and less frequent communication with the child's audiologists than teachers of CDHH. Overall communication with audiologists was more frequent in the preschool years. Conclusions: As preschool-age CHH transition into school, the majority continue to qualify for services. Congruent with national trends, school-age CHH in the Outcomes of Children with Hearing Loss study were most often in general education settings. Without specialized preprofessional or postgraduate training, SLPs and teachers of CDHH did not report comfort with all the skills critical to developing listening and spoken language. This finding supports the need for increased implementation of interprofessional practice among SLPs and teachers of CDHH, as well as audiologists, to best meet the needs unique to this population.

Purpose: The aim of this study was to develop a risk prediction model for detecting middle ear pathology in 6- to 9-month-old infants using wideband absorbance measures. Method: Two hundred forty-nine infants aged 23-39 weeks (Mdn = 28 weeks) participated in the study. Distortion product otoacoustic emissions and high-frequency tympanometry were tested in both ears of each infant to assess middle ear function. Wideband absorbance was measured at ambient pressure in each participant from 226 to 8000 Hz. Absorbance results from 1 ear of each infant were used to predict middle ear dysfunction, using logistic regression. To develop a model likely to generalize to new infants, the number of variables was reduced using principal component analysis, and a penalty was applied when fitting the model. The model was validated using the opposite ears and with bootstrap resampling. Model performance was evaluated through measures of discrimination and calibration. Discrimination was assessed with the area under the receiver operating characteristic curve (AUC); and calibration, with calibration curves, which plotted actual against predicted probabilities. Results: AUC of the fitted model was 0.887. The model validated adequately when applied to the opposite ears (AUC = 0.852) and with bootstrap resampling (AUC = 0.874). Calibration was satisfactory, with high agreement between predictions and observed results. Conclusions: The risk prediction model had accurate discrimination and satisfactory calibration. Validation results indicate that it may generalize well to new infants. The model could potentially be used in diagnostic and screening settings. In the context of screening, probabilities provide an intuitive and flexible mechanism for setting the referral threshold that is sensitive to the costs associated with true and false-positive outcomes. In a diagnostic setting, predictions could be used to supplement visual inspection of absorbance for individualized diagnoses. Further research assessing the performance and impact of the model in these contexts is warranted.

Central auditory processing disorder (CAPD), as defined by the American Speech-Language-Hearing Association (ASHA), refers to difficulties in the perceptual processing of auditory information in the central nervous system and the neurobiological activity that underlies that processing and gives rise to electrophysiologic auditory potentials (ASHA, 2005). Many researchers have characterized CAPD as one of the less well-validated learning disorders and have raised questions regarding its role and viability as a diagnosis in school-age children. Despite the lack of agreement, children with CAPD are still regularly identified by audiologists and subsequently treated by professionals in the fields of audiology, speech-language pathology, and psychology. Given that CAPD may impact a child's learning environment, many states and jurisdictions have found that children with CAPD may be eligible for special education services (under the 2004 Individuals with Disabilities Education Act categories of speech or language impairment or specific learning disability) or for Section 504 plans. The many years of debate surrounding CAPD and the contradicting literature is evidence for school psychologists to be wary of this diagnosis. Yet, given its prevalence rate, school psychologists still need to be prepared to work with this label. Additionally, school psychologists are ethically obligated to promote responsible assessment and intervention practices, thus making it important for them to become aware of the available data regarding CAPD. This article discusses the characteristics of CAPD, how to assess CAPD, interventions for CAPD, and implications for school psychologists.

Health care professionals including physicians, nurses, and audiologists are charged with providing comprehensive geriatric care for millions of aging adults. As baby boomers mature, prevalence of age-related hearing loss (ARHL) among adults aged 45+ years has risen from 30% to 50%. New findings have emerged regarding risk factors affecting ARHL prevalence. Many aging adults have medical comorbidities, such as diabetes, cardiovascular disease, and hypertension, which substantially increase the risk for ARHL. Recent studies highlighted links between cognitive skills, psychological health, and lifestyle choices like exercise and smoking that also relate to hearing loss. Thus, both intrinsic and extrinsic factors influence risk for ARHL. However, many practitioners are unaware of the relationship between such risk factors and ARHL. Therefore, this tutorial article highlights key research findings and summarizes current knowledge for clinical application. Specific audiologic and interdisciplinary strategies for clinical intervention are recommended within a framework of developing community-specific hearing health promotion programs.

Purpose: This review examined (a) the current evidence from studies on teleaudiology applications for rehabilitation of adults with hearing impairment with hearing aids and (b) whether it is sufficient to support the translation into routine clinical practice. Method: A search strategy and eligibility criteria were utilized to include articles specifically related to hearing aid fitting and follow-up procedures that are involved in consultations for the rehabilitation of adults, where the service was provided by the clinician by teleaudiology. A search using key words and Medical Subject Headings (MeSH) was conducted on the main electronic databases that index health-related studies. The included studies were assessed using validated evaluation tools for methodological quality, level of evidence, and grade recommendations for application into practice. Results: Fourteen studies were identified as being within the scope of this review. The evaluation tools showed that none of these studies demonstrated either a strong methodological quality or high level of evidence. Analysis of evidence identified 19 activities, which were classified into service outcomes categories of feasibility, barriers, efficiency, quality, and effectiveness. Recommendations could be made regarding the (a) feasibility, (b) barriers, and (c) efficiency of teleaudiology for the rehabilitation of hearing loss with hearing aids. Conclusion: This review provides up-to-date evidence for teleaudiology hearing aid services in new and experienced hearing aid users in different practice settings. Findings direct future research priorities to strengthen evidence-based practice. There is a need for further studies of many aspects of teleaudiology services for rehabilitation with hearing aids to support their implementation into clinical practice.

Background: Family-centred care (FCC) is recognized as best practice in the delivery of early intervention services for children with hearing loss (HL) and their families. However, there has been little research involving direct observation of family-centred communication practices in paediatric hearing habilitation appointments, which means little is currently known about how family members are involved within appointments, and how FCC is accomplished by health professionals through their interactions with families. Aims: To examine the interaction between hearing healthcare professionals, children with HL, and their parents within video-recorded paediatric hearing habilitation appointments (including both audiology and speech and language therapy appointments), with a particular focus on how parents were involved in the interaction. Methods & Procedures: The data for this study involved a corpus of 48 video-recorded paediatric hearing habilitation appointments from three clinical sites (including 33 audiology appointments and 15 speech pathology appointments). Participants included 14 audiologists, 8 speech and language therapists, 41 children with HL (aged 18 months and over) and 48 of their attending family members (e.g., parents/carers). The data were analyzed using conversation analysis. Outcomes & Results: Analysis revealed one specific practice that health professionals used to engage parents in the interaction during child-directed assessment and therapy tasks: that of 'parent-directed commentaries', where health professionals shifted their attention to the parent(s) to describe or evaluate what they were observing during appointment tasks. Health professionals were observed to produce two types of parent-directed commentaries: (1) a positive evaluation of the child's just-prior response; and (2) an account for the child's prior behaviour (sometimes also accompanied by a positive evaluation). These commentaries appeared at systematic points in the interaction when the child had been displaying difficulty with their response to the health professional. The parent-directed commentaries accomplished several important functions: they engaged the parent's attention in the interaction; focused the parent's attention on positive responses from the child (while shrouding less positive responses); played down potential negative perceptions of the child's previous missed/incorrect responses; and provided parents with reassurance of their child's progress during the ongoing task. Conclusions & Implications: The parent-directed commentaries identified in this study provide an example of the practical, interactional resources that health professionals can draw on within paediatric appointments to facilitate FCC with parents.

Listening and spoken language (LSL) intervention and education have emerged as the preferred terms representing an intervention perspective that promotes "auditory oral" outcomes for many of today's children who are deaf or hard of hearing (D/HH), including those who are English learners. Practitioners (including speech-language pathologists, educational audiologists, and teachers) working with students who are D/HH require access to evidence-based principles of LSL. A deep understanding of general principles will inform practitioners' development of intervention to promote outcomes for school-aged students who are D/HH or D/HH and English learners. The purpose of this article is to identify principles and practices foundational to developing LSL. Knowledge, skills, and dispositions for practitioners are discussed; descriptions and examples of strategies and resources associated with LSL are included.

The professions of speech-language pathology and audiology provide valuable services for persons with communication, hearing, and feeding/swallowing disabilities. However, from a global perspective, mainstream practice discourses represent values from colonial perspectives (called Northern here). As such, they remain largely inaccessible to most people in the world. We argue, from a South African perspective, for a postcolonial or Southern discourse in alignment with other Africans, Latin Americans, and Asians who historically have had limited opportunities to shape professional practices. We use ideology critique (a disruptive tool) to reflect and make visible hegemonic Northern practices. Critical science and decoloniality are offered as pivotal axes for transformation. Decoloniality is discussed in relation to (i) Equitable (ii) Population-based (iii) Innovations for (iv) Communication (EPIC) using illustrative examples of emerging South African practices. We argue for redefining communication disorder professions' cultural borderlands to engage Northern with Southern ideologies critically to strengthen professional practice transformation.

Purpose: The purpose of this article is to assess speech processing for listeners with simulated age-related hearing loss (ARHL) and to investigate whether the observed performance can be replicated using an automatic speech recognition (ASR) system. The long-term goal of this research is to develop a system that will assist audiologists/hearing-aid dispensers in the fine-tuning of hearing aids. Method: Sixty young participants with normal hearing listened to speech materials mimicking the perceptual consequences of ARHL at different levels of severity. Two intelligibility tests (repetition of words and sentences) and 1 comprehension test (responding to oral commands by moving virtual objects) were administered. Several language models were developed and used by the ASR system in order to fit human performances. Results: Strong significant positive correlations were observed between human and ASR scores, with coefficients up to 0.99. However, the spectral smearing used to simulate losses in frequency selectivity caused larger declines in ASR performance than in human performance. Conclusion: Both intelligibility and comprehension scores for listeners with simulated ARHL are highly correlated with the performances of an ASR-based system. In the future, it needs to be determined if the ASR system is similarly successful in predicting speech processing in noise and by older people with ARHL.

Purpose: The purpose was to examine author-level impact metrics for faculty in the communication sciences and disorder research field across a variety of databases. Method: Author-level impact metrics were collected for faculty from 257 accredited universities in the United States and Canada. Three databases (i.e., Google Scholar, ResearchGate, and Scopus) were utilized. Results: Faculty expertise was in audiology (24.4%; n = 490) and speech-language pathology (75.6%; n = 1,520). Women comprised 68.1% of faculty, and men comprised 31.9% of faculty. The percentage of faculty in the field of communication sciences and disorders identified in each database was 10.5% (n = 212), 44.0% (n = 885), and 84.4% (n = 1,696) for Google Scholar, ResearchGate, and Scopus, respectively. In general, author-level impact metrics were positively skewed. Metric values increased significantly with increasing academic rank (p < 0.05), were greater for men versus women (p < 0.05), and were greater for those in audiology versus speech-language pathology (p < 0.05). There were statistically significant positive correlations between all author-level metrics (p < 0.01). Conclusions: These author-level metrics may serve as a benchmark for scholarly production of those in the field of communication sciences and disorders and may assist with professional identity management, tenure and promotion review, grant applications, and employment.

Increased life expectancy in persons with Down syndrome (DS) is associated with premature age-related changes. The aim of this study was to assess auditory function in adults with DS and to evaluate the prevalence of hearing loss in this population. Audiometric tests were performed in 72 adults with DS (mean age 37.3 ± 10.1 years, 51.4% females). Air conduction pure tone average (PTA) thresholds at frequencies 0.5-1-2-4 kHz were calculated to assess hearing function. Hearing loss was present if the PTA threshold was > 20 dB hearing level. Higher frequencies of 4 and 8 kHz were also assessed. Hearing loss was shown in 47 (65.3%) participants. The prevalence of hearing loss increased with age, ranging from 42.86% in the 20-29 years group to 90.91% in the 50-59 years group. High frequencies (4 and 8 kHz) were more often impaired than other frequencies used to measure PTA. Thus, the study concluded hearing loss is common in adults with DS and shows a pattern compatible with precocious aging of the hearing system. Auditory evaluation is strongly recommended in adults with DS.

High levels of stress and anxiety are common in children with Autism Spectrum Disorder (ASD). Within this study of school-aged children (20 male, 6 female) we hypothesised that functional hearing deficits (also pervasive in ASD) could be ameliorated by auditory interventions and that, as a consequence, stress levels would be reduced. The use of Ear-Level Remote Microphone devices and Classroom Amplification systems resulted in significantly improved listening, communication and social interaction and a reduction in physiologic stress levels (salivary cortisol) in both one-on-one and group listening situations.

Purpose: Although an interdisciplinary approach is recommended for assessment and management of feeding or swallowing difficulties, audiologists are not always included in the interdisciplinary team. The purpose of this study is to report the prevalence of middle ear and hearing problems in children with feeding and swallowing disorders and to compare this prevalence with that in typical children. Method: A total of 103 children were included in the study: 44 children with feeding and swallowing disorders and 59 children without any such disorders. Audiological examinations included case-history information, visualization of the ear canals through otoscopy, middle ear evaluation through tympanometry, and hearing screenings using an audiometer. Results: The odds of excessive cerumen (p = 0.0000, small effect size), middle ear dysfunction (p = 0.0148, small effect size), and hearing screening failure (p = 0.0000, large effect size) were 22.14%, 2.97%, and 13.5% higher, respectively, in children with feeding and swallowing disorders compared with typically developing children. Conclusion: The significantly higher prevalence of hearing problems in children with feeding and swallowing disorders compared with typically developing children suggests that inclusion of an audiologist on the interdisciplinary team is likely to improve overall interventional outcomes for children with feeding and swallowing disorders.

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.