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Objectives: A wide variety of intraoperative tests are available in cochlear implantation. However, no consensus exists on which tests constitute the minimum necessary battery. We assembled an international panel of clinical experts to develop, refine, and vote upon a set of core consensus statements., Design: A literature review was used to identify intraoperative tests currently used in the field and draft a set of provisional statements. For statement evaluation and refinement, we used a modified Delphi consensus panel structure. Multiple interactive rounds of voting, evaluation, and feedback were conducted to achieve convergence., Results: Twenty-nine provisional statements were included in the original draft. In the first voting round, consensus was reached on 15 statements. Of the 14 statements that did not reach consensus, 12 were revised based on feedback provided by the expert practitioners, and 2 were eliminated. In the second voting round, 10 of the 12 revised statements reached a consensus. The two statements which did not achieve consensus were further revised and subjected to a third voting round. However, both statements failed to achieve consensus in the third round. In addition, during the final revision, one more statement was decided to be deleted due to overlap with another modified statement., Conclusions: A final core set of 24 consensus statements was generated, covering wide areas of intraoperative testing during CI surgery. These statements may provide utility as evidence-based guidelines to improve quality and achieve uniformity of surgical practice., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Objective: The effectiveness of audiological monitoring for detecting early hearing changes in patients receiving ototoxic medication could be limited by the lack of adequate audiological ototoxicity monitoring (OtoM) guidelines. This study aimed to evaluate existing OtoM guidelines using the AGREE II tool for guideline evaluation., Design: Guideline Review., Study Sample: Three audiological OtoM guidelines., Results: An online search identified three audiological OtoM guidelines published by the American Speech-Language and Hearing Association (ASHA), the American Academy of Audiology (AAA) and the Health Professionals Council of South Africa (HPCSA). Evaluation using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool found the HPCSA audiological OtoM guideline scored higher than the ASHA and AAA guidelines in five of the six tool domains. All guidelines received average domain ratings of less than 50% with each reviewer recommending all three guidelines for use following modification., Conclusion: The findings of this study could partly explain the poor uptake of audiological OtoM practices internationally, further investigation is needed to identify the specific factors limiting the implementation of audiological OtoM in clinical practice.

Objective: Recognition of familiar noises is crucial for understanding and reacting appropriately to our auditory environment. Its improvement is one of the benefits expected after cochlear implantation. The aim of this study was to standardize three environmental sounds noise recognition tests and to illustrate their application to a population of deaf adults with cochlear implants., Method: Norms were established on a sample of 126 normal-hearing adults divided into 6 age groups. Three familiar sound recognition tests were used: 1) the Blue Mouse "First Familiar Sounds" (BM), 2) the UCL-IRSA test (TI), and 3) the Bernadette Piérart Familiar Sounds Test (TBF). These tests were also administered to 61 implanted deaf ears., Results: We observed a significant effect of age on the accuracy scores of the TI and TBF tests for the hearing group and on the time scores of the TI and BM tests. Overall, the performance of the deaf participants was poorer and more variable than that of the hearing participants., Conclusion: We have three tests that can be used in practice to measure the performance of deaf people (with cochlear implants) at different stages of their pre- and post-implant rehabilitation., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Aim: To review existing guidelines for universal newborn hearing screening (UNHS), identify those that provide comprehensive and clear recommendations on the subject, and provide a brief overview., Method: A scoping literature review was performed in PubMed, the Guidelines International Network library, and national guideline databases to identify guidelines on newborn hearing screening developed or updated between 2004 and 2019. The quality of the guidelines was checked with the Checklist for the Quality Assessment of Guidelines (AGREE II)., Results: Six guidelines met all the inclusion criteria. All six were based on the 1-3-6 benchmark (screening completed by 1mo, audiological diagnosis by 3mo, enrolment in early intervention by 6mo). However, the guidelines varied in terms of their recommendations for the application of screening methods, role of health professionals in the screening process, and quality. Based on the AGREE II score, flexibility, adaptability, and foundation role for all other guidelines, the 2019 guidelines of the Joint Committee on Infant Hearing position statement were identified as the most appropriate to be recommended for adaptation by countries or programmes., Interpretation: The diversity in the existing guidance can be confusing for countries and institutions that are planning to develop universal hearing screening programmes. As more countries and organizations develop their newborn hearing screening programmes, they will need examples to emulate. This review provides an evaluation of the quality, comprehensiveness, and applicability of existing clinical guidelines that can serve as a facilitator for countries, institutions, or organizations in their planning and implementation of a UNHS programme., (© 2020 Mac Keith Press.)

Auditory brain stem response (ABR) and compound action potential (CAP) recordings have been used in animal research to determine hearing sensitivity. Because of the relative ease of testing, the ABR test has been more commonly used in assessing cochlear lesions than the CAP test. The purpose of this experiment is to examine the difference between these two methods in monitoring the dynamic changes in auditory function after cochlear damage and in detecting asymmetric hearing loss due to unilateral cochlear damage. ABR and CAP were measured in two models of cochlear damage: acoustic trauma induced by exposure to a narrowband noise centered at 4 kHz (2,800-5,600 Hz) at 105 dB sound pressure level for 5 h in chinchillas and unilateral cochlear damage induced by surgical destruction of one cochlea in guinea pigs. Cochlear hair cells were quantified after completing the evoked potential testing. In the noise-damaged model, we found different recovery patterns between ABR and CAP. At 1 day after noise exposure, the ABR and CAP assessment revealed a similar level of threshold shifts. However, at 30 days after noise exposure, ABR thresholds displayed an average of 20-dB recovery, whereas CAP thresholds showed no recovery. Notably, the CAP threshold signifies the actual condition of sensory cell pathogenesis in the cochlea because sensory cell death is known to be irreversible in mammals. After unilateral cochlear damage, we found that both CAP and ABR were affected by cross-hearing when testing the damaged ear with the testing stimuli delivered directly into the canal of the damaged ear. When cross-hearing occurred, ABR testing was not able to reveal the presence of cross-hearing because the ABR waveform generated by cross-stimulation was indistinguishable from that generated by the test ear (damaged ear), should the test ear be intact. However, CAP testing can provide a warning sign, since the typical CAP waveform became an ABR-like waveform when cross-hearing occurred. Our study demonstrates two advantages of the CAP test over the ABR test in assessing cochlear lesions: contributing evidence for the occurrence of cross-hearing when subjects have asymmetric hearing loss and providing a better assessment of the progression of cochlear pathogenesis. NEW & NOTEWORTHY Auditory brain stem response (ABR) is more commonly used to evaluate cochlear lesions than cochlear compound action potential (CAP). In a noise-induced cochlear damage model, we found that the reduced CAP and enhanced ABR caused the threshold difference. In a unilateral cochlear destruction model, a shadow curve of the ABR from the contralateral healthy ear masked the hearing loss in the destroyed ear.

Objective: To evaluate Newborn Hearing Screening Program of Hospital Regional de Sobradinho, from January 2016 to December 2017, according to Multiprofessional Committee on Auditory Health parameters and Joint Committee on Infant Hearing (JCIH) recommendations, as well as to describe the prevalence of risk factors for hearing loss within the study population and their impact on the respective program., Method: This is a quantitative, cross-sectional and retrospective study that carefully analyzed registration books of screened newborns. It was established the prevalence of "pass" and "fail" in test and retest, retest percentage of attendance and referral for audiological diagnosis. Risk factors for hearing loss were described, as well as their influence on "pass" and "fail" rates. Inferential statistical analysis was performed using chi-square test and Anderson-Darling test, with 5% reliability index., Results: A total of 3,981 newborns were screened; 2,963 (74.4%) presented no risk factors whereas 1,018 (25.6%) did, prematurity being the most frequent (51.6%). In the test, 166 (4.2%) failed and 118 (71.1%) attended the retest. The referral rate for diagnosis was 0.3%., Conclusion: Regarding the percentage of referral for diagnosis, the program reached indexes recommended by the Joint Committee on Infant Hearing and Multiprofessional Committee on Auditory Health. The most prevalent risk factor within the population was prematurity.

Objective: In occupational hearing conservation programmes, age adjustments may be used to subtract expected age effects. Adjustments used in the U.S. came from a small dataset and overlooked important demographic factors, ages, and stimulus frequencies. The present study derived a set of population-based age adjustment tables and validated them using a database of exposed workers. Design: Cross-sectional population-based study and retrospective longitudinal cohort study for validation. Study sample: Data from the U.S. National Health and Nutrition Examination Survey (unweighted n  = 9937) were used to produce these tables. Male firefighters and emergency medical service workers (76,195 audiograms) were used for validation. Results: Cross-sectional trends implied less change with age than assumed in current U.S. regulations. Different trends were observed among people identifying with non-Hispanic Black race/ethnicity. Four age adjustment tables (age range: 18-85) were developed (women or men; non-Hispanic Black or other race/ethnicity). Validation outcomes showed that the population-based tables matched median longitudinal changes in hearing sensitivity well. Conclusions: These population-based tables provide a suitable replacement for those implemented in current U.S. regulations. These tables address a broader range of worker ages, account for differences in hearing sensitivity across race/ethnicity categories, and have been validated for men using longitudinal data.

Purpose Because of uncertainty about the level of hearing where hearing aids should be provided to children, the goal of the current study was to develop audibility-based hearing aid candidacy criteria based on the relationship between unaided hearing and language outcomes in a group of children with hearing loss who did not wear hearing aids. Method Unaided hearing and language outcomes were examined for 52 children with mild-to-severe hearing losses. A group of 52 children with typical hearing matched for age, nonverbal intelligence, and socioeconomic status was included as a comparison group representing the range of optimal language outcomes. Two audibility-based criteria were considered: (a) the level of unaided hearing where unaided children with hearing loss fell below the median for children with typical hearing and (b) the level of unaided hearing where the slope of language outcomes changed significantly based on an iterative, piecewise regression modeling approach. Results The level of unaided audibility for children with hearing loss that was associated with differences in language development from children with typical hearing or based on the modeling approach varied across outcomes and criteria but converged at an unaided speech intelligibility index of 80. Conclusions Children with hearing loss who have unaided speech intelligibility index values less than 80 may be at risk for delays in language development without hearing aids. The unaided speech intelligibility index potentially could be used as a clinical criterion for hearing aid fitting candidacy for children with hearing loss.

Swept tones allow the efficient measurement of otoacoustic emissions (OAEs) with fine frequency resolution. Although previous studies have explored the influence of different sweep parameters on the measured OAE, none have directly considered their effects on the measurement noise floor. The present study demonstrates that parameters such as sweep type (e.g., linear or logarithmic), sweep rate, and analysis bandwidth affect the measurement noise and can be manipulated to control the noise floor in individual subjects. Although responses to discrete-tone stimuli can be averaged until the uncertainty of the measurement meets a specified criterion at each frequency, linear or logarithmic sweeps offer no such flexibility. However, measurements of the power spectral density of the ambient noise can be used to construct variable-rate sweeps that yield a prescribed (e.g., constant) noise floor across frequency; in effect, they implement a form of frequency-dependent averaging. The use of noise-compensating frequency sweeps is illustrated by the measurement of distortion-product OAEs at low frequencies, where the ear-canal noise is known to vary significantly.

Introduction: There is evidence pointing to the importance of the evaluation of musical perception through objective and subjective instruments. In Brazil, there is a shortage of instruments that evaluates musical perception., Objective: To develop an instrument to evaluate the recognition of traditional Brazilian melodies and investigate the performance of children with typical hearing., Methods: The study was carried out after approval of the research ethics committee (1.198.607). The instrument was developed in software format with website access, using the languages PHP 5.5.12, Javascript, Cascade style sheets and "HTML5"; database "MYSQL 5.6.17" on the "Apache 2.4.9" server. Fifteen melodies of Brazilian folk songs were recorded in piano synthesized timbre, with 12 seconds per melody reproduction and four second intervals between them. A total of 155 schooled children, aged eight to 11 years, of both sexes, with typical hearing participated in the study. The test was performed in a silent room with sound stimuli amplified by a sound box at 65dBNA, positioned at 0 azimuth, and at one meter from the participant, the notebook was used for children to play with on the screen on the title and illustration of the melody they recognized they were listening to. The responses were recorded on their own database., Results: The instrument titled "Evaluation of recognition of traditional melodies in children" can be run on various devices (computers, notebooks, tablets, mobile phones) and operating systems (Windows, Macintosh, Android, Linux). Access: http://192.185.216.17/ivan/home/login.php by login and password. The most easily recognized melody was "Cai, cai balão" (89%) and the least recognized was "Capelinha de melão" (25.2%). The average time to perform the test was 3'15″., Conclusion: The development and application of the software proved effective for the studied population. This instrument may contribute to the improvement of protocols for the evaluation of musical perception in children with hearing aid and/or cochlear implants users., (Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: Develop valid and defensible hearing standards for Ontario constables to ensure safe and efficient operations. Design: Research involved three steps: (1) identification of hearing critical (HC) tasks, (2) characterisation of real-world noise environments where these tasks are performed (3) and establishment of screening criteria and protocols for determining fitness for duty. Study sample: Three panels of subject matter experts (SMEs) from different Ontario police services participated in Steps 1 and 3. Result: Fifty-one HC tasks conducted in 25 different environments were identified. Acceptable levels of speech communication in noise were based on environments with the highest frequency, importance and difficulty ratings. The ability to understand soft speech was also deemed critical. These translated into a 2 dB maximum elevation in the Noise Composite speech recognition threshold (SRT) with the Hearing-In-Noise-Test and a threshold in quiet of 35 dBA or better. Conclusions : Speech communication modelling methodology greatly facilitates the task of developing fitness for duty hearing standards, but participation of SMEs is crucial for face validity.

Objective: The stimuli used to evoke otoacoustic emissions (OAEs) are typically calibrated based on the total SPL measured at the probe microphone. However, due to the acoustics of the ear-canal space (i.e., standing-wave interference), this method can underestimate the stimulus pressure reaching the tympanic membrane at certain frequencies. To mitigate this effect, stimulus calibrations based on forward pressure level (FPL) can be applied. Furthermore, the influence of ear-canal acoustics on measured OAE levels can be compensated by expressing them in emitted pressure level (EPL). To date, studies have used artificial shallow versus deep probe fits to assess the effects of calibration method on changes in probe insertion. In an attempt to better simulate a clinical setting, the combined effects of FPL calibration of stimulus level and EPL compensation of OAE level on response variability during routine (noncontrived) probe fittings were examined., Design: The distortion component of the distortion-product OAE (DPOAE) and the stimulus-frequency OAE (SFOAE) were recorded at low and moderate stimulus levels in 20 normal-hearing young-adult subjects across a five-octave range. In each subject, three different calibration approaches were compared: (1) the conventional SPL-based stimulus calibration with OAE levels expressed in SPL; (2) FPL stimulus calibration with OAEs expressed in SPL; and (3) FPL stimulus calibration with OAEs expressed in EPL. Test and retest measurements were obtained during the same session and, in a subset of subjects, several months after the initial test. The effects of these different procedures on the inter- and intra-subject variability of OAE levels were assessed across frequency and level., Results: There were no significant differences in the inter-subject variability of OAE levels across the three calibration approaches. However, there was a significant effect on OAE intra-subject variability. The FPL/EPL approach resulted in the overall lowest test-rest differences in DPOAE level for frequencies above 4 kHz, where standing-wave interference is strongest. The benefit was modest, ranging on average from 0.5 to 2 dB and was strongest at the lower stimulus level. SFOAE level variability did not show significant differences among the three procedures, perhaps due to insufficient signal-to-noise ratio and nonoptimized stimulus levels. Correlations were found between the short-term replicability of DPOAEs and the benefit derived from the FPL/EPL procedure: the more variable the DPOAE, the stronger the benefit conferred by the advanced calibration methods., Conclusions: Stimulus and response calibration procedures designed to mitigate the effects of standing-wave interference on both the stimulus and the OAE enhance the repeatability of OAE measurements and reduce their dependence on probe position, even when probe shifts are small. Modest but significant improvements in short-term test-retest repeatability were observed in the mid- to high-frequency region when using combined FPL/EPL procedures. The authors posit that the benefit will be greater in a more heterogeneous group of subjects and when different testers participate in the fitting and refitting of subjects, which is a common practice in the audiology clinic. The impact of calibration approach on OAE inter-subject variability was not significant, possibly due to a homogeneous subject population and because factors other than probe position are at play.

Middle ear muscle contractions (MEMC) can be elicited in response to high-level sounds, and have been used clinically as acoustic reflexes (ARs) during evaluations of auditory system integrity. The results of clinical AR evaluations do not necessarily generalize to different signal types or durations. The purpose of this study was to evaluate the likelihood of observing MEMC in response to brief sound stimuli (tones, recorded gunshots, noise) in adult participants (N = 190) exhibiting clinical ARs and excellent hearing sensitivity. Results revealed that the presence of clinical ARs was not a sufficient indication that listeners will also exhibit MEMC for brief sounds. Detection rates varied across stimulus types between approximately 20% and 80%. Probabilities of observing MEMC also differed by clinical AR magnitude and latency, and declined over the period of minutes during the course of the MEMC measurement series. These results provide no support for the inclusion of MEMC as a protective factor in damage-risk criteria for impulsive noises, and the limited predictability of whether a given individual will exhibit MEMC in response to a brief sound indicates a need to measure and control for MEMC in studies evaluating pharmaceutical interventions for hearing loss.

The study aimed to describe ages at identification and initiation of early intervention (EI) services for children enrolled in centre-based EI programmes in Gauteng, as well as to describe the nature of EI services that the children received. The researchers conducted retrospective record reviews of the EI programme files. In addition, caregivers of eight children identified with hearing impairments and enrolled in centre-based EI programmes in Gauteng completed a newly constructed questionnaire. The caregiver questionnaire produced data pertaining to the child's family demographics, background information and schooling history. Descriptive statistics were used to analyse the data, using frequency distribution and measures of central tendency. None of the children received newborn hearing screening services, thus they were identified late following maternal suspicion of hearing impairment. Late identification of the hearing impairment resulted in suboptimal initiation of EI services. All the children received aural habilitation and/or speech-language therapy services. These findings indicate that there is a great need for the establishment of widespread early hearing detection and intervention programmes that will lead to earlier identification of infant and childhood hearing impairment and timely initiation of EI services.

Purpose This study assessed the confidence of speech-language pathologists (SLPs) and school psychologists (SPs) in working with children with hearing loss (HL) and other co-occurring disabilities. Professionals' opinions on barriers to and importance of interdisciplinary collaboration were also of interest. Method A 59-item online survey was distributed to SLPs and SPs in the United States through state professional organizations and social media posts. A total of 320 respondents completed the survey and met criteria. Perceptions of confidence across 5 different skill set types were assessed, along with experiences and attitudes concerning professional training and interdisciplinary collaboration. Results A 2-way analysis of variance revealed significant main effects of profession and skill set type on professionals' confidence in assessing a student with HL and other co-occurring disabilities, as well as their confidence in determining the etiology of a student's difficulties. Results from a multiple linear regression revealed the number of students worked with who have HL and the amount of training in graduate school as significant predictors of confidence in both aforementioned skill set types. Results indicate that respondents value interdisciplinary collaboration but that time and access to other professionals are barriers to collaboration. Conclusions Results of the current study indicate that many school-based SLPs and SPs have insufficient training or experience in working with students who have HL and other co-occurring disabilities. Limited training and experience with this unique population among practitioners have the potential to affect the quality of services provided to these students and thus need to be addressed within the school system and the fields of school psychology and speech-language pathology. Supplemental Material https://doi.org/10.23641/asha.7772867.

Purpose Clinical services for tinnitus are needed by millions of people annually. These services have not been standardized, and patients are vulnerable to receiving services that may appear legitimate but are not based on research evidence. The purpose of this clinical focus article is to promote standardization of tinnitus services by proposing an efficient clinical protocol for audiologists. Method The suggested clinical protocol is based primarily on research conducted at the National Center for Rehabilitative Auditory Research for the past 2 decades, with the focus on 2 randomized controlled trials completed recently that showed efficacy of an audiologic protocol involving hearing aids and brief tinnitus counseling. The protocol is mostly consistent with clinical practice guidelines that have been published. Results The two National Center for Rehabilitative Auditory Research randomized controlled trials revealed significant reduction of tinnitus functional effects for both hearing aids and "combination instruments" (hearing aids with a built-in sound generator), although there were no significant differences between devices. Existing clinical practice guidelines for tinnitus are summarized with respect to their common recommendations for assessment and intervention. Conclusions A defined clinical protocol is suggested for audiologists, which includes a case history, appropriate referral, audiologic assessment, use of the Tinnitus and Hearing Survey ( Henry, Griest, et al., 2015 ), brief tinnitus counseling, hearing aids or combination instruments as warranted, follow-up assessment, and criteria for determining if further tinnitus-specific services are needed. Use of this protocol can help to promote standardization of tinnitus practice by audiologists.

: This short review article gives an introduction to some of the fundamental concepts and challenges facing measurement in hearing healthcare practice and research. The impact of hearing loss almost always extends beyond the sensory impairment itself, even when the measured degree of audiometric loss is mild. Yet, going beyond audibility, into the realm of measuring impact, takes us into a much more complex and less well-defined space. How does one therefore best measure the therapeutic benefit for evaluating efficacy or for clinical practice audit? Three case studies illustrate approaches to overcome such challenges. Each example highlights the importance of thinking critically about what it is one is seeking trying to measure, rather than selecting a questionnaire instrument based simply on its popularity or accessibility. We conclude by highlighting the important role that clinicians can play in collecting clinical data about their preferred instruments so that we have some evidence to inform decisions about good practice (content validity etc.). We would also strongly support open data sharing as we think that this is one of the best ways to make the most rapid progress the field.

Pure-tone threshold audiometry is currently the standard test of hearing. However, in everyday life, we are more concerned with listening to speech of moderate loudness and, specifically, listening to a particular talker against a background of other talkers. FreeHear delivers strings of three spoken digits (0-9, not 7) against a background babble via three loudspeakers placed in front and to either side of a listener. FreeHear is designed as a rapid, quantitative initial assessment of hearing using an adaptive algorithm. It is designed especially for children and for testing listeners who are using hearing devices. In this first report on FreeHear, we present developmental considerations and protocols and results of testing 100 children (4-13 years old) and 23 adults (18-30 years old). Two of the six 4 year olds and 91% of all older children completed full testing. Speech reception threshold (SRT) for digits and noise colocated at 0° or separated by 90° both improved linearly across 4 to 12 years old by 6 to 7 dB, with a further 2 dB improvement for the adults. These data suggested full maturation at approximately 15 years old SRTs at 90° digits/noise separation were better by approximately 6 dB than SRTs colocated at 0°. This spatial release from masking did not change significantly across age. Test-retest reliability was similar for children and adults (standard deviation of 2.05-2.91 dB SRT), with a mean practice improvement of 0.04-0.98 dB. FreeHear shows promise as a clinical test for both children and adults. Further trials in people with hearing impairment are ongoing.

Background: Audiology clinics have many tools available to evaluate auditory and vestibular complaints. However, many tools lack established normative ranges across the life span. We conducted this study to establish reference ranges across the life span for audiology/vestibular measures commonly used to evaluate patients with traumatic brain injury., Materials and Methods: In this repeated measures study, 75 adults, ages 18-65 years, without a history of traumatic brain injury, underwent robust auditory/vestibular evaluations three times over six months, including rotational chair, videonystagmography, computerized dynamic posturography, vestibular evoked myogenic potentials, and retinal fundoscopy., Results: Age effect was notable for transient evoked otoacoustic emissions, pure-tone audiometry, auditory brainstem response, auditory middle latency response, and auditory-steady state response at 4000 hertz (Hz). Older participants (50-65 years) were more likely to have delayed latency horizontal saccades, positional nystagmus, slowed lower-extremity motor control responses, and delayed latency ocular vestibular evoked myogenic potentials. Low to mid-frequency horizontal (0.003-4 Hz) and mid-frequency vertical (1-3 Hz) vestibulo-ocular reflex, otolith-mediated reflexes, dynamic visual acuity and balance measures were generally not influenced by age. Females had larger static subjective visual testing offset angles, longer cervical vestibular evoked myogenic potential P1 latency, faster velocity horizontal saccades, and quicker motor control latency for large backward translations than age-matched males., Conclusion: These reference ranges can be used to discern impairment within the auditory and vestibular pathway following traumatic brain injury in young to middle-aged adults., Id: TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01925963., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)

Background and Aims: Eustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustachian tube opening and closure, which may be associated with severe symptoms and middle ear disease. Currently the diagnosis of obstructive and patulous forms of ETD is primarily based on non-specific symptoms or examination findings, rather than measurement of the underlying function of the Eustachian tube. This has proved problematic when selecting patients for treatment, and when designing trial inclusion criteria and outcomes. This study aims to determine the correlation and diagnostic value of various tests of ET opening and patient reported outcome measures (PROMs), in order to generate a recommended diagnostic pathway for ETD., Methods: Index tests included two PROMs and 14 tests of ET opening (nine for obstructive, five for patulous ETD). In the absence of an accepted reference standard two methods were adopted to establish index test accuracy: expert panel diagnosis and latent class analysis. Index test results were assessed with Pearson correlation and principle component analysis, and test accuracy was determined. Logistic regression models assessed the predictive value of grouped test results., Results: The expert panel diagnosis and PROMs results correlated with each other, but not with ET function measured by tests of ET opening. All index tests were found to be feasible in clinic, and acceptable to patients. PROMs had very poor specificity, and no diagnostic value. Combining the results of tests of ET function appeared beneficial. The latent class model suggested tympanometry, sonotubometry and tubomanometry have the best diagnostic performance for obstructive ETD, and these are included in a proposed diagnostic pathway., Conclusions: ETD should be diagnosed on the basis of clinical assessment and tests of ET opening, as PROMs have no diagnostic value. Currently diagnostic uncertainty exists for some patients who appear to have intermittent ETD clinically, but have negative index test results., Competing Interests: The authors have declared that no competing interests exist.

Background: The prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses' current experiences of screening and caring for long-term care residents who have dementia and sensory impairment., Methods: As part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis., Results: Following a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed., Conclusions: Nurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.

Purpose: To validate the accuracy of an internet-based speech-in-noise hearing screening test for high-frequency hearing loss (HFHL) 'Occupational Earcheck (OEC)' incorporating an automatic conditional rescreening, in an occupationally noise-exposed population. Secondary objectives were to assess the effects of age on test accuracy measures, and to assess the test accuracy for different degrees of HFHL., Methods: A study was conducted on cross-sectional data of occupational audiometric examinations, including the index test OEC and reference standard pure-tone air conduction audiometry, of 80 noise-exposed workers. Sensitivity, specificity, and likelihood ratios were calculated for the OEC, after automatic conditional rescreening, for a younger and an older age group, and for two degrees of HFHL (HFHL 25 : PTA3,4,6 ≥ 25 dB HL, and HFHL 35 : PTA3,4,6 ≥ 35 dB HL, both for at least one ear)., Results: Test specificity for HFHL 25 after a single test was 63%, and improved to 93% after the automatic conditional rescreen. Test sensitivity for HFHL 25 decreased from 65% to 59%. Test sensitivity and specificity including automatic conditional rescreening for HFHL 35 was 94% and 90%, respectively. The positive likelihood ratio for HFHL 25 was 8.4, and for HFHL 35 9.4. The negative likelihood ratio for HFHL 35 was below 0.1., Conclusions: The OEC is an appropriate screening test, especially for HFHL 35 . Normal-hearing workers who obtained a positive test result for the first test for one or two ears, benefit from having an automatic rescreen, resulting in an improvement of the test specificity, and hence prevent unnecessary referral.

A Bayesian adaptive procedure, the interleaved-equal-loudness contour (IELC) procedure, was developed to improve the efficiency in estimating the equal-loudness contour. Experiment 1 evaluated the test-retest reliability of the IELC procedure using six naive normal-hearing listeners. Two IELC runs of 200 trials were conducted and excellent test-retest reliability was found at both the group and individual levels. Using the same group of listeners, Experiment 2 compared the IELC procedure to two other procedures that required frequency-by-frequency testing. One of these procedures was the commonly adopted interleaved staircase (ISC) procedure from Jesteadt [(1980). Atten. Percept. Psychophys. 28 , 85-88]. The other procedure, the interleaved maximum-likelihood (IML) procedure, was a modification of the updated maximum-likelihood procedure [Shen and Richards (2012). J. Acoust. Soc. Am. 132 , 957-967]. For each of the ISC and IML procedures, two runs of approximately 500 trials were conducted, followed by one additional IELC run. The test-retest reliability of the IELC procedure was comparable to that of the ISC and IML procedure. The accuracies of all three procedures measured in Experiment 2 were similar, which was superior to the accuracies of the IELC runs from Experiment 1, indicating a potential training effect.

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.

Objectives: One of the most important factors that can improve hearing screening indicators is testing infants after 48 h of birth. The neonatal thyroid screening program is done during the third to fifth day after birth in many countries. So this screening is done at the appropriate time for hearing screening. The aim of the present study was to evaluate hearing screening outcomes (the referral rate, false positive rate, and positive predictive value) conducted with the thyroid screening at the healthcare centers and compare the results with hospital before discharge the infant., Methods: This was a prospective exploratory cohort study. The study population included all the newborns at a hospital (group 1) and newborns who were referred to healthcare centers for thyroid screening (group 2), except for infants with risk factors, from March 2012 to December 2017. Transient evoked otoacoustic emissions (TEOAE) and automatic auditory brainstem response (AABR) were used for the evaluation. The results were compared between the two groups., Results: Of the 4729 newborns, who participated in the study, 3001 were referred from a hospital (group 1) and 1728 from two healthcare centers (group 2). The referral rate in group 1 and 2 was 16.1% and 7.6%, respectively. Also, the false positive rate in group 1 and 2 was 15.9% and 7.6%, respectively. Our study showed that the referral rate and false positive rate of hearing screening in group 2 were significantly lower than that in group 1 (p < 0.001). The positive predictive value in group 1 was significantly higher than that in group 2 (p < 0.05). There was no significant sex difference in any of the variables., Conclusions: Our results showed that performing the hearing screening during the thyroid program, instead of the hospital could be significantly improved screening outcomes and suggest that hearing and thyroid screening together after discharge from the hospital could be a good opportunity to introduce new framework for hearing screening in many countries., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To raise awareness and propose a good practice guide for translating and adapting any hearing-related questionnaire to be used for comparisons across populations divided by language or culture, and to encourage investigators to publish detailed steps., Design: From a synthesis of existing guidelines, we propose important considerations for getting started, followed by six early steps: (1) Preparation, (2, 3) Translation steps, (4) Committee Review, (5) Field testing and (6) Reviewing and finalising the translation., Study Sample: Not applicable., Results: Across these six steps, 22 different items are specified for creating a questionnaire that promotes equivalence to the original by accounting for any cultural differences. Published examples illustrate how these steps have been implemented and reported, with shared experiences from the authors, members of the International Collegium of Rehabilitative Audiology and TINnitus research NETwork., Conclusions: A checklist of the preferred reporting items is included to help researchers and clinicians make informed choices about conducting or omitting any items. We also recommend using the checklist to document these decisions in any resulting report or publication. Following this step-by-step guide would promote quality assurance in multinational trials and outcome evaluations but, to confirm functional equivalence, large-scale evaluation of psychometric properties should follow.

Objective: Significant differences in performance on an eclectic German test battery for Auditory Processing Disorders (APD) was found in the most diagnostic tools between children with APD and controls in the 2nd, 3rd and 4th school year of primary education. Aim of the present study was to examine whether it is also the case for first graders., Material and Methods: The performance in the behavioral test battery (including 14 specific auditory tests) was compared in two subject groups (aged 6-8 yrs): 41 first graders with APD of a clinical database, 37 typically developing first graders without APD (controls)., Results: Significant mean group differences were detected in the performance on 12 of 14 tests, because children with APD showed lower scores (excepted from two PaTsy-subtests: sound frequencies; sound intensities). The significance concerning the monaural threshold values narrowly retained statistical significance with Bonferroni correction. The controls mastered the PaTsy-subtests only in 86-89 % of all cases, children with APD in 73-83 %. The test scores of both boys and girls with APD were lower than those of their peers without APD., Conclusions: First graders with versus without APD could be significantly distinguished. Generally, there was seen a trend that in first graders the same performance was reduced as in elementary school pupils of higher grade level. For use in clinical diagnosis of APD, nonverbal auditory tests for the investigated specific age segment appears debatable., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To estimate normative values and repeatability of thresholds for the TEN(HL) test for diagnosing dead regions in the cochlea, as a function of signal frequency, TEN(HL) level, age and gender., Design: The TEN(HL) test was administered twice for each ear of each participant using signal frequencies from 0.5 to 4 kHz and TEN(HL) levels of 30, 50 and 70 dB HL/ERB N ., Study Sample: In all, 29 young participants and 8 older participants were tested. All had normal audiograms with no history of hearing problems., Results: There was good repeatability across sessions. There was no significant effect of ear, gender or age group. The average signal-to-TEN ratio (STR) at threshold was close to 0 dB. For low signal frequencies, the STR at threshold varied only slightly with TEN(HL) level, but for the signal frequencies of 3 and 4 kHz the STR at threshold increased to about +2.7 dB for the TEN(HL) level of 70 dB/ERB N ., Conclusions: For a high TEN(HL) level, the "normal" STR at threshold at 3 and 4 kHz is closer to +2 dB than to 0 dB. Further research is needed to assess whether the TEN(HL)-test criteria need to be modified when testing at high frequencies and high levels.

Introduction: The success of a newborn hearing screening program depends on successful tracking and follow-up to ensure that children who have had positive screening results in the first few days of life receive appropriate and timely diagnostic and intervention services. The easy availability, through a suitable infrastructure, of the data necessary for the tracking, diagnosis, and care of children concerned is a major key to enhancing the quality and efficiency of newborn hearing screening programs., Materials and Methods: Two systems for the automated two-way transmission of newborn hearing screening and configuration data, based on mobile communication technology, for the screening devices MADSEN AccuScreen ® and Natus Echo-Screen ® were developed and tested in a field study. Radio modem connections were compared with conventional analogue modem transmissions from Natus Echo-Screen devices for duration, transmission rate, number of lost connections, and frequency of use., Results: The average session duration was significantly lower with the MADSEN AccuScreen (12 s) and Natus Echo-Screen both with radio modem (15 s) than the Natus Echo-Screen with analogue modem (108 s). The transmission rate was significantly higher (898 and 1,758 vs. 181 bytes/s) for the devices with radio modems. Both radio modem devices had significantly lower rates of broken connections after initial connection (2.1 and 0.9 vs. 5.5%). An increase in the frequency of data transmission from the clinics with mobile radio devices was found., Conclusions: The use of mobile communication technology in newborn hearing screening devices offers improvements in the average session duration, transmission rate, and reliability of the connection over analogue solutions. We observed a behavioral change in clinical staff using the new technology: the data exchange with the tracking center is more often used. The requirements for on-site support were reduced. These savings outweigh the small increase in costs for the Internet service provider.

High frequency hearing loss (HFHL), often related to hazardous noise, affects one in six U.S. adolescents. Yet, only 20 states include school-based hearing screens for adolescents. Only six states test multiple high frequencies. Study objectives were to (1) compare the sensitivity of state school-based hearing screens for adolescents to gold standard sound-treated booth testing and (2) consider the effect of adding multiple high frequencies and two-step screening on sensitivity/specificity. Of 134 eleventh-grade participants (2013-2014), 43 of the 134 (32%) did not pass sound-treated booth testing, and 27 of the 43 (63%) had HFHL. Sensitivity/specificity of the most common protocol (1,000, 2,000, 4,000 Hz at 20 dB HL) for these hearing losses was 25.6% (95% confidence interval [CI] = [13.5, 41.2]) and 85.7% (95% CI [76.8, 92.2]), respectively. A protocol including 500, 1,000, 2,000, 4,000, 6,000 Hz at 20 dB HL significantly improved sensitivity to 76.7% (95% CI [61.4, 88.2]), p < .001. Two-step screening maintained specificity (84.6%, 95% CI [75.5, 91.3]). Adolescent school-based hearing screen sensitivity improves with high frequencies., (© The Author(s) 2016.)

The school nurse is the key figure in successful school screening programs. A student with unidentified and unmet health care needs is unlikely to perform at their full potential, both academically and socially. The purpose of the article is to serve as a resource, providing guidance, strategies, and a discussion of available equipment to assist with successful screening programs., (© 2016 The Author(s).)

Purpose: One in 6 US adolescents has high-frequency hearing loss, often related to hazardous noise. Yet, the American Academy of Pediatrics (AAP) hearing screen (500, 1,000, 2,000, 4,000 Hertz) primarily includes low frequencies (<3,000 Hertz). Study objectives were to determine (1) sensitivity and specificity of the AAP hearing screen for adolescent hearing loss and (2) if adding high frequencies increases sensitivity, while repeat screening of initial referrals reduces false positive results (maintaining acceptable specificity)., Methods: Eleventh graders (n = 134) participated in hearing screening (2013-2014) including "gold-standard" sound-treated booth testing to calculate sensitivity and specificity., Results: Of the 43 referrals, 27 (63%) had high-frequency hearing loss. AAP screen sensitivity and specificity were 58.1% (95% confidence interval 42.1%-73.0%) and 91.2% (95% confidence interval 83.4-96.1), respectively. Adding high frequencies (6,000, 8,000 Hertz) significantly increased sensitivity to 79.1% (64.0%-90.0%; p = .003). Specificity with repeat screening was 81.3% (71.8%-88.7%; p = .003)., Conclusions: Adolescent hearing screen sensitivity improves with high frequencies. Repeat testing maintains acceptable specificity., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Approximately 15% of children in the United States 6-19 years of age have hearing loss. Even mild, unilateral hearing loss may adversely affect educational success. In 2014, the Pennsylvania Department of Health (PA DOH) began updating the 2001 regulations on state-mandated school hearing screens. To inform the updates, a needs assessment was conducted with PA-certified school nurses (CSNs) regarding current screening practice and potential barriers to making changes., Methods: A 42-item electronic survey of CSNs developed with pediatricians, audiologists, nurses, and the PA DOH was administered in October 2014., Results: There were 536 completed surveys. Most CSNs (50.8%) screened 251-500 students annually. Only 35.8% strictly followed PA DOH protocol, while 51.6% followed protocol and added nonguideline frequencies. Over half of screens (60.2%) were conducted in places where other people were present. Most CSNs (82.5%) reported annual audiometer calibration, but 92.4% were unsure whether the calibration was exhaustive or limited. Reported barriers to change included time, cost, and staffing., Conclusions: As most CSNs added frequencies to the PA DOH hearing screen, an update with added frequencies should be well accepted. Clarification regarding test environment and exhaustive audiometer calibration is needed. Adherence to best practice may be optimized by addressing CSN reported barriers to change., (© 2016, American School Health Association.)

Objective: Although vascular pulsatile tinnitus (VPT) has been classified as "objective", VPT is not easily recognizable or documentable in most cases. In response to this, we have developed transcanal sound recording (TSR) and spectro-temporal analysis (STA) for the objective diagnosis of VPT. By refining our initial method, we were able to apply TSR/STA to post-treatment outcome evaluation, as well as pre-treatment objective diagnosis., Methods: TSR was performed on seven VPT patients and five normal controls before and after surgical or interventional treatment. VPT was recorded using an inserted microphone with the subjects placed in both upright and supine positions with 1) a neutral head position, 2) head rotated to the tinnitus side, 3) head rotated to the non-tinnitus side, and 4) a neutral position with ipsi-lesional manual cervical compression. The recorded signals were analyzed in both time and time-frequency domains by performing a short-time Fourier transformation., Results: The pre-treatment ear canal signals of all VPT patients demonstrated pulse-synchronous periodic structures and acoustic characteristics that were representative of their presumptive vascular pathologies, whereas those the controls exhibited smaller peaks and weak periodicities. Compared with the pre-treatment signals, the post-treatment signals exhibited significantly reduced peak- and root mean square amplitudes upon time domain analysis. Additionally, further sub-band analysis confirmed that the pulse-synchronous signal of all subjects was not identifiable after treatment and, in particular, that the signal decrement was statistically significant at low frequencies. Moreover, the post-treatment signals of the VPT subjects revealed no significant differences when compared to those of the control group., Conclusion: We reconfirmed that the TSR/STA method is an effective modality to objectify VPT. In addition, the potential role of the TSR/STA method in the objective evaluation of treatment outcomes in patients with VPT was proven. Further studies incorporating a larger sample size and more refined recording techniques are warranted.

Background: The Home Hearing Test™ (HHT) is an automated pure-tone threshold test that obtains an air-conduction audiogram at five test frequencies. It was developed to provide increased access to hearing testing and support home telehealth programs., Purpose: The study was conducted as part of an audiology telehealth trial based at the U.S. Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. Air-conduction audiograms obtained by the HHT were compared to results obtained in the clinic., Research Design: Prospective, repeated measures., Study Sample: Twenty-eight participants, aged 44-88 yr (mean = 65) were recruited from the Nashville U.S. Department of Veterans Affairs audiology clinic. Participants were required to have a Windows personal computer in the home and were self-reported to be comfortable with using computers. Two participants had normal hearing and 26 had hearing loss of various severities and configurations., Data Collection and Analysis: Audiograms were obtained in the audiology clinic by experienced audiologists following standard clinical protocols. Participants were provided with a kit for installing HHT on their home computers. The HHT air-conduction audiogram is obtained with Automated Method for Testing Auditory Sensitivity (AMTAS(®)), described in previous publications. Threshold pairs (clinic versus HHT) were analyzed by determining distributions of threshold differences and absolute differences. These were compared to distributions of differences between manual threshold pairs obtained by two audiologists and AMTAS(®) versus manual threshold pairs obtained under laboratory conditions., Results: Threshold differences (clinic versus HHT) were slightly larger than differences between thresholds obtained by two audiologists and AMTAS(®) versus manual threshold differences obtained under laboratory conditions. The differences were not statistically significant., Conclusions: HHT air-conduction audiograms agree well with audiograms obtained in the clinic. HHT is well suited to home telehealth applications and personal use., (American Academy of Audiology.)

Objective: This paper explores the pass or fail cut-off criteria, the number of test fails, and the nature of tests that are most appropriate in predicting listening difficulties (LiD) in children with suspected APD (SusAPD)., Methods: One hundred and nine English-speaking children (67 males, 42 females) aged between 6 and 11 years with SusAPD were assessed. The Children's Auditory Performance Scale (CHAPS) scores 2 SD below the mean were taken as markers of LiD in different listening conditions. Binary logistic regression analyses were carried out to evaluate the cut-off criterion (2 SD or 1.5 SD or 1 SD below the mean) of failing at least two tests, from the SCAN-C and IMAP test batteries, which significantly predicted LiD. Analyses were also carried out to assess if the group of auditory processing (AP) or cognitive or combination of AP plus cognitive tests were significant in predicting LiD. Receiver Operative Characteristic (ROC) curves were also explored to evaluate how the sensitivity and specificity in confirming LiD varied with the number of test fails., Results: Filtered Words, Competing Words, Competing Sentences, VCV in ICRA noise, Digit Span, Sight Word Reading and the Cued Auditory Attention tests correlated with one or more of the CHAPS domains. Failing at least two of these tests 1.5 SD below the mean significantly predicted (p<.05) CHAPS Ideal scores 2 SD below the mean, and failing at least two of the tests 1 SD below the mean significantly predicted (p<.05) CHAPS Memory and CHAPS Attention scores 2 SD below the mean. The combination of AP plus cognitive tests had significantly higher ability to predict CHAPS Ideal, Memory and Attention scores, compared to the group of AP or cognitive tests separately. ROC curves showed that failing at least two of the tests was associated with the best sensitivity and specificity in predicting LiD., Conclusion: Of the different CHAPS domains only the CHAPS Ideal, Memory and Attention correlated with the APD tests. Failing at least two APD tests from a combination of AP and cognitive tests 1 SD and 1.5 SD below the mean, but not 2 SD, is more appropriate in confirming LiD., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The National Institute of Health and Care Excellence (NICE) has derived candidacy guidelines for cochlear implants in the UK based on audiometric thresholds (90 dB HL or above at 2 and 4 kHz; hereafter referred to as the 90 dB HL criteria). Recent research has proposed that these criteria should be changed to 80 dB HL at 2 and 4 kHz (hereafter referred to as the 80 dB HL criteria) in the ear to be implanted., Methods: In this study, we analysed aided SII scores derived for different hearing loss profiles falling within the current 90 dB HL criteria and equivalent profiles falling within the new 80 dB HL criteria., Results: The aided SII scores demonstrated that the majority of potential hearing configurations falling within the new proposed 80 dB HL criteria have aided SII values of less than 0.65 (a recommended cut-off point below which there is not sufficient audibility to receive adequate benefit through hearing aids)., Conclusions: This supports the proposed change to the 80 dB HL criterion level and also highlights the additional value of the SII score in supporting candidacy decisions for CI, especially for borderline candidates.

Congenital hearing loss is the most frequent birth defect. The American Academy of Pediatrics and the Joint Committee on Infant Hearing established quality of care process indicators for Universal Newborn Hearing Screening starting from 1999. In a previous systematic review of Universal Newborn Hearing Screening studies we highlighted substantial variability in program design and in reported performance data. In order to overcome these heterogeneous findings we think it is necessary to optimize the implementation of Universal Newborn Hearing Screening programs with an appropriate application of the planning, executing, and monitoring, verifications and reporting phases. For this reason we propose a conceptual framework that logically integrates these three phases and, consequently, a tool (a check-list) for their rationalization and standardization.Our paper intends to stimulate debate on how to ameliorate the routine application of high quality Universal Newborn Hearing Screening programs. The conceptual framework is proposed to optimize, rationalise and standardise their implementation. The checklist is intended to allow an inter-program comparison by removing heterogeneity in processes description and assessment.

The Speech, Spatial and Qualities of Hearing Scale (SSQ) is applied worldwide as a highly reliable tool for the characteristic of the quality of life and subjective sensations of the patients presenting with hearing impairment as well as for the estimation of the efficiency of hearing aids. The objective of the present study was to validate and adapt the Russian language version of the SSQ questionnaire (SSQrus) for its application in the audiological practice under conditions of this country. After the cultural and language adaptation of SSQrus, it was validated by means of repeat interviewing of three groups of the respondents (a total of 93 subjects with normal, moderately and severely impaired hearing). The results of the validation give evidence of the high reliability of the modified questionnaire. Specifically, high reproducibility of the data estimated from the results of the second interview has been demonstrated (r=0.85--0.99). High sensitivity of SSQruswas confirmed by the agreement between the results of the estimation (in scores) and the degree of the observed loss of hearing. The estimates obtained by the application of the SSQrus questionnaire are comparable with those reported by the foreign authors. It is concluded that the SSQrus questionnaire can be used in routine audiological practice as an additional diagnostic instrument for the estimation of hearing problems experienced by a patient, monitoring efficiency of therapy and surgical treatment of hearing impairment, improvement of hearing aids, and hearing dysfunction research.

Background: This study determined the accuracy of pure tone air conduction (AC) thresholds obtained using a synchronous telemedicine approach without a sound booth in a rural South African community. The global need for increased hearing healthcare currently far exceeds the capacity for delivering these services, especially in developing countries. A tele-audiology approach using a portable diagnostic audiometer could provide the solution, enabling hearing assessments to be conducted remotely and without a sound booth., Materials and Methods: Hearing thresholds in a sound booth and natural environment were obtained from an initial sample of 20 adults (age range, 19-63 years; mean age, 50±13 years; 55% female), recruited from a rural agricultural community. A subgroup of 10 adults (20 ears) volunteered for the telemedicine threshold testing. AC thresholds (250-8,000 Hz) were determined and subsequently compared in these environments. Typical threshold variability was determined using test-retest correspondence as a reference for the threshold correspondence using a telemedicine mode., Results: Test-retest threshold correspondence in the booth and natural environments was within±5 dB in 96.7% and 97.5% of comparisons, respectively. No significant differences were obtained in AC hearing thresholds determined in the telemedicine configuration compared with those recorded in the gold standard booth environment. Threshold correspondence between the telemedicine compared with booth and natural environments were within±5 dB in 82% and 85% of comparisons, respectively., Conclusions: The current study demonstrates the validity of using synchronous telemedicine for conducting hearing assessments in a remote rural agricultural community without a sound booth.

Background: Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium., Methods: A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting)., Results: Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a 'high' level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a 'moderate' level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from 'very low' to 'low' levels, and ototoxic drugs were evidenced as 'very low'. Possible explanations for these 'very low' and 'low' levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss., Conclusions: We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.

Background: In a 2-stage neonatal hearing screening protocol, if an infant fails the first-stage abstract screening with an otoacoustic emissions test, an automated auditory brainstem response (ABR)test is performed. The purpose of this study was to estimate the rate of hearing loss detected byfirst-stage otoacoustic emissions test but missed by second-stage automated ABR testing., Methods: The data of 17 078 infants who were born at Lis Maternity Hospital between January 2013 and June 2014 were reviewed. Infants who failed screening with a transient evoked otoacoustic emissions (TEOAE) test and infants admitted to the NICU for more than 5 days underwent screening with an automated ABR test at 45 decibel hearing level (dB HL). All infants who failed screening with TEOAE were referred to a follow-up evaluation at the hearing clinic., Results: Twenty-four percent of the infants who failed the TEOAE and passed the automated ABR hearing screening tests were eventually diagnosed with hearing loss by diagnostic ABR testing (22/90). They comprised 52% of all of the infants in the birth cohort who were diagnosed with permanent or persistent hearing loss .25 dB HL in 1 or both ears (22/42).Hearing loss .45 dB HL, which is considered to be in the range of moderate to profound severity, was diagnosed in 36% of the infants in this group (8/22), comprising 42% of the infants with hearing loss of this degree (8/19)., Conclusions: The sensitivity of the diverse response detection methods of automated ABR devices needs to be further empirically evaluated.

Introduction: Newborn hearing screening (NHS) programs are implemented across the globe to detect early hearing impairment. In order to meet this objective, the quality of these programs should be monitored using internationally recognized indicators., Objective: To evaluate a newborn hearing screening service (NHSS) using international quality indicators., Methods: A retrospective cohort study on the NHSS of Minas Gerais was conducted, analyzing the services performed between 2010 and 2011. Results were analyzed according to criteria from the American Academy of Pediatrics and the Joint Committee on Infant Hearing., Results: This study assessed 6987 children. The proportions of cases that were referred for a retest, that followed through with retest, and that were referred for diagnosis were 8.0%, 71.9%, and 2.1%, respectively. The proportion of assessed newborn children in the first 30 days of life in this study was 65%. The median age of those children who failed both the NHS and the retest was significantly higher than the other children. The chance of a child with a hearing impairment risk indicator to fail the NHS was 2.4 times higher than of those without a risk indicator., Conclusion: NHSS achieved three of four evaluated indicators. Despite this, it is still necessary to perform NHS earlier and to ensure that the subsequent steps are followed., (Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To report the development of a standardized German version of a reading span test (RST) with a dual task design. Special attention was paid to psycholinguistic control of the test items and time-sensitive scoring. We aim to establish our RST version to use for determining an individual's working memory in the framework of hearing research in German contexts., Design: RST stimuli were controlled and pretested for psycholinguistic factors. The RST task was to read sentences, quickly determine their plausibility, and later recall certain words to determine a listener's individual reading span. RST results were correlated with outcomes of additional sentence-in-noise tests measured in an aided and an unaided listening condition, each at two reception thresholds., Study Sample: Item plausibility was pre-determined by 28 native German participants. An additional 62 listeners (45-86 years, M = 69.8) with mild-to-moderate hearing loss were tested for speech intelligibility and reading span in a multicenter study., Results: The reading span test significantly correlated with speech intelligibility at both speech reception thresholds in the aided listening condition., Conclusion: Our German RST is standardized with respect to psycholinguistic construction principles of the stimuli, and is a cognitive correlate of intelligibility in a German matrix speech-in-noise test.

Objective: To introduce a new method of measuring sound localization ability based on eye-tracking and to test this method by analysing the influence of mild induced conductive hearing loss on sound localization., Design: Sound signals were presented from different angles, and the participant's responses were measured using an eye-tracking device. For validation, a comparison of responses to visual stimuli was performed. To test the clinical application of this method, a mild conductive hearing loss was simulated, and the impact of this change on sound localization was measured., Study Sample: Fifteen participants., Results: The system provided repeatable measurements, and there was a good correlation of sound and visual signals. A large number of trials could be completed fairly rapidly. Following the induced conductive hearing loss, a decline of 5.5° in the accuracy of sound localization in the horizontal plane was found towards the side of the non-impaired ear for frontal presentations., Conclusions: Quantifying sound localization by eye-tracking was found to be feasible, fast and accurate. A mild conductive hearing loss caused a slight degradation of sound localization accuracy within the 30° frontal sector, which is in good agreement with results found using methods requiring more extensive instrumentation.

Objective: This study had three main goals: (1) to determine the hearing configuration in hearing-impaired children born with a congenital CMV (cCMV) infection, (2) to see whether auditory neuropathy spectrum disorder (ANSD) was present, and (3) to propose a flow chart for the follow-up of hearing in children with cCMV., Design: Hearing configuration and the presence of ANSD in cCMV infected children was analysed. Selection criteria were: hearing-impaired children with a regular audiometric follow-up for at least 36 months, no other major risk factors for hearing loss, a normal middle-ear status, and an appropriate behavioral response to the given pure-tone stimuli., Study Sample: Out of a cohort of 206 cCMV infected children, 18 hearing-impaired children were selected., Results: Audiograms of all children showed a flat configuration of SNHL: the slope between octave bands was never greater than 10 decibels. None of the 18 children were found to have ANSD., Conclusions: Hearing impairment in cCMV infants affected all frequencies equally and ANSD does not appear to be a feature of cCMV infection. A flow chart for hearing follow-up in children with cCMV infection was suggested in order to provide guidance, improve uniformity in follow-up, and to make results easier to compare.