Search

Eight cochlear implant users with near-normal hearing in their non-implanted ear compared pitch percepts for pulsatile electric and acoustic pure-tone stimuli presented to the two ears. Six subjects were implanted with a 31-mm MED-EL FLEX(SOFT) electrode, and two with a 24-mm medium (M) electrode, with insertion angles of the most apical contacts ranging from 565° to 758°. In the first experiment, frequency-place functions were derived from pure-tone matches to 1500-pps unmodulated pulse trains presented to individual electrodes and compared to Greenwood's frequency position map along the organ of Corti. While the overall median downward shift of the obtained frequency-place functions (-0.16 octaves re. Greenwood) and the mean shifts in the basal (<240°; -0.33 octaves) and middle (-0.35 octaves) regions were statistically significant, the shift in the apical region (>480°; 0.26 octaves) was not. Standard deviations of frequency-place functions were approximately half an octave at electrode insertion angles below 480°, increasing to an octave at higher angular locations while individual functions were gradually leveling off. In a second experiment, subjects matched the rates of unmodulated pulse trains presented to individual electrodes in the apical half of the array to low-frequency pure tones between 100 Hz and 450 Hz. The aim was to investigate the influence of electrode place on the salience of temporal pitch cues, for coding strategies that present temporal fine structure information via rate modulations on select apical channels. Most subjects achieved reliable matches to tone frequencies from 100 Hz to 300 Hz only on electrodes at angular insertion depths beyond 360°, while rate-matches to 450-Hz tones were primarily achieved on electrodes at shallower insertion angles. Only for electrodes in the second turn the average slopes of rate-pitch functions did not differ significantly from the pure-tone references, suggesting their use for the encoding of within-channel fine frequency information via rate modulations in temporal fine structure stimulation strategies., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objective: Audiologists routinely observe patients struggle with psycho-emotional difficulties associated with hearing loss, yet are often underprepared to manage this vital aspect of patient care. For this reason, a workshop was developed for audiologists interested in expanding their counselling skills. Since one-time workshops typically do not result in changes in practice, this program adopted a distributed-over-time learning model, consisting of 20 hours of participation across six weeks. The extended nature of the program provided multiple opportunities to learn several counselling strategies, and apply and evaluate the effectiveness of these strategies in clinical settings., Design: Learning objectives were assessed throughout the six-week program. However, at the conclusion of each program, it was unknown whether new knowledge carried over into sustained new skills. Therefore, we surveyed attendees six months after their program, to determine if the program had affected changes in their practice., Study Sample: Twenty clinicians (response rate = 91%) participated in the survey., Results: All respondents made some, and often many, changes in patient communication. They applied several counseling concepts to their work settings and reported positive changes in patient-clinician dynamics., Conclusion: Results suggest that a six-week program is effective in helping clinicians change their counseling skills within their practice.

Objective: To evaluate the effect of the intracochlear electrode position on the residual hearing and VNG- and cVEMP responses., Design: Prospective pilot study., Study Sample: Thirteen adult patients who underwent unilateral cochlear implant surgery were examined with high-resolution rotational tomography after cochlear implantation. All subjects were also tested with VNG, and 12 of the subjects were tested with cVEMP and audiometry before and after surgery., Results: We found that although the electrode was originally planned to be positioned inside the scala tympani, only 8 of 13 had full insertion into the scala tympani. Loss of cVEMP response occurred to the same extent in the group with full scala tympani positioning and the group with scala vestibuli involvement. There was a non-significant difference in the loss of caloric response and residual hearing between the two groups. Interscalar dislocation of the electrode inside the cochlea was observed in two patients. A higher loss of residual hearing could be seen in the group with electrode dislocation between the scalae., Conclusions: Our findings indicate that intracochlear electrode dislocation is a possible cause to loss of residual hearing during cochlear implantation but cannot be the sole cause of postoperative vestibular loss.

Objective: The speech, spatial, and qualities of hearing questionnaire (SSQ) is a self-report test of auditory disability. The 49 items ask how well a listener would do in many complex listening situations illustrative of real life. The scores on the items are often combined into the three main sections or into 10 pragmatic subscales. We report here a factor analysis of the SSQ that we conducted to further investigate its statistical properties and to determine its structure., Design: Statistical factor analysis of questionnaire data, using parallel analysis to determine the number of factors to retain, oblique rotation of factors, and a bootstrap method to estimate the confidence intervals., Study Sample: 1220 people who have attended MRC IHR over the last decade., Results: We found three clear factors, essentially corresponding to the three main sections of the SSQ. They are termed "speech understanding", "spatial perception", and "clarity, separation, and identification". Thirty-five of the SSQ questions were included in the three factors. There was partial evidence for a fourth factor, "effort and concentration", representing two more questions., Conclusions: These results aid in the interpretation and application of the SSQ and indicate potential methods for generating average scores.

Primary Objective: The objective was to compare symptoms in service members diagnosed with a blast-related mTBI (mild traumatic brain injury) with a loss of consciousness (LOC) to those without LOC., Research Design: Clinicians saw US military personnel within 72 hours of sustaining a blast-related mTBI and at a follow-up visit 48-72 hours later (n = 210)., Methods and Procedures: Demographics, post-concussive symptoms, diagnosis of acute stress reaction (ASR) and simple reaction time data from the Automated Neuropsychological Assessment Metric (ANAM) were collected., Main Outcomes and Results: ASRs were significantly more likely in patients reporting LOC versus patients reporting no LOC. At the first post-injury visit, LOC was associated with difficulty sleeping, hearing loss, memory problems and reporting more symptoms. A follow-up analysis explored if symptomatic differences were influenced by ASR. Adjusting for ASR, the statistical relationships between LOC and symptoms were weaker (i.e. reduced Odds Ratios). At the follow-up visit, difficulty sleeping was associated with LOC before and after adjusting for ASR. Patients with both ASR and LOC had the slowest simple reaction times., Conclusions: Results suggest ASR may partially mediate symptom presentation and cognitive dysfunction in the acute phase following blast-related mTBI. Future research is warranted.

Unlabelled: The purpose of this study was to use the Cognitive Anxiety Scale (CAS) to investigate relationships between state-anxiety level (cognitive anxiety) and audiometric variables in adults with hearing impairment at their initial consultation. Thirty-five adults with hearing impairment who consulted an audiologist for the first time participated in this study. An interview to obtain information about cognitive anxiety was conducted prior to the audiological assessment. The results indicated that cognitive anxiety was significantly related to an ability to understand speech in noise. Further, cognitive anxiety and ability to understand speech in noise significantly contributed to the classification of hearing aid adopters and non-adopters. These results indicate that the measure of cognitive anxiety may have clinical applications in the future., Learning Outcomes: The reader will be able to: (1) discuss the relationship between anxiety and hearing impairment; (2) define cognitive anxiety; (3) state the relationship between cognitive anxiety and audiometric variables; (4) state the relationship between cognitive anxiety and the decision to adopt hearing aids; (5) identify signs of cognitive anxiety in adults with hearing impairment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The objective of this prospective study was to investigate the relationship between acceptable noise level (ANL), which was measured using Taiwanese and the international speech test signal (ISTS), and real-world hearing-aid success for listeners who were representative of the population commonly seen in clinics., Design: Unaided ANLs were measured pre-hearing-aid fitting. Hearing-aid success was assessed three months post-fitting using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire., Study Sample: Eighty adults with hearing impairment completed the study., Results: Both Taiwanese and ISTS ANLs were significantly associated with hearing-aid success, with higher ANLs suggesting poorer outcomes. However, the ANL's prediction accuracy for the probability of hearing-aid success was either much lower than that suggested by some literature, or was not much different from that of simply predicting all listeners as successful users., Conclusions: The current study suggested the possibility of using ANL to predict hearing-aid success. However, the usefulness of ANL as a clinical tool is unlikely to be as great as indicated by the literature.

Background: The population of ageing people with mild and moderate intellectual disabilities (ID) is growing rapidly. This study examines how personal resources (physical health, mental health and social networks) impact the well-being of ageing people with ID., Methods: Longitudinal survey data on 667 people with a mild or moderate ID were acquired via interviews in 2006 and 2010. Indicators of personal resources (physical health, mental health and social networks) were assessed, as were indicators of well-being (satisfaction with life, happiness and loneliness). Additionally, data on background characteristics and autonomy were gathered., Results: The results show that age is positively related to decreased mobility and auditory disabilities and negatively related to independent living, autonomy in how one spends one's leisure time and autonomy in decision-making. Longitudinal analyses demonstrated that, with the exception of health that deteriorated, and social satisfaction that improved, almost all variables remained stable over the 4-year period. Further, good physical health in 2006 predicted happiness in 2010., Conclusion: Despite the fact that age is associated with poorer physical and mental health and a smaller social network, this study showed that older people with ID have relatively high levels of well-being. Findings are discussed in the light of coping with ageing and impact of life events., (© 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.)

Objective: To assess the American Medical Association (AMA) guide to the evaluation of binaural hearing impairment (BHI) as a procedure for estimating severity of hearing loss from audiograms., Design: The BHIs of Australian war veterans were calculated from their hearing threshold levels (HTLs) and compared with their scores on a hearing questionnaire, the hearing measurement scale (HMS)., Study Sample: The HTLs of 282 Australian war veterans were measured at frequencies from 0.25 to 8 kHz and scores on the HMS were obtained from 154 of those veterans., Results: No grounds could be found for altering the frequencies included in the average HTL or the high fence of 92 dB HL used in calculating the monaural hearing impairments (MHIs) of the veterans, and no grounds could be found for altering the ratio of 5:1 used in determining the BHI from the MHIs of the better and worse ears. However, agreement between HMS score and BHI was improved by reducing the low fence used in calculating MHI from 25 to 15 dB HL., Conclusion: A modified version of BHI provided an improved procedure for estimating severity of hearing loss from audiograms but would not be suitable for compensation purposes.

Objective: Everyday conversation is the most widely reported difficulty arising from adult acquired hearing impairment (HI), yet no clinical method currently exists by which direct observation of conversational ability can be measured. This review of recent research argues that specific patterns of conversation repair arise in interaction involving adults who have acquired HI and that they may be of utility in assessing the outcome of intervention., Methods: This brief review paper presents a summary of data on the conduct of repair in free and unstructured conversations between HI adults and their frequent communication partners using Conversation Analysis as the guiding theory and analytic method., Results: Results indicate that certain types of repair are influenced by one participant in the conversation having an acquired hearing impairment. Further, these patterns of repair behaviour are resolved in concert by the participants in the conversation. Discussion Patterns of repair behaviour may be used as criterion variables in assessing the need for and outcome of audiological intervention, including implantation, hearing aid fitting and/or conversation-based therapy. Previous research has shown that these measures are both consistent across time in the absence of intervention and that they are sensitive to intervention., Conclusion: These findings support the potential for conversationally-oriented therapy models of assessment and intervention and suggest a framework by which clinical tasks might be analysed with respect to their conversation 'reality'. This initial evidence needs to be supported by investigations across larger samples of adults with acquired hearing impairment.

Background: Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age., Methods/design: In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis., Discussion: The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated., Clinical Trials Registration: ClinicalTrials.gov, NCT01217502.

Objective: Up to a quarter of the adults who own hearing aids never use them. To provide these 'non-users' with the best help, hearing care professionals need to have an in-depth understanding of the non-users' beliefs and feelings with regard to the non-use. This qualitative study explored these beliefs and feelings in order to increase our understanding of hearing aid non-users., Design: Individual face-to-face semi-structured interviews were completed., Study Sample: Eleven hearing aid owners (aged 54-80 years) who reported that they never or hardly ever used their hearing aids., Results: The participants expressed a variety of feelings towards their non-use, including indifference, self-annoyance, frustration, powerlessness, shame, and guilt. Their feelings were related to beliefs about: (1) the severity of their hearing handicap with and without hearing aids, (2) whom or what was responsible for the non-use, and (3) the attitudes of significant others towards the non-use., Conclusions: Hearing-aid non-users differ in their beliefs and feelings towards the non-use. A patient-centred approach is needed.

The aim of the present study was to compare the adolescents' attitudes toward loud music in relation to a set of self-perceived auditory symptoms and psychological variables such as norms, preparedness to take risks and risk-judgment in noisy situations. A questionnaire on hearing and preventive behavior was distributed to 281 upper secondary school students aged 15-19 years. The questionnaire included youth attitude to noise scale, questions about perceived hearing symptoms such as tinnitus and sound sensitivity and finally statements on perceived behavioral norms regarding hearing protection use, risk-taking and risk-judgment in noisy settings. Self-perceived auditory symptoms such as sound sensitivity and permanent tinnitus had a significant relationship with less tolerant attitudes toward loud music. Permanent tinnitus and sound sensitivity together accounted for 15.9% of the variation in attitudes toward loud music. Together with the psychological variables norms, preparedness to take risks and risk-judgment 48.0% of the variation in attitudes could be explained. Although perceived hearing symptoms (sound sensitivity and permanent tinnitus) was associated with less tolerant attitudes toward loud music, psychological variables such as norms, preparedness to take risks and risk-judgment were found to be more strongly associated with attitudes toward loud music and should therefore be considered more in future preventive work. Health promotive strategies should focus on changing not merely individual attitudes, but also societal norms and regulations in order to decrease noise induced auditory symptoms among adolescents.

Objective: To determine characteristics of children with special health care needs (CSHCN) with hearing difficulties including patterns of hearing aid use, comorbidity, and social and communication function., Methods: Bivariate and multivariable analysis of cross-sectional data on 40,723 children aged from birth to 17 years from the 2005-2006 National Survey of Children with Special Health Care Needs, including 1,982 (5%) with parent-reported hearing difficulties., Results: Among CSHCN, 383 (1%) used hearing aids, representing 20% of those with reported hearing difficulties. Odds of hearing aid use increased with age, primary language other than English, and lower income. More than half (58%) of the aided children reported hearing difficulties even with their aid. Among CSHCN with cerebral palsy, 13% had reported hearing difficulties and 3% used hearing aids. Equivalent figures for children with Down syndrome were 24% and 4%, mental retardation/developmental delay 12% and 5%, and autism spectrum disorder 9% and 2%. Overall, two-thirds of CSHCN with hearing difficulties had one or more sensory/developmental comorbidities; CSHCN with both hearing difficulties and a sensory/developmental comorbidity had highest odds of learning difficulties, speaking/communication difficulties, feeling anxious/depressed, acting out/bullying, and difficulty making friends. CSHCN with hearing difficulties alone, or sensory/developmental conditions alone had intermediate odds, after socio-demographic adjustment., Conclusions: Sensory/developmental comorbidities are common among CSHCN with hearing difficulties, and they are associated with higher odds of poorer social, communication, and educational function. Services for CSHCN must be equipped to address a range of hearing difficulties as well as sensory/developmental comorbidities and to improve social/emotional functioning as well as learning and communication.

Objectives: The aims were to compare health-related quality of life (HRQOL) and hearing handicap between two groups of employees with normal hearing and aided hearing impairment (HI). HRQOL was also compared to a normative population. The second aim was to compare perceived effort (PE) and disturbance after completing a task in office noise between the two study groups., Design: A Swedish version of the short form-36 (SF-36) and the hearing handicap inventory for adults (HHIA) was used to determine HRQOL and hearing handicap. The Borg-CR 10 scale was used to measure PE and disturbance., Study Sample: Hearing impaired (n = 20) and normally hearing (n = 20) participants. The normative sample comprised of 597 matched respondents., Results: Hearing-impaired employees report relatively good HRQOL in relation to the normative population, but significantly lower physical functioning and higher PE than their normally-hearing peers in noise. Results from the HHIA showed mild self-perceived hearing handicap., Conclusions: The current results demonstrate that physical health status can be negatively affected even at a mild-moderate severity of HI, and that a higher PE is reported from this group when performing a task in noise, despite the regular use of hearing aids.

Objective: The aim of this study was to develop a user-friendly way of measuring patients' threshold and supra-threshold hearing, with potential for application in clinical research. The end-product of these tests is a graphical profile summarizing absolute threshold, frequency selectivity, and compression characteristics across a spectrum of frequencies (0.25-6 kHz)., Design: A battery of three psychophysical hearing tests consisted of measures of absolute threshold, frequency selectivity, and compression. An automated, cued, single-interval, adaptive tracking procedure was employed. The tests results were collated and used to generate a readily visualized 'profile' for each listener., Study Sample: Participants were 83 adults (57 impaired-hearing and 26 good-hearing, age 20-75 years)., Results: Listeners tolerated the tests well. Single-ear profiles were obtained in an average of 74 minutes testing time (range 46-120 minutes). The variability of individual measurements was low. Substantial differences between normal and impaired listeners and also among the impaired listeners were observed. Qualitative differences in compression and frequency-selectivity were seen that could not be predicted by threshold measurements alone., Conclusions: The hearing profiles are informative with respect to supra-threshold hearing performance and the information is easily accessible through the graphical display. Further development is required for routine use in a clinical context.

Objective: To explore whether the accumulation of sensory difficulties predicts fear of falling (FOF), and whether the traits correlate with each other regardless of familial factors., Methods: Self-reported hearing, vision and balance difficulties, and FOF were assessed using structured questionnaires at the baseline and after a 3-year follow-up in 63- to 76-year-old women (n = 434)., Results: Among the women without FOF at baseline (n = 245), 41% reported FOF at follow-up. Increasing numbers of sensory difficulties at baseline predicted higher incidence of FOF. The relationship between accumulated sensory difficulties and FOF was not mediated by familial factors., Discussion: The accumulation of multiple sensory difficulties may hinder older people from receiving compensatory information about body position and environment, thus jeopardizing a person's confidence in maintaining a balanced position. Regular screening of sensory functions followed by appropriate actions may prevent the development of FOF, and thus contribute to prevention of falls and promotion of healthy aging.

Objective: This study set out to determine the accuracy with which tone pip ABR and click ABR, carried out in babies referred from universal newborn hearing screening, is able to predict the hearing outcome as determined by follow-up hearing tests., Study Sample: The cohort of babies studied were all babies referred for hearing assessment from the universal newborn hearing screen in Sheffield, UK for the period January 2002 to September 2007, who were found to have a significant hearing impairment., Design: The results of hearing assessment following referral from the newborn hearing screen were collected together with those of follow-up tests carried out up to an age when behavioural testing had established ear- and frequency-specific thresholds at 0.5, 1, 2 and 4 kHz., Results: The standard deviation of the difference between the follow up and the tone pip ABR thresholds was 10.5 dB for the 4-kHz tone pip, 16.8 dB for the 1-kHz tone pip, and ranged between 21.7 and 24.7 dB for click ABR., Conclusions: The results of the study show that tone pip ABR following referral from newborn hearing screening has a similar accuracy to that reported in older subjects, and is a much better predictor compared to click ABR.

Objective: The purpose of this study was to measure real-ear aided and saturated responses of SpeechEasy™ devices and compare responses while devices delivered altered auditory feedback (AAF) and non-altered feedback (NAF)., Design: A repeated measures quasi-experimental design was employed., Study Sample: Ten people fitted with completely-in-the-canal or open fit behind-the-ear devices participated. Probe microphone measures were obtained with speech, and 17 chirp stimuli presented at 75 dB and 85 dB SPL, respectively. Measurements were compared with devices delivering AAF (i.e. delayed and frequency shifted) versus NAF., Results: Maximum outputs were approximately 100-105 dB SPL in the 2000-4000 Hz range. Statistically significant differences in device SPL output as a function of device setting (AAF vs. NAF) were found for seven chirp stimuli (p <.05) when levels were sampled at points that were not temporally aligned with the output chirps but not for speech stimulus (p = .17). Device output varied across individuals and with open fit devices dominated by ear canal resonance effects., Conclusions: Real-ear aided responses were equivalent with speech input when devices delivered AAF and NAF. Real-ear saturated responses were not, however, comparable between AAF and NAF settings and may be underestimated if AAF delay is not accounted for.

Objective: The aim of this study was to determine whether a failure of neonatal hearing screening affected the anxiety level of parents of high-risk infants., Methods: Two hundred and eighty-eight parents of infants included in the neonatal hearing screening protocol of our Institution were tested with the Spielberger State-Trait Anxiety Inventory and with an open-question questionnaire investigating parents' attitude to hearing problems in their child, done at the time of audiological follow-up. 105 were parents of high-risk infants who had been discharged from neonatal intensive care unit (NICU) and 183 of low-risk infants discharged from well-baby nursery., Results: No differences in anxiety levels were seen between parents of high-risk infants passing and failing neonatal hearing screening using homogeneous case-control pairs. Additionally, no differences in the level of anxiety were found between parents of high- and low-risk infants failing neonatal auditory screening., Conclusions: Failure of neonatal auditory screening does not affect the anxiety levels of parents of high-risk infants at post discharge from NICU. This finding is a key factor to be considered when evaluating the costs and benefits of tests for universal neonatal hearing screening.

Objective: The purpose of the study was twofold: (1) to assess the ability of hearing-impaired adults in the developing world to independently and accurately assemble a pair of hearing aids by following instructions that were written and illustrated according to best-practice health literacy principles; and (2) to determine which factors influence independent and accurate task completion., Design: Correlational study., Study Sample: Forty South African and 40 Chinese adults with a hearing loss and their partners. The participant group included 42 females and 38 males ranging in age from 32 to 92 years., Results: Ninety-five percent of South African and 60% of Chinese participants completed the assembly task, either on their own or with assistance from their partners. Better health literacy, younger age, and a more prestigious occupation were significantly associated with independent task completion for the South African and Chinese participants. Task accuracy was significantly linked to higher levels of cognitive function among South African participants, while a paucity of valid data prevented an analysis of accuracy from being conducted with the Chinese data., Conclusion: Individuals of diverse backgrounds can manage the self-fitting hearing-aid assembly task as long as health literacy levels and cultural differences are considered.

There is much debate on how the spectrotemporal modulations of speech (or its spectrogram) are encoded in the responses of the auditory nerve, and whether speech intelligibility is best conveyed via the "envelope" (E) or "temporal fine-structure" (TFS) of the neural responses. Wide use of vocoders to resolve this question has commonly assumed that manipulating the amplitude-modulation and frequency-modulation components of the vocoded signal alters the relative importance of E or TFS encoding on the nerve, thus facilitating assessment of their relative importance to intelligibility. Here we argue that this assumption is incorrect, and that the vocoder approach is ineffective in differentially altering the neural E and TFS. In fact, we demonstrate using a simplified model of early auditory processing that both neural E and TFS encode the speech spectrogram with constant and comparable relative effectiveness regardless of the vocoder manipulations. However, we also show that neural TFS cues are less vulnerable than their E counterparts under severe noisy conditions, and hence should play a more prominent role in cochlear stimulation strategies.

Objective: This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported disability and handicap, and cognition. Clinical applicability and comparability across different centres are investigated., Design: Headphone tests were conducted in five centres divided over four countries. Effects of test-retest, ear, and centre were investigated. Results for normally-hearing (NH) and hearing-impaired (HI) listeners are presented., Study Sample: Thirty NH listeners aged 19-39 years, and 72 HI listeners aged 22-91 years with a broad range of hearing losses were included., Results: Test-retest reliability was generally good and there were very few right/left ear effects. Results of all tests were comparable across centres for NH listeners after baseline correction to account for necessary differences between test materials. For HI listeners, results were comparable across centres for the language-independent tests., Conclusions: The auditory profile forms a clinical test battery that is applicable in four different languages. Even after baseline correction, differences between test materials have to be taken into account when interpreting results of language-dependent tests in HI listeners.

Objective: The aim of the study was to describe the association between otoacoustic emissions (OAEs), pure-tone thresholds, and self-reported hearing disability., Design: A population-based cohort of 4202 adults was examined with air conduction pure-tone audiometry, transient OAE (TEOAE), and distortion product OAE (DPOAE). Participants completed 15 self-report items on hearing disability., Results: Correlation coefficients in the range of 0.3 to 0.5 were observed between OAE (TEOAE, and DPOAE) and self-reported hearing depending on age and sex. Pure-tone average hearing thresholds generally predicted self-reported hearing slightly better than did the OAE measures. Adding TEOAE and DPOAE as predictors in a multivariate model together with the scores from pure-tone audiometry did not predict self-reported hearing better than did pure-tone audiometry alone. The relationship between OAE and self-reported hearing was stronger in men than in women and became more manifest with age, a trend also stronger in men., Conclusions: OAEs were shown to be a valid measure of self-reported hearing disability of the general population but added no additional information to what pure-tone hearing thresholds had already captured.

Objective: Evaluation of pure-tone audiometry (PTA) in hearing screening of a population with mild to profound intellectual disability (ID)., Design: PTA was performed at six frequencies at the screening level 20 dB HL. Referral criteria were threshold levels ≥ 25 dB HL at two or more frequencies for one ear or both., Study Sample: 1478 participants aged 7-91 years were included., Results: 1470 (99.5%) people cooperated in screening of which 1325 (90%) could be tested on both ears at all six frequencies. A majority, 987 (66.8%), performed ordinary PTA, 234 (15.8%) conditioned play audiometry, and 249 (16.9%) behavioural observation audiometry. Six hundred and sixty-nine (45%) passed and 809 (55%) failed according to referral criteria. Of those failing, 441 (54.5%) accepted referral to clinical evaluation., Conclusions: PTA with slight modifications is applicable for screening of a population with mild to profound intellectual disability. The most challenging and time-consuming activity is to introduce the test procedure in a way that reduces anxiety and establishes trust.

The objective of this study was to find out the perceptions of age and aging among women in Qatar. Respondents consisted of 250 women aged between 20 and 70 years, selected from those attending the health centers in Doha city, the capital of Qatar. They were interviewed using a pretested validated questionnaire, and data were collected through direct face-to-face interviews using the incidental sampling method. It was found that physical appearance and mental alertness were the most important criteria for defining aging in men and women. A statistically significant association was found between age of respondents and physical criteria for aging such as hair color (p < .000) in women and body image in men (p < .0298). As for aging characteristics, decreasing hearing ability (p < .000), performance as before (p < .004), more irritability (p < .0227), ability to travel alone (p < .0429), needs check up (p < .001), and needs a geriatric home (p < .001) were statistically associated with age of women studied. Both positive (socializing factors, independence, housework, retirement, and geriatric care) and negative stereotyping (care for self, learning capabilities, irritability, and worries) with regard to aging were evident among the Qatari women. In general, Qatari women had several positive attitudes toward aging. Such attitudes could be utilized in any health promotion for elderly people.

Background: Despite evidence suggesting inaccuracy in the default fittings provided by hearing aid manufacturers, the use of probe-microphone measures for the verification of fitting accuracy is routinely used by fewer than half of practicing audiologists., Purpose: The present study examined whether self-perception of hearing aid benefit, as measured through the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), differed as a function of hearing aid fitting method, specifically, manufacturer's initial-fit approach versus a verified prescription. The prescriptive fit began at NAL-NL1 targets, with adjustments based on participant request. Each of the two fittings included probe-microphone measurement., Research Design: A counterbalanced, cross-over, repeated-measures, single-blinded design was utilized to address the research objectives., Study Sample: Twenty-two experienced hearing aid users from the general Bay Pines VA Healthcare System audiology clinic population were randomized into one of two intervention groups., Intervention: At the first visit, half of the participants were fit with new hearing aids via the manufacturer's initial fit while the second half were fit to a verified prescription using probe-microphone measurement. After a wear period of 4-6 wk, the participants' hearing aids were refit via the alternate method and worn for an additional 4-6 wk. Participants were blinded to the method of fitting by utilizing probe-microphone measures with both approaches., Data Collection and Analysis: The APHAB was administered at baseline and at the end of each intervention trial. At the end of the second trial period, the participants were asked to identify which hearing aid fitting was "preferred." The APHAB data were subjected to a general linear model repeated-measures analysis of variance., Results: For the three APHAB communication subscales (i.e., Ease of Communication, Reverberation, and Background Noise) mean scores obtained with the verified prescription were higher than those obtained with the initial-fit approach, indicating greater benefit with the former. The main effect of hearing aid fitting method was statistically significant [F (1, 21) = 4.69, p = 0.042] and accounted for 18% of the variance in the data (partial eta squared = 0.183). Although the mean benefit score for the APHAB Aversiveness subscale was also better (i.e., lower) for the verified prescription than the initial-fit approach, the difference was not statistically significant. Of the 22 participants, 7 preferred their hearing aids programmed to initial-fit settings and 15 preferred their hearing aids programmed to the verified prescription., Conclusions: The data support the conclusion that hearing aids fit to experienced hearing aid wearers using a verified prescription are more likely to yield better self-perceived benefit as measured by the APHAB than if fit using the manufacturer's initial-fit approach., (American Academy of Audiology.)

Objectives: Relations between personality and affect are generally regarded as robust. Extraversion is closely linked to positive affect (PA), but not to negative affect (NA), whereas neuroticism is closely linked to NA, but not to PA. We argue in this work that the stress experience associated with age-related vision and hearing impairment may alter this commonly found pattern as compared with sensory unimpaired (UI) older adults., Method: We analyzed data from a sample of severely visually impaired (VI; N = 121), severely hearing impaired (HI; N = 116), and a control condition of sensory UI (grand age mean: 82 years; N = 150)., Results: Based on a structural equation modeling approach, we found that the relationship between extraversion and PA was higher in the UI as compared with the sensory impaired groups. In contrast, the strong linkage between neuroticism and NA was not affected by sensory status. Furthermore, we observed a meaningful negative relation between extraversion and NA only in the VI group., Discussion: Findings support the argument that the relationship between personality and affect deserves qualification when chronic vision and hearing impairment is present.

Distortion-product otoacoustic emission (DPOAE) suppression tuning curves (STCs) were measured in 65 hearing-impaired (HI) subjects at f(2) frequencies of 2.0, 2.8, 4.0, and 5.6 kHz and L(2) levels relative to sensation level (SL) from 10 dB to as much as 50 dB. Best frequency, cochlear-amplifier gain (tip-to-tail difference, T-T), and tuning (Q(ERB)) were estimated from STCs. As with normal-hearing (NH) subjects, T-T differences and Q(ERB) decreased as L(2) increased. T-T differences and Q(ERB) were reduced in HI ears (compared to normal) for conditions in which L(2) was fixed relative to behavioral threshold (dB SL). When STCs were compared with L(2) at constant sound pressure levels (dB SPL), differences between NH and HI subjects were reduced. The large effect of level and small effect of hearing loss were both confirmed by statistical analyses. Therefore, the magnitude of the differences in DPOAE STCs between NH and HI subjects is mainly dependent on the manner in which level (L(2)) is specified. Although this conclusion may appear to be at odds with previous, invasive measures of cochlear-response gain and tuning, the apparent inconsistency may be resolved when the manner of specifying stimulus level is taken into account.

Recent auditory brain stem response measurements in tinnitus subjects with normal audiograms indicate the presence of hidden hearing loss that manifests as reduced neural output from the cochlea at high sound intensities, and results from mice suggest a link to deafferentation of auditory nerve fibers. As deafferentation would lead to deficits in hearing performance, the present study investigates whether tinnitus patients with normal hearing thresholds show impairment in intensity discrimination compared to an audiometrically matched control group. Intensity discrimination thresholds were significantly increased in the tinnitus frequency range, consistent with the hypothesis that auditory nerve fiber deafferentation is associated with tinnitus.

Objective: A review is given of internationally comparable speech-in-noise tests for hearing screening purposes that were part of the European HearCom project. This report describes the development, optimization, and evaluation of such tests for headphone and telephone presentation, using the example of the German digit triplet test. In order to achieve the highest possible comparability, language- and speaker-dependent factors in speech intelligibility should be compensated for., Materials and Methods: The tests comprise spoken numbers in background noise and estimate the speech reception threshold (SRT), i.e. the signal-to-noise ratio (SNR) yielding 50% speech intelligibility., Results: The respective reference speech intelligibility functions for headphone and telephone presentation of the German version for 15 and 10 normal-hearing listeners are described by a SRT of -9.3 ± 0.2 and -6.5 ± 0.4 dB SNR, and slopes of 19.6 and 17.9%/dB, respectively. Reference speech intelligibility functions of all digit triplet tests optimized within the HearCom project allow for investigation of the comparability due to language specificities., Conclusions: The optimization criteria established here should be used for similar screening tests in other languages.

Objective: The acceptable noise level (ANL) test is used for quantification of the amount of background noise subjects accept when listening to speech. This study investigates Danish hearing-aid users' ANL performance using Danish and non-semantic speech signals, the repeatability of ANL, and the association between ANL and outcome of the international outcome inventory for hearing aids (IOI-HA)., Design: ANL was measured in three conditions in both ears at two test sessions. Subjects completed the IOI-HA and the ANL questionnaire., Study Sample: Sixty-three Danish hearing-aid users; fifty-seven subjects were full time users and 6 were part time/non users of hearing aids according to the ANL questionnaire., Results: ANLs were similar to results with American English speech material. The coefficient of repeatability (CR) was 6.5-8.8 dB. IOI-HA scores were not associated to ANL., Conclusions: Danish and non-semantic ANL versions yield results similar to the American English version. The magnitude of the CR indicates that ANL with Danish and non-semantic speech materials is not suitable for prediction of individual patterns of future hearing-aid use or evaluation of individual benefit from hearing-aid features. The ANL with Danish and non-semantic speech materials is not related to IOI-HA outcome.

Objectives/hypothesis: Hypernasality is considered a prevalent speech abnormality that could significantly contribute to the unintelligibility of the hearing-impaired speakers. The aim of this study was to evaluate the effect of cochlear implantation and the duration of hearing loss on nasalance of speech of a postlingually impaired group of Saudi adult patients., Study Design: Retrospective study., Methods: This study included 25 postlingually hearing-impaired patients who underwent cochlear implantation and 25 age-matched control subjects. Patients were divided into three groups according to the duration of hearing loss. The nasometric data of the hearing-impaired group were compared with the control group. Also, the preoperative values were compared with the postoperative values 6, 12, and 24 months after surgery., Results: Significant differences were demonstrated between the preimplantation nasalance scores of the three subgroups and between the patients and control groups. There were statistically significant differences demonstrated between the pre- and the postimplantation nasalance values for the three groups of patients., Conclusion: Cochlear implantation appears to have significant effects on improving the nasalance of the speech of postlingually hearing-impaired adult patients. However, the degree of improvement might vary according to the duration of hearing loss the patients had preimplantation., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Introduction: Tonsil cancer (TC) is a type of head and neck cancer (HNC) that is predominantly associated with infection with human papilloma virus (HPV). In Denmark, the incidence of HPV-related HNC has increased fivefold over the past three decades. HNC more often affects men than women, and HPV-related HNC tends to affect younger age groups than other HNCs. The present study examined the long-term health-related quality of life (QoL) in patients with TC., Material and Methods: A medical anthropological approach was applied using individual qualitative interviews with seven former TC patients. The participants included men and women who had undergone various treatments, i.e. radiation therapy, chemotherapy and operation. Data were analyzed using a narrative methodology., Results: Treatment sequelae peaked within the first three months and included severe pain in the radiated area, nausea and fatigue. Within this period, patients were unable to eat solid food and often had difficulty speaking. Half of the participants lost some of their hearing due to radiation. Even two years after treatment, most participants had persisting sequelae, mainly xerostomia, porous teeth and reduced mobility of the tongue and jaw. Fatigue and difficulties eating and communicating, in particular, had a very negative effect on the participants' psycho-social QoL., Conclusion: This study allowed for a deeper understanding of the negative effects of HNC on patients' QoL. These QoL effects ought to be included in future considerations of HPV vaccination of boys as well as girls., Funding: The study was funded by an unrestricted research grant from Sanofi Pasteur MSD., Trial Registration: not relevant.

Two approaches to the automated detection of alarm sounds are compared, one based on a change in overall sound level (RMS), the other a change in periodicity, as given by the power of the normalized autocorrelation function (PNA). Receiver operating characteristics in each case were obtained for different exemplars of four classes of alarm sounds (bells/chimes, buzzers/beepers, horns/whistles, and sirens) embedded in four noise backgrounds (cafeteria, park, traffic, and music). The results suggest that PNA combined with RMS may be used to improve current alarm-sound alerting technologies for the hard-of-hearing.

Aim: This pilot study uses qualitative methods to learn about the psycho-social needs of people who seek help with hearing loss., Background: There has been some emphasis in health policy to reduce the number of appointments required between assessment of hearing loss and fitting of hearing aids. This may respond to audiological needs but may not address the psycho-social needs. This study piloted a phenomenological approach to identify the patient's perspective., Methods: A phenomenological approach was taken to provide description of patient perspectives. Findings Six patients reported that help-seeking was primarily influenced by the need to appease social partners and to improve hearing performance. Hearing aids were not regarded as acceptable treatments., Conclusions: Service providers need to consider the psycho-social consequences of hearing-aid issue alongside audiological needs.

Objective: The hypersensitivity of children with autism to sound is a relatively unexplained behavior. The goal of the current study was to investigate the DPOAE characteristics of children with autism compared to a control group., Design: DPOAEs with and without contralateral stimuli were measured in two groups in three different conditions., Study Sample: The study employed 14 children with autism and a control group with 28 age-matched participants., Results: In the without-contralateral stimulus condition, the overall S/N of DPOAEs was greater for the control group compared to the autism group (p < 0.0005). For both groups, the DPOAE S/N increased as a function of frequency in both ears. In the with contralateral stimulus condition, group and ear effects were noticed, however, no age, frequency, or contralateral stimulus type (BBN vs. 1000 Hz) effect could be detected., Conclusions: Presence of reduced DPOAEs in the autism group does not support the hypothesis that sound hypersensitivity in children with autism may be related to overactive outer hair cells function; rather it may be due to early cochlear dysfunction. Also, sound hypersensitivity in the autism group may be due to abnormality of the efferent auditory pathway as shown by lack of sufficient contralateral suppression.

Objective: To measure the acceptable noise level (ANL) with and without noise reduction algorithms (NRAs), and to predict ΔANL, i.e. the difference in acceptable noise level with and without NRAs., Design: The ANL test was applied to three NRAs. Furthermore, the measured ΔANL was predicted using several methods based on either the calculation of the signal-to-noise ratio or correlation methods of the processed signals with an unprocessed reference signal., Study Sample: Ten normal-hearing and eleven hearing-impaired subjects accomplished the ANL test., Results: In general, the ANL test could determine an increased acceptance of noise with some NRAs. However, great inter-individual differences also resulted that were attributed to audible distortions when an NRA was used. Prediction of the mean measured DANL was possible, but individual prediction of DANL failed due to inter-individual differences. Mean DANL was predicted more accurately for hearing-impaired subjects when individual hearing loss was taken into account., Conclusions: The ANL test is a suitable tool for measuring the advantage of one NRA. A prediction of the measured individual ΔANL failed. However, mean DANL could be predicted with some methods. Furthermore, the individual hearing loss should be taken into account for a more accurate prediction for hearing-impaired subjects.

Unlabelled: The parents' evaluation of aural/oral performance of children (PEACH) scale was developed to assess the effectiveness of amplification for children, based on a systematic use of parents' observations of children's performance in real-world environments., Objective: The purpose of the present study was to adapt the PEACH scale into the Malay language, and to collect normative data on a group of children with normal hearing., Study Sample: The participants were parents of 74 children aged between 3 months and 13 years of age. Parents were requested to observe their children's auditory/oral behavior in everyday life and to record their observations in the PEACH booklet., Results: High internal consistency (Cronbach's alpha = 0.93) and item-total correlation were found (0.52-0.85). Similar to the published norms for English-speaking children, near-perfect scores were achieved by Malaysian children around 40 months of age., Conclusions: The adapted version can be used to evaluate amplification for children in the Malay speaking environment. The normative curve relating age to scores for the Malay PEACH can be used as a reference against which functional aural/oral performance of hearing-impaired Malaysian children can be evaluated.

Objective: An assessment of the effect of otolaryngological management on the health-related quality of life of patients., Design: Application of the Health Utilities Index mark 3 (HUI-3) before and after treatment; application of the Glasgow Benefit Inventory (GBI) after treatment., Setting: Six otolaryngological departments around Scotland., Participants: A 9005 adult patients referred to outpatient clinics., Main Outcome Measures: Complete HUI-3 data was collected from 4422 patients; complete GBI data from 4235; complete HUI-3 and GBI data from 3884., Results: The overall change in health related quality of life from before to after management was just +0.02. In the majority of subgroups of data (classified by type of management) there was essentially no change in HUI-3 score. The major exceptions were those patients provided with a hearing aid (mean change 0.08) and those whose problem was managed surgically (mean change 0.04). The mean GBI score was 5.3 which is low. Those managed surgically reported a higher GBI score of 13.0., Conclusion: We found that patients treated surgically or given a hearing aid reported a significant improvement in their health related quality of life after treatment in otolaryngology departments. In general, patients treated in other ways reported no significant improvement. We argue that future research should look carefully at patient groups where there is unexpectedly little benefit from current treatment methods and consider more effective methods of management., (© 2011 Blackwell Publishing Ltd.)

Objective: With increasing focus on the consequences of aural rehabilitation for the everyday conversational difficulties arising from adult acquired hearing impairment, this study aimed to compare patterns of repair behaviour arising in conversation and a widely used aural rehabilitation tool, continuous discourse tracking (de Filippo & Scott, 1978), in order to better understand the procedure's role in the assessment and training of repair behaviour., Design: A parallel case study design was adopted. Communication dyads undertook a 20-minute conversation followed by a 20-minute session of tracking. The interactions were audio-recorded, transcribed, and analysed for patterns of repair according to current conversation analytic conventions (Schegloff et al, 1977). The research questions were addressed via both qualitative and quantitative methods., Study Sample: Three communication pairs (dyads), each comprising an adult with acquired hearing impairment and their chosen familiar communication partner, participated in this study., Results: Analysis revealed that patterns of repair were constrained by the task requirement in tracking for the receiver/hearing-impaired adult to repeat text segments spoken by the sender/familiar communication partner with 100% accuracy., Conclusions: Whilst tracking has a number of useful conversational qualities, it may have only limited ecological validity when applied to the evaluation and training of repair behaviour.

Purpose: To investigate the social-cognitive performance of children with diagnostics of autism spectrum disorder (ASD), mental disability (MD) and hearing impairment (HI) in two different communicative situations., Methods: Participated in this study 30 children ages between 3 and 12 years starting speech language therapy processes, divided in three groups: Group 1 - ten children with diagnoses included in the Autism Spectrum Disorders (ASD); Group 2: ten children diagnosed with mental disabilities (MD) and Group 3: ten children diagnosed with hearing impairment (HI). The subjects were assessed in two different communicative situations (group and individual therapy situation) for 12 months., Results: Data regarding the performance of the three groups in the two situations show that G3 had better absolute performance when compared with other groups, with the variable symbolic play as an important differential criterion for the three groups., Conclusion: We conclude that the social-cognitive performance can be used as an auxiliary tool for intervention, helping the identification of variables that could interfere in the communicative performance.

It has long been understood that the level of a sound at the ear is dependent on head orientation, but the way in which listeners move their heads during listening has remained largely unstudied. Given the task of understanding a speech signal in the presence of a simultaneous noise, listeners could potentially use head orientation to either maximize the level of the signal in their better ear, or to maximize the signal-to-noise ratio in their better ear. To establish what head orientation strategy listeners use in a speech comprehension task, we used an infrared motion-tracking system to measure the head movements of 36 listeners with large (>16 dB) differences in hearing threshold between their left and right ears. We engaged listeners in a difficult task of understanding sentences presented at the same time as a spatially separated background noise. We found that they tended to orient their heads so as to maximize the level of the target sentence in their better ear, irrespective of the position of the background noise. This is not ideal orientation behavior from the perspective of maximizing the signal-to-noise ratio (SNR) at the ear, but is a simple, easily implemented strategy that is often effective in an environment where the spatial position of multiple noise sources may be difficult or impossible to determine., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Speech-in-noise-measurements are important in clinical practice and have been the subject of research for a long time. The results of these measurements are often described in terms of the speech reception threshold (SRT) and SNR loss. Using the basic concepts that underlie several models of speech recognition in steady-state noise, the present study shows that these measures are ill-defined, most importantly because the slope of the speech recognition functions for hearing-impaired listeners always decreases with hearing loss. This slope can be determined from the slope of the normal-hearing speech recognition function when the SRT for the hearing-impaired listener is known. The SII-function (i.e., the speech intelligibility index (SII) against SNR) is important and provides insights into many potential pitfalls when interpreting SRT data. Standardized SNR loss, sSNR loss, is introduced as a universal measure of hearing loss for speech in steady-state noise. Experimental data demonstrates that, unlike the SRT or SNR loss, sSNR loss is invariant to the target point chosen, the scoring method or the type of speech material.

Objectives: Hearing impairment constitutes a highly prevalent chronic health condition among older adults worldwide which negatively impacts on communication and health-related quality of life. Irrespective of this, the majority of older adults do not seek professional help for hearing impairment and/or do not obtain hearing aids. Therefore, a new approach for detecting and promoting help-seeking for hearing impairment is needed. The purpose of this study was to investigate the actions taken by those who failed Telscreen, a telephone-based screening tool for hearing loss, and to increase our understanding of factors that influence taking action., Design: A cohort of 193 participants (112 females, 81 males; age range 24-93 yr) who had failed Telscreen participated in a follow-up telephone interview 4 to 5 mo later. Participants were asked why they called Telscreen, about their hearing ability, their Telscreen result, and what action they had taken toward hearing rehabilitation. One outcome measure was identified: decision to seek professional help for hearing impairment (yes/no). Given that the outcome measure was dichotomized, a logistic regression model for binary outcomes was fitted to the data., Results: Of the 193 participants who failed Telscreen, only 36% sought help from a range of sources (e.g., audiologist, hearing service or hearing aid provider, and family doctor). Results of the logistic regression analysis indicated that individuals who had considered hearing aids before calling Telscreen and/or who recalled their Telscreen result were significantly more likely to seek professional help for their hearing impairment. Nineteen participants who sought help for their hearing impairment had hearing aid fitting recommended to them. Eight participants had aid/s fitted, and of these, six reported a successful outcome., Conclusions: For every 100 individuals who fail a hearing screening, only 36 seek help. Of these 36 individuals who take some action, 13 are recommended hearing aids, approximately half of whom follow this advice and obtain hearing aids. Approximately three-quarters of these individuals use and value their hearing aids. Provided that the screening is automated and low cost, hearing screening via telephone has proven to change the lives of 5% of individuals who decided to seek professional help for hearing impairment at little cost to the other 95% of individuals. Suggestions for future research based on the present research findings are discussed.

Human listeners prefer consonant over dissonant musical intervals and the perceived contrast between these classes is reduced with cochlear hearing loss. Population-level activity of normal and impaired model auditory-nerve (AN) fibers was examined to determine (1) if peripheral auditory neurons exhibit correlates of consonance and dissonance and (2) if the reduced perceptual difference between these qualities observed for hearing-impaired listeners can be explained by impaired AN responses. In addition, acoustical correlates of consonance-dissonance were also explored including periodicity and roughness. Among the chromatic pitch combinations of music, consonant intervals/chords yielded more robust neural pitch-salience magnitudes (determined by harmonicity/periodicity) than dissonant intervals/chords. In addition, AN pitch-salience magnitudes correctly predicted the ordering of hierarchical pitch and chordal sonorities described by Western music theory. Cochlear hearing impairment compressed pitch salience estimates between consonant and dissonant pitch relationships. The reduction in contrast of neural responses following cochlear hearing loss may explain the inability of hearing-impaired listeners to distinguish musical qualia as clearly as normal-hearing individuals. Of the neural and acoustic correlates explored, AN pitch salience was the best predictor of behavioral data. Results ultimately show that basic pitch relationships governing music are already present in initial stages of neural processing at the AN level., (© 2011 Acoustical Society of America)