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Purpose: This project was undertaken to develop automated tests of speech recognition, including speech-recognition threshold (SRT) and word-recognition test, using forced-choice responses and computerized scoring of responses. Specific aims were (1) to develop an automated method for measuring SRT for spondaic words that produces scores that are in close agreement with average pure-tone thresholds and (2) to develop an automated test of word recognition that distinguishes listeners with normal hearing from those with sensorineural hearing loss and which informs the hearing aid evaluation process., Method: An automated SRT protocol was designed to converge on the lowest level at which the listener responds correctly to two out of two spondees presented monaurally. A word-recognition test was conducted with monosyllabic words (female speaker) presented monaurally at a fixed level. For each word, there were three rhyming foils, displayed on a touchscreen with the test word. The listeners touched the word they thought they heard. Participants were young listeners with normal hearing and listeners with sensorineural hearing loss. Words were also presented with nonrhyming foils and in an open-set paradigm. The open-set responses were scored by a graduate student research assistant., Results: The SRT results agreed closely with the pure-tone average (PTA) obtained by automated audiometry. The agreement was similar to results obtained with the conventional SRT scoring method. Word-recognition scores were highest for the closed-set, nonrhyming lists and lowest for open-set responses. For the hearing loss participants, the scores varied widely. There was a moderate correlation between word-recognition scores and pure-tone thresholds which increased as more high frequencies were brought into the PTA. Based on the findings of this study, a clinical protocol was designed that determines if a listener's performance was in the normal range and if the listener benefited from increasing the level of the stimuli., Conclusion: SRTs obtained using the automated procedure are comparable to the results obtained by the conventional clinical method that is in common use. The automated closed-set word-recognition test results show clear differentiation between scores for the normal and hearing loss groups. These procedures provide clinical test results that are not dependent on the availability of an audiologist to perform the tests., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Background: Three infants with different risk factors, behavioral and physiologic audiometric histories, and diagnoses were fit with amplification between 3 and 8 months of age. Two of the three met criteria for cochlear implantation., Purpose: This article aims to heighten awareness of the rare possibility of recovery from sensorineural hearing loss in infants with varying histories and emphasize the importance of a full diagnostic test battery in all infants diagnosed with sensorineural hearing loss every 3 months until objective and subjective thresholds are stable to ensure appropriate intervention., Research Design: Case reports., Results: All three infants demonstrated improvement or full recovery of hearing and cochlear function by approximately 12 months old. Their change in hearing was discovered due to frequent follow-up and/or caregiver report. One of these infants was tentatively scheduled to have cochlear implant surgery 2 months later., Conclusion: Appropriate early intervention for infants with hearing loss is critical to ensure maximum accessibility to speech and language cues. The Federal Drug Administration approves cochlear implantation in infants as young as 12 months. When providing audiometric management of infants with sensorineural hearing loss, it is imperative to conduct a full diagnostic test battery every 3 months (including tympanometric, acoustic reflex, and otoacoustic emission measurement) until objective and subjective thresholds are stable. There was no apparent pattern of factors to predict that the infants highlighted in these cases would recover. Discussion among pediatric audiologists and otologists and comparison of data from clinics across the U.S. is needed to identify predictive patterns and determine appropriate, consistent monitoring of infants with sensorineural hearing loss., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Background: Two audiometric speech measures have been recognized to have associations with hearing aid use success: the Quick Speech in Noise (QuickSIN) test and the Performance-Perceptual Test (PPT). The PPT involves using the same speech test material (Hearing in Noise Test [HINT]) twice, to evaluate patients' objective and subjective speech recognition performance in noise and the discrepancy between the two measures (Performance-Perceptual Discrepancy [PPDIS]). Using the QuickSIN to conduct the PPT (revised-PPT) may provide clinicians two pieces of important information from one test to help predict hearing aid use success and the need for counseling. Moreover, we could achieve the desired clinical efficiency without purchasing additional test materials., Purpose: This study aimed (1) to evaluate the validity and reliability of using the QuickSIN speech material to administer the PPT and (2) to establish normative data across listeners with normal hearing (NH) and hearing loss (HL)., Research Design: This study used a repeated measures design., Study Sample: Of the total 65 participants between 18 and 88 years of age, 20 (31%) had NH and 45 (69%) had sensorineural HL, ranging from mild to profound in both ears. Thirty-two of the 45 participants with HL were hearing aid users., Data Collection and Analysis: All participants completed the original PPT using HINT and the revised-PPT using QuickSIN, via sound field. Generalized linear mixed models were used to compare the performance, perceptual, and PPDIS data between the two test materials across all participants. Normative data for the revised-PPT were established from all participants., Results: Significant main effects for both the test material and hearing status were found for the performance and perceptual data. All interactions were nonsignificant. There were no significant PPDIS differences between the original PPT and the revised-PPT. Normative values for the revised-PPT were established and comparable to the norms for the original PPT in the present study. The test-retest results suggested that the revised-PPT has good reliability. In addition, it appeared that there was a negative association between underestimation of hearing ability and hearing aid use success., Conclusions: It is concluded that the QuickSIN speech material can replace HINT to measure PPT. The revised-PPT may serve as a useful and efficient clinical tool in any clinics for hearing aid fitting and counseling., (American Academy of Audiology.)

Background: The relationship between type-1 diabetes mellitus (DM) and cochlear dysfunction remains inconclusive., Purpose: The purpose of this study was to examine otoacoustic emissions (OAEs) in normal-hearing young adults with type-1 DM as compared with matched controls and identify potential covariates influencing OAE findings., Research Design: Cross-sectional study., Study Sample: N = 40 young adults aged 18-28 years including individuals with type-1 DM (n = 20) and age-gender matched controls (n = 20) with normal hearing sensitivity., Data Collection and Analysis: Measures of pure-tone threshold sensitivity and OAEs, including distortion product otoacoustic emissions (DPOAEs), transient evoked OAEs, and DPOAE fine structure, were compared between groups. Covariates such as noise exposure and DM-related factors (e.g., duration of disease, glycated hemoglobin levels) were considered. Statistical analysis included analysis of variance and linear regression., Results: Measures of hearing sensitivity and auditory function in both groups were comparable for all assays, except DPOAE fine structure. A reduced number of fine structure peaks and component amplitudes were found in the type-1 diabetes DM group with the primary difference in the reflection component., Conclusions: The results indicate that reduced cochlear function in young adults with type-1 DM can be revealed using DPOAE fine structure, suggesting potential clinical applications of DPOAE fine structure in early identification of cochlear pathology. Potential factors underlying these findings are discussed., (American Academy of Audiology.)

Background: The Auditec of St. Louis and the Department of Veterans Affairs (VA) recorded versions of the Northwestern University Auditory Test No. 6 (NU-6) are in common usage. Data on young adults with normal hearing for pure tones (YNH) demonstrate equal recognition performances on the two versions when the VA version is presented 5 dB higher but similar data on older listeners with sensorineural hearing loss (OHL) are lacking., Purpose: To compare word-recognition performances on the Auditec and VA versions of NU-6 presented at six presentation levels with YNH and OHL listeners., Research Design: A quasi-experimental, repeated-measures design was used., Study Sample: Twelve YNH (M = 24.0 years; PTA = 9.9-dB HL) and 36 OHL listeners (M = 71.6 years; PTA = 26.7-dB HL) participated in three, one-hour sessions., Data Collection and Analyses: Each listener received 100 stimulus words that were randomized by 6 presentation levels for each of two speakers (YNH, -2 to 28-dB SL; OHL, -2 to 38-dB SL). The sessions were limited to 25 practice and 400 experimental words. Digital versions of the 16, 25-word tracks for each session were alternated between speakers., Results: Each of the 48 listeners had higher recognition performances on the Auditec version of NU-6 than on the VA version. The respective overall recognition performances on the Auditec and VA versions were 71.4% and 64.1% (YNH) and 68.7% and 58.2% (OHL). At the highest presentation levels, recognition performances on the two versions differed by only 0.5% (YNH) and 3.3% (OHL). At the 50% correct point, performances on the Auditec version were 3.2 dB (YNH) and 6.1 dB (OHL) better than those on the VA version. The slopes at the 50% points on the mean functions for both speakers were about 4.9%/dB (YNH) and 3.0%/dB (OHL); however, the slopes evaluated from the individual listener data were steeper, 5.2 to 5.3%/dB (YNH) and 3.3 to 3.5%/dB (OHL). When the individual data were transformed from dB SL to dB HL, the differences between the two listener groups were emphasized. The four functions (2 speakers by 2 listener groups) were plotted for each of the 48 participants and each of the 200 words, which revealed the gamut of relations among the datasets. Examination of the data for each speaker across test sessions, in the traditional 50-word lists, and in the typically used 25-word lists of Randomization A revealed no differences of clinical concern. Finally, introspective reports from the listeners revealed that 91.7% and 83.3% of the YNH and OHL listeners, respectively, thought the Auditec speaker was easier to understand than the VA speaker. Recognition performances on each participant and on each word are presented., (American Academy of Audiology.)

Background: The hearing in noise test (HINT) is the most popular adaptive test used to evaluate speech in noise performance, especially in context of hearing aid features. However, the number of conditions that can be tested on the HINT is limited by a small speech corpus. The American English Matrix test (AEMT) is a new alternative adaptive speech in noise test with a larger speech corpus. The study examined the relationships between the performance of hearing aid wearers on the HINT and the AEMT., Purpose: To examine whether there was a difference in performance of hearing aid wearers on the HINT and the AEMT. A secondary purpose, given the AEMT's steep performance-intensity function, was to determine whether the AEMT is more sensitive to changes in speech recognition resulting from directional (DIR) microphone processing in hearing aids., Research Design: A repeated measures design was used in this study. Multiple measurements were made on each subject. Each measurement involved a different experimental condition., Study Sample: Ten adults with hearing loss participated in this study., Data Collection and Analysis: All participants completed the AEMT and HINT, using adaptive and fixed test formats while wearing hearing aids. Speech recognition was assessed in two hearing aid microphone settings-omnidirectional and fixed DIR. All testing was conducted via sound field presentation. Performance on HINT and AEMT were systematically compared across all test conditions using a linear model with repeated measures., Results: The results of this study revealed that adult hearing aid users perform differently on the HINT and AEMT, with adaptive AEMT testing yielding significantly better (more negative) thresholds than the HINT. Slopes of performance intensity functions obtained by testing at multiple fixed signal-to-noise ratios, revealed a somewhat steeper slope for the HINT compared with the AEMT. Despite this steeper slope, the benefit provided by DIR microphones was not significantly different between the two speech tests., Conclusions: The observation of similar DIR benefits of the HINT and AEMT suggests that the HINT and AEMT are equally sensitive to changes in speech recognition thresholds following intervention. Therefore, the decision to use the AEMT or the HINT will depend on the purpose of the study and/or the technology being investigated. Other test related factors such as available sentence corpus, learning effects and test time will also influence test selection., (American Academy of Audiology.)

Background: In listening environments with background noise that fluctuates in level, listeners with normal hearing can "glimpse" speech during dips in the noise, resulting in better speech recognition in fluctuating noise than in steady noise at the same overall level (referred to as masking release). Listeners with sensorineural hearing loss show less masking release. Amplification can improve masking release but not to the same extent that it does for listeners with normal hearing., Purpose: The purpose of this study was to compare masking release for listeners with sensorineural hearing loss obtained with an experimental hearing-aid signal-processing algorithm with instantaneous compression (referred to as a suppression hearing aid, SHA) to masking release obtained with fast compression. The suppression hearing aid mimics effects of normal cochlear suppression, i.e., the reduction in the response to one sound by the simultaneous presentation of another sound., Research Design: A within-participant design with repeated measures across test conditions was used., Study Sample: Participants included 29 adults with mild-to-moderate sensorineural hearing loss and 21 adults with normal hearing., Intervention: Participants with sensorineural hearing loss were fitted with simulators for SHA and a generic hearing aid (GHA) with fast (but not instantaneous) compression (5 ms attack and 50 ms release times) and no suppression. Gain was prescribed using either an experimental method based on categorical loudness scaling (CLS) or the Desired Sensation Level (DSL) algorithm version 5a, resulting in a total of four processing conditions: CLS-GHA, CLS-SHA, DSL-GHA, and DSL-SHA., Data Collection: All participants listened to consonant-vowel-consonant nonwords in the presence of temporally-modulated and steady noise. An adaptive-tracking procedure was used to determine the signal-to-noise ratio required to obtain 29% and 71% correct. Measurements were made with amplification for participants with sensorineural hearing loss and without amplification for participants with normal hearing., Analysis: Repeated-measures analysis of variance was used to determine the influence of within-participant factors of noise type and, for participants with sensorineural hearing loss, processing condition on masking release. Pearson correlational analysis was used to assess the effect of age on masking release for participants with sensorineural hearing loss., Results: Statistically significant masking release was observed for listeners with sensorineural hearing loss for 29% correct, but not for 71% correct. However, the amount of masking release was less than masking release for participants with normal hearing. There were no significant differences among the amplification conditions for participants with sensorineural hearing loss., Conclusions: The results suggest that amplification with either instantaneous or fast compression resulted in similar masking release for listeners with sensorineural hearing loss. However, the masking release was less for participants with hearing loss than it was for those with normal hearing., (American Academy of Audiology.)

Background: Examination of cochlear and neural potentials is necessary to assess sensory and neural status in infants, especially those cared for in neonatal intensive care units (NICU) who have high rates of hyperbilirubinemia and thus are at risk for auditory neuropathy (AN)., Purpose: The purpose of this study was to determine whether recording parameters commonly used in click-evoked auditory brain stem response (ABR) are useful for recording cochlear microphonic (CM) and Wave I in infants at risk for AN. Specifically, we analyzed CM, summating potential (SP), and Waves I, III, and V. The overall aim was to compare latencies and amplitudes of evoked responses in infants cared for in NICUs with infants in a well-baby nursery (WBN), both of which passed newborn hearing screening., Research Design: This is a prospective study in which infants who passed ABR newborn hearing screening were grouped based on their birth history (WBN and NICU). All infants had normal hearing status when tested with diagnostic ABR at about one month of age, corrected for prematurity., Study Sample: Thirty infants (53 ears) from the WBN [mean corrected age at test = 5.0 weeks (wks.)] and thirty-two infants (59 ears) from the NICU (mean corrected age at test = 5.7 wks.) with normal hearing were included in this study. In addition, two infants were included as comparative case studies, one that was diagnosed with AN and another case that was diagnosed with bilateral sensorineural hearing loss (SNHL)., Data Collection and Analysis: Diagnostic ABR, including click and tone-burst air- and bone-conduction stimuli were recorded. Peak Waves I, III, and V; SP; and CM latency and amplitude (peak to trough) were measured to determine if there were differences in ABR and electrocochleography (ECochG) variables between WBN and NICU infants., Results: No significant group differences were found between WBN and NICU groups for ABR waveforms, CM, or SP, including amplitude and latency values. The majority (75%) of the NICU group had hyperbilirubinemia, but overall, they did not show evidence of effects in their ECochG or ABR responses when tested at about one-month corrected age. These data may serve as a normative sample for NICU and well infant ECochG and ABR latencies at one-month corrected age. Two infant case studies, one diagnosed with AN and another with SNHL demonstrated the complexity of using ECochG and otoacoustic emissions to assess the risk of AN in individual cases., Conclusions: CM and SPs can be readily measured using standard click stimuli in both well and NICU infants. Normative ranges for latency and amplitude are useful for interpreting ECochG and ABR components. Inclusion of ECochG and ABR tests in a test battery that also includes otoacoustic emission and acoustic reflex tests may provide a more refined assessment of the risks of AN and SNHL in infants., (American Academy of Audiology.)

Background: Despite the well-established relationship between aging and auditory processing decline, identifying the extent to which age effect is the main factor on auditory processing performance remains a great challenge due to the co-occurrence of age-related hearing loss and age-related cognitive decline as potential confounding factors., Purpose: To investigate the effects of age-related hearing loss and working memory on the clinical evaluation of auditory processing of middle-aged and elderly., Research Design: Cross-sectional study., Study Sample: A total of 77 adults between 50 and 70 yr of age were invited to participate in the study., Data Collection and Analysis: The participants were recruited from a larger study that focused on the assessment and management of sensory and cognitive skills in elderly participants. Only participants with normal hearing or mild-to-moderate age-related hearing loss, with no evidence of cognitive, psychological, or neurological conditions were included. Speech-in-noise, dichotic digit, and frequency pattern tests were conducted as well as a working memory test. The hearing loss effect was investigated using an audibility index, calculated from the audiometric threshold. The performance on the digit span test was used to investigate working memory effects. Both hearing loss and working memory effects were investigated via correlation and regression analyses, partialling out age effects. The significance level was set at p < 0.05., Results: The results demonstrated that, while hearing loss was associated to the speech-in-noise performance, working memory was associated to the frequency pattern and dichotic digit performances. Regression analyses confirmed the relative contribution of hearing loss to the variance in speech-in-noise and working memory test to the variance in frequency pattern and dichotic digit test performance., Conclusions: The performance decline of the elderly in auditory processing tests may be partially attributable to the working memory performance and, consequently, to the cognitive decline exhibited by this population. Mild-to-moderate hearing loss seems to affect performance on specific auditory processing tasks, such as speech in noise, reinforcing the idea that auditory processing disorder in the elderly might also be associated to auditory peripheral deficits., (American Academy of Audiology)

Background: Reverberation is a source of acoustic degradation, present to varying extents in many everyday listening environments. The presence of reverberation decreases speech intelligibility, especially for listeners with hearing impairment. There is substantial variability in how susceptible individuals with hearing impairment are to the effects of reverberation (i.e., how intelligible reverberant speech is to a listener). Relatively little is known about the listener factors which drive that susceptibility., Purpose: To identify listener factors that are associated with an individual's susceptibility to reverberation. Another purpose was to investigate how these listener factors are associated with reverberant susceptibility in relation to the amount of reverberation. The listener factors investigated were degree of hearing loss, age, temporal envelope sensitivity, and working memory capacity., Research Design: This study used a correlational design to investigate the association between different listener factors and speech intelligibility with varying amounts of reverberation., Study Sample: Thirty-three older adults with sensorineural hearing loss participated in the study., Data Collection and Analysis: Listener temporal envelope sensitivity was measured using a gap detection threshold task. Listener working memory capacity was measured using the Reading Span Test. Intelligibility of reverberant speech was measured using a set of low-context sentence materials presented at 70 dB SPL without individual frequency shaping. Sentences were presented at a range of realistic reverberation times, including no reverberation (0.0 sec), moderate reverberation (1.0 sec), and severe reverberation (4.0 sec). Stepwise linear regression analyses were conducted to model speech intelligibility using individual degree of hearing loss, age, temporal envelope sensitivity, and working memory capacity. A separate stepwise linear regression model was conducted to model listener speech intelligibility at each of the three levels of reverberation., Results: As the amount of reverberation increased, listener speech intelligibility decreased and variability in scores among individuals increased. Temporal envelope sensitivity was most closely associated with speech intelligibility in the no reverberation condition. Both listener age and degree of hearing loss were significantly associated with speech intelligibility in the moderate reverberation condition. Both listener working memory capacity and age were significantly associated with speech intelligibility in the severe reverberation condition., Conclusions: The results suggest that suprathreshold listener factors can be used to best predict speech intelligibility across a range of reverberant conditions. However, which listener factor(s) to consider when predicting a listener's susceptibility to reverberation depends on the amount of reverberation in an environment. Clinicians may be able to use different listener factors to identify individuals who are more susceptible to reverberation and would be more likely to have difficulty communicating in reverberant environments., (American Academy of Audiology)

Background: Tinnitus is a common condition and there is a need to evaluate effects of tinnitus management in relation to moderating factors such as degree of hearing loss. As it is possible that tinnitus influences concentration, and thus is likely to disturb cognitive processing, the role of cognitive functioning also needs to be investigated., Purpose: To compare a group of patients with sensorineural hearing loss and tinnitus to a control group with only sensorineural hearing loss (and no tinnitus). To investigate working memory, sleep, and hearing problems measured before and after hearing rehabilitation., Research Design: A prospective study., Study Sample: The sample consisted of 100 patients, 50 with hearing loss and tinnitus, and 50 controls with hearing loss but no tinnitus. All patients were between 40 and 82 yr old and had a pure-tone average (PTA; average of 0.5, 1, 2, and 4 kHz) <70 dB HL., Intervention: Patients were tested before and after rehabilitation with hearing aids with regard to their working memory capacity, sleep quality, hearing problems, speech recognition, and tinnitus annoyance., Data Collection and Analysis: Eight patients dropped out of the study. Thus, a total of 92 patients were included for analysis, with 46 in each group. As a consequence of unplanned age and PTA differences between the groups, an age-matched subsample (n = 30 + 30) was selected for further analysis. Tests including the Reading Span, Hearing-in-Noise Test (HINT), Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for the Elderly (HHIE), and Pittsburgh Sleep Quality Index (PSQI) were administered before and after hearing aid rehabilitation., Results: There were no between-group differences at baseline in the full sample (n = 92), with the exception of the THI (p < 0.001) and the PSQI (p < 0.002), on which the hearing loss and tinnitus group had significantly higher scores. Pre/post changes were significant for both groups on the Reading Span, and HHIE. However, these improvements were significantly larger for the patients in the hearing loss and tinnitus group on the Reading Span test (p < 0.001) and the PSQI (p < 0.001). Patients with tinnitus and hearing loss also exhibited significantly improved THI scores at follow-up, compared to baseline (p < 0.001). We conducted the same analyses for the age-matched subsample (n = 30 + 30). For the baseline data, only the THI (p < 0.001) and the PSQI (p < 0.015) difference remained significant. With regard to the pre/post changes, we found the same differences in improvement in Reading Span (p < 0.001) and the PSQI (p < 0.015) as in the full sample., Conclusions: Patients with tinnitus benefited from hearing aid rehabilitation. The observed differences in cognitive function were unexpected, and there were larger score improvements on the Reading Span test in the hearing loss and tinnitus group than in the hearing loss group. Patients with tinnitus and hearing loss may receive extra benefit in terms of cognitive function following hearing aid rehabilitation., (American Academy of Audiology)

Background: Graphical methods for calculating the speech intelligibility index (SII), such as the count-the-dot audiogram, are useful tools in quantifying how much weighted audibility is restored when amplification is used for individuals with hearing loss. The band-importance function (BIF), which is an important component of the SII, depends on the language. Thus, language may affect the prediction of weighted audibility using the graphical SII., Purpose: The purpose of this study was to apply language-specific BIFs to develop and compare graphical SIIs for English, Korean, and Mandarin., Research Design: The graphical SIIs were developed and compared using a research design that applied and analyzed existing datasets., Data Collection and Analysis: Language-specific BIFs and dynamic ranges were used to derive graphical SIIs for English, Korean, and Mandarin. SII predictions were compared by calculating the language-specific predictions for the same audiometric configurations., Results: The graphical SIIs for English, Korean, and Mandarin yielded different unaided and aided predictions for the same audiogram configurations., Conclusions: A graphical SII helps patients easily understand their weighted audibility for unaided and aided conditions; thus, it is a useful counseling tool in the clinic. The most accurate graphical SII's will, however, be based on a patient's spoken language., (American Academy of Audiology)

Background: Xeroderma pigmentosum (XP) is a rare autosomal recessive condition characterized by extreme sensitivity to ultraviolet light. Individuals with XP lack the ability to repair DNA (deoxyribonucleic acid) damage caused by ultraviolet radiation, leading to sunburn and increased susceptibility to skin cancers. Approximately 25% of patients also exhibit neural degeneration, which includes progressive mental deterioration, cortical thinning, and sensorineural hearing loss., Purpose: Herein, we describe the audiological and genetic findings in a patient with XP subtype D with neural degeneration and hearing loss., Research Design: This is a case report of a patient with XP subtype D, type 1 diabetes, and some clinical features typical of Charcot-Marie-Tooth disease., Data Collection and Analysis: We obtained audiological evaluations over a course of 11 yr, including serial audiograms, auditory processing disorders evaluations, and electrophysiological testing., Results: Hearing sensitivity has progressed from a unilateral mild high-frequency sensorineural hearing loss to a bilateral sloping moderate to severe/profound sensorineural hearing loss. In addition to the dramatic decline in hearing sensitivity, the patient demonstrates global auditory processing deficits, indicating a central component to his hearing loss., Conclusion: These findings emphasize the importance of the contribution of audiological evaluations to the diagnosis of a genetic disorder. Periodic evaluations of hearing sensitivity and auditory processing can provide information on disease progression in patients with XP with neural degeneration., (American Academy of Audiology)

Background: Hearing loss affects more than 27 million people in mainland China. It would be helpful to develop a portable and self-testing audiometer for the timely detection of hearing loss so that the optimal clinical therapeutic schedule can be determined., Purpose: The objective of this study was to develop a software-based hearing self-testing system., Research Design: The software-based self-testing system consisted of a notebook computer, an external sound card, and a pair of 10-Ω insert earphones. The system could be used to test the hearing thresholds by individuals themselves in an interactive manner using software. The reliability and validity of the system at octave frequencies of 0.25 Hz to 8.0 kHz were analyzed in three series of experiments., Study Sample: Thirty-seven normal-hearing particpants (74 ears) were enrolled in experiment 1. Forty individuals (80 ears) with sensorineural hearing loss (SNHL) participated in experiment 2. Thirteen normal-hearing participants (26 ears) and 37 participants (74 ears) with SNHL were enrolled in experiment 3. Each participant was enrolled in only one of the three experiments., Data Collection and Analysis: In all experiments, pure-tone audiometry in a sound insulation room (standard test) was regarded as the gold standard. SPSS for Windows, version 17.0, was used for statistical analysis. The paired t-test was used to compare the hearing thresholds between the standard test and software-based self-testing (self-test) in experiments 1 and 2. In experiment 3 (main study), one-way analysis of variance and post hoc comparisons were used to compare the hearing thresholds among the standard test and two rounds of the self-test. Linear correlation analysis was carried out for the self-tests performed twice. The concordance was analyzed between the standard test and the self-test using the kappa method. p < 0.05 was considered statistically significant., Results: Experiments 1 and 2: The hearing thresholds determined by the two methods were not significantly different at frequencies of 250, 500, or 8000 Hz (p > 0.05) but were significantly different at frequencies of 1000, 2000, and 4000 Hz (p < 0.05), except for 1000 Hz in the right ear in experiment 2. Experiment 3: The hearing thresholds determined by the standard test and self-tests repeated twice were not significantly different at any frequency (p > 0.05). The overall sensitivity of the self-test method was 97.6%, and the specificity was 98.3%. The sensitivity was 97.6% and the specificity was 97% for the patients with SNHL. The self-test had significant concordance with the standard test (kappa value = 0.848, p < 0.001)., Conclusions: This portable hearing self-testing system based on a notebook personal computer is a reliable and sensitive method for hearing threshold assessment and monitoring., (American Academy of Audiology.)

Background: Hearing threshold estimation based on cortical auditory evoked potentials (CAEPs) has been applied for some decades. However, available research is scarce evaluating the accuracy of this technique with an automated paradigm for the objective detection of CAEPs., Purpose: To determine the difference between behavioral and CAEP thresholds detected using an objective paradigm based on the Hotelling's T² statistic. To propose a decision tree to choose the next stimulus level in a sample of hearing-impaired adults. This knowledge potentially could increase the efficiency of clinical hearing threshold testing., Research Design: Correlational cohort study. Thresholds obtained behaviorally were compared with thresholds obtained through cortical testing., Study Sample: Thirty-four adults with hearing loss participated in this study., Data Collection and Analysis: For each audiometric frequency and each ear, behavioral thresholds were collected with both pure-tone and 40-msec tone-burst stimuli. Then, corresponding cortical hearing thresholds were determined. An objective cortical-response detection algorithm based on the Hotelling's T² statistic was applied to determine response presence. A decision tree was used to select the next stimulus level. In total, 241 behavioral-cortical threshold pairs were available for analysis. The differences between CAEP and behavioral thresholds (and their standard deviations [SDs]) were determined for each audiometric frequency. Cortical amplitudes and electroencephalogram noise levels were extracted. The practical applicability of the decision tree was evaluated and compared to a Hughson-Westlake paradigm., Results: It was shown that, when collapsed over all audiometric frequencies, behavioral pure-tone thresholds were on average 10 dB lower than 40-msec cortical tone-burst thresholds, with an SD of 10 dB. Four percent of CAEP thresholds, all obtained from just three individual participants, were more than 30 dB higher than their behavioral counterparts. The use of a decision tree instead of a Hughson-Westlake procedure to obtain a CAEP threshold did not seem to reduce test time, but there was significantly less variation in the number of CAEP trials needed to determine a threshold., Conclusions: Behavioral hearing thresholds in hearing-impaired adults can be determined with an acceptable degree of accuracy (mean threshold correction and SD of both 10 dB) using an objective statistical cortical-response detection algorithm in combination with a decision tree to determine the test levels., (American Academy of Audiology.)

Background: In order to differentiate between a conductive hearing loss (CHL) and a sensorineural hearing loss (SNHL) in the hearing-impaired individual, we compared thresholds to air conduction (AC) and bone conduction (BC) auditory stimulation. The presence of a gap between these thresholds (an air-bone gap) is taken as a sign of a CHL, whereas similar threshold elevations reflect an SNHL. This is based on the assumption that BC stimulation directly excites the inner ear, bypassing the middle ear. However, several of the classic mechanisms of BC stimulation such as ossicular chain inertia and the occlusion effect involve middle ear structures. An additional mode of auditory stimulation, called soft tissue conduction (STC; also called nonosseous BC) has been demonstrated, in which the clinical bone vibrator elicits hearing when it is applied to soft tissue sites on the head, neck, and thorax., Purpose: The purpose of this study was to assess the relative contributions of threshold determinations to stimulation by STC, in addition to AC and osseous BC, to the differential diagnosis between a CHL and an SNHL., Research Design: Baseline auditory thresholds were determined in normal participants to AC (supra-aural earphones), BC (B71 bone vibrator at the mastoid, with 5 N application force), and STC (B71 bone vibrator) to the submental area and to the submandibular triangle with 5 N application force) stimulation in response to 0.5, 1.0, 2.0, and 4.0 kHz tones. A CHL was then simulated in the participants by means of an ear plug. Separately, an SNHL was simulated in these participants with 30 dB effective masking., Study Sample: STUDY SAMPLE consisted of 10 normal-hearing participants (4 males; 6 females, aged 20-30 yr)., Data Collection and Analysis: AC, BC, and STC thresholds were determined in the initial normal state and in the presence of each of the simulations., Results: The earplug-induced CHL simulation led to a mean AC threshold elevation of 21-37 dB (depending on frequency), but not of BC and STC thresholds. The masking-induced SNHL led to a mean elevation of AC, BC, and STC thresholds (23-36 dB, depending on frequency). In each type of simulation, the BC threshold shift was similar to that of the STC threshold shift., Conclusions: These results, which show a similar threshold shift for STC and for BC as a result of these simulations, together with additional clinical and laboratory findings, provide evidence that BC thresholds likely represent the threshold of the nonosseous BC (STC) component of multicomponent BC at the BC stimulation site, and thereby succeed in clinical practice to contribute to the differential diagnosis. This also provides evidence that STC (nonosseous BC) stimulation at low intensities probably does not involve components of the middle ear, represents true cochlear function, and therefore can also contribute to a differential diagnosis (e.g., in situations where the clinical bone vibrator cannot be applied to the mastoid or forehead with a 5 N force, such as in severe skull fracture)., (American Academy of Audiology.)

Background: The Ling 6(HL) test offers a calibrated version of naturally produced speech sounds in dB HL for evaluation of detection thresholds. Aided performance has been previously characterized in adults., Purpose: The purpose of this work was to evaluate and refine the Ling 6(HL) test for use in pediatric hearing aid outcome measurement., Research Design: This work is presented across two studies incorporating an integrated knowledge translation approach in the characterization of normative and typical performance, and in the evaluation of clinical feasibility, utility, acceptability, and implementation., Study Sample: A total of 57 children, 28 normally hearing and 29 with binaural sensorineural hearing loss, were included in Study 1. Children wore their own hearing aids fitted using Desired Sensation Level v5.0. Nine clinicians from The Network of Pediatric Audiologists participated in Study 2., Data Collection and Analysis: A CD-based test format was used in the collection of unaided and aided detection thresholds in laboratory and clinical settings; thresholds were measured clinically as part of routine clinical care. Confidence intervals were derived to characterize normal performance and typical aided performance according to hearing loss severity. Unaided-aided performance was analyzed using a repeated-measures analysis of variance. The audiologists completed an online questionnaire evaluating the quality, feasibility/executability, utility/comparative value/relative advantage, acceptability/applicability, and interpretability, in addition to recommendation and general comments sections., Results: Ling 6(HL) thresholds were reliably measured with children 3-18 yr old. Normative and typical performance ranges were translated into a scoring tool for use in pediatric outcome measurement. In general, questionnaire respondents generally agreed that the Ling 6(HL) test was a high-quality outcome evaluation tool that can be implemented successfully in clinical settings., Conclusions: By actively collaborating with pediatric audiologists and using an integrated knowledge translation framework, this work supported the creation of an evidence-based clinical tool that has the potential to be implemented in, and useful to, clinical practice. More research is needed to characterize performance in alternative listening conditions to facilitate use with infants, for example. Future efforts focused on monitoring the use of the Ling 6(HL) test in daily clinical practice may help describe whether clinical use has been maintained across time and if any additional adaptations are necessary to facilitate clinical uptake., (American Academy of Audiology.)

Background: Previous studies have demonstrated that cortical auditory-evoked potentials (CAEPs) can be reliably elicited in response to speech stimuli in listeners wearing hearing aids. It is unclear, however, how close to the aided behavioral threshold (i.e., at what behavioral sensation level) a sound must be before a cortical response can reliably be detected., Purpose: The purpose of this study was to systematically examine the relationship between CAEP detection and the audibility of speech sounds (as measured behaviorally), when the listener is wearing a hearing aid fitted to prescriptive targets. A secondary aim was to investigate whether CAEP detection is affected by varying the frequency emphasis of stimuli, so as to simulate variations to the prescribed gain-frequency response of a hearing aid. The results have direct implications for the evaluation of hearing aid fittings in nonresponsive adult clients, and indirect implications for the evaluation of hearing aid fittings in infants., Research Design: Participants wore hearing aids while listening to speech sounds presented in a sound field. Aided thresholds were measured, and cortical responses evoked, under a range of stimulus conditions. The presence or absence of CAEPs was determined by an automated statistic., Study Sample: Participants were adults (6 females and 4 males). Participants had sensorineural hearing loss ranging from mild to severe-profound in degree., Data Collection and Analysis: Participants' own hearing aids were replaced with a test hearing aid, with linear processing, during assessments. Pure-tone thresholds and hearing aid gain measurements were obtained, and a theoretical prediction of speech stimulus audibility for each participant (similar to those used for audibility predictions in infant hearing aid fittings) was calculated. Three speech stimuli, (/m/, /t/, and /g/) were presented aided (monaurally, nontest ear occluded), free field, under three conditions (+4 dB/octave, -4 dB/octave, and without filtering), at levels of 40, 50, and 60 dB SPL (measured for the unfiltered condition). Behavioral thresholds were obtained, and CAEP recordings were made using these stimuli. The interaction of hearing loss, presentation levels, and filtering conditions resulted in a range of CAEP test behavioral sensation levels (SLs), from -25 to +40 dB., Results: Statistically significant CAEPs (p < .05) were obtained for virtually every presentation where the behavioral sensation level was >10 dB, and for only 5% of occasions when the sensation level was negative. In these ("false-positive") cases, the greatest (negative) sensation level at which a CAEP was judged to be present was -6 dB SL., Conclusions: CAEPs are a sensitive tool for directly evaluating the audibility of speech sounds, at least for adult listeners. CAEP evaluation was found to be more accurate than audibility predictions, based on threshold and hearing aid response measures., (American Academy of Audiology.)

Background: It is widely believed that suprathreshold distortions in auditory processing contribute to the speech recognition deficits experienced by hearing-impaired (HI) listeners in noise. Damage to outer hair cells and attendant reductions in peripheral compression and frequency selectivity may contribute to these deficits. In addition, reduced access to temporal fine structure (TFS) information in the speech waveform may play a role., Purpose: To examine how measures of peripheral compression, frequency selectivity, and TFS sensitivity relate to speech recognition performance by HI listeners. To determine whether distortions in processing reflected by these psychoacoustic measures are more closely associated with speech deficits in steady-state or modulated noise., Research Design: Normal-hearing (NH) and HI listeners were tested on tasks examining frequency selectivity (notched-noise task), peripheral compression (temporal masking curve task), and sensitivity to TFS information (frequency modulation [FM] detection task) in the presence of random amplitude modulation. Performance was tested at 500, 1000, 2000, and 4000 Hz at several presentation levels. The same listeners were tested on sentence recognition in steady-state and modulated noise at several signal-to-noise ratios., Study Sample: Ten NH and 18 HI listeners were tested. NH listeners ranged in age from 36 to 80 yr (M = 57.6). For HI listeners, ages ranged from 58 to 87 yr (M = 71.8)., Results: Scores on the FM detection task at 1 and 2 kHz were significantly correlated with speech scores in both noise conditions. Frequency selectivity and compression measures were not as clearly associated with speech performance. Speech Intelligibility Index (SII) analyses indicated only small differences in speech audibility across subjects for each signal-to-noise ratio (SNR) condition that would predict differences in speech scores no greater than 10% at a given SNR. Actual speech scores varied by as much as 80% across subjects., Conclusions: The results suggest that distorted processing of audible speech cues was a primary factor accounting for differences in speech scores across subjects and that reduced ability to use TFS cues may be an important component of this distortion. The influence of TFS cues on speech scores was comparable in steady-state and modulated noise. Speech recognition was not related to audibility, represented by the SII, once high-frequency sensitivity differences across subjects (beginning at 5 kHz) were removed statistically. This might indicate that high-frequency hearing loss is associated with distortions in processing in lower-frequency regions., (American Academy of Audiology.)

Background: A model that can accurately predict speech intelligibility for a given hearing-impaired (HI) listener would be an important tool for hearing-aid fitting or hearing-aid algorithm development. Existing speech-intelligibility models do not incorporate variability in suprathreshold deficits that are not well predicted by classical audiometric measures. One possible approach to the incorporation of such deficits is to base intelligibility predictions on sensitivity to simultaneously spectrally and temporally modulated signals., Purpose: The likelihood of success of this approach was evaluated by comparing estimates of spectrotemporal modulation (STM) sensitivity to speech intelligibility and to psychoacoustic estimates of frequency selectivity and temporal fine-structure (TFS) sensitivity across a group of HI listeners., Research Design: The minimum modulation depth required to detect STM applied to an 86 dB SPL four-octave noise carrier was measured for combinations of temporal modulation rate (4, 12, or 32 Hz) and spectral modulation density (0.5, 1, 2, or 4 cycles/octave). STM sensitivity estimates for individual HI listeners were compared to estimates of frequency selectivity (measured using the notched-noise method at 500, 1000, 2000, and 4000 Hz), TFS processing ability (2 Hz frequency-modulation detection thresholds for 500, 1000, 2000, and 4000 Hz carriers) and sentence intelligibility in noise (at a 0 dB signal-to-noise ratio) that were measured for the same listeners in a separate study., Study Sample: Eight normal-hearing (NH) listeners and 12 listeners with a diagnosis of bilateral sensorineural hearing loss participated., Data Collection and Analysis: STM sensitivity was compared between NH and HI listener groups using a repeated-measures analysis of variance. A stepwise regression analysis compared STM sensitivity for individual HI listeners to audiometric thresholds, age, and measures of frequency selectivity and TFS processing ability. A second stepwise regression analysis compared speech intelligibility to STM sensitivity and the audiogram-based Speech Intelligibility Index., Results: STM detection thresholds were elevated for the HI listeners, but only for low rates and high densities. STM sensitivity for individual HI listeners was well predicted by a combination of estimates of frequency selectivity at 4000 Hz and TFS sensitivity at 500 Hz but was unrelated to audiometric thresholds. STM sensitivity accounted for an additional 40% of the variance in speech intelligibility beyond the 40% accounted for by the audibility-based Speech Intelligibility Index., Conclusions: Impaired STM sensitivity likely results from a combination of a reduced ability to resolve spectral peaks and a reduced ability to use TFS information to follow spectral-peak movements. Combining STM sensitivity estimates with audiometric threshold measures for individual HI listeners provided a more accurate prediction of speech intelligibility than audiometric measures alone. These results suggest a significant likelihood of success for an STM-based model of speech intelligibility for HI listeners., (American Academy of Audiology.)

Background: Hearing-impaired (HI) individuals with similar ages and audiograms often demonstrate substantial differences in speech-reception performance in noise. Traditional models of speech intelligibility focus primarily on average performance for a given audiogram, failing to account for differences between listeners with similar audiograms. Improved prediction accuracy might be achieved by simulating differences in the distortion that speech may undergo when processed through an impaired ear. Although some attempts to model particular suprathreshold distortions can explain general speech-reception deficits not accounted for by audibility limitations, little has been done to model suprathreshold distortion and predict speech-reception performance for individual HI listeners. Auditory-processing models incorporating individualized measures of auditory distortion, along with audiometric thresholds, could provide a more complete understanding of speech-reception deficits by HI individuals. A computational model capable of predicting individual differences in speech-recognition performance would be a valuable tool in the development and evaluation of hearing-aid signal-processing algorithms for enhancing speech intelligibility., Purpose: This study investigated whether biologically inspired models simulating peripheral auditory processing for individual HI listeners produce more accurate predictions of speech-recognition performance than audiogram-based models., Research Design: Psychophysical data on spectral and temporal acuity were incorporated into individualized auditory-processing models consisting of three stages: a peripheral stage, customized to reflect individual audiograms and spectral and temporal acuity; a cortical stage, which extracts spectral and temporal modulations relevant to speech; and an evaluation stage, which predicts speech-recognition performance by comparing the modulation content of clean and noisy speech. To investigate the impact of different aspects of peripheral processing on speech predictions, individualized details (absolute thresholds, frequency selectivity, spectrotemporal modulation [STM] sensitivity, compression) were incorporated progressively, culminating in a model simulating level-dependent spectral resolution and dynamic-range compression., Study Sample: Psychophysical and speech-reception data from 11 HI and six normal-hearing listeners were used to develop the models., Data Collection and Analysis: Eleven individualized HI models were constructed and validated against psychophysical measures of threshold, frequency resolution, compression, and STM sensitivity. Speech-intelligibility predictions were compared with measured performance in stationary speech-shaped noise at signal-to-noise ratios (SNRs) of -6, -3, 0, and 3 dB. Prediction accuracy for the individualized HI models was compared to the traditional audibility-based Speech Intelligibility Index (SII)., Results: Models incorporating individualized measures of STM sensitivity yielded significantly more accurate within-SNR predictions than the SII. Additional individualized characteristics (frequency selectivity, compression) improved the predictions only marginally. A nonlinear model including individualized level-dependent cochlear-filter bandwidths, dynamic-range compression, and STM sensitivity predicted performance more accurately than the SII but was no more accurate than a simpler linear model. Predictions of speech-recognition performance simultaneously across SNRs and individuals were also significantly better for some of the auditory-processing models than for the SII., Conclusions: A computational model simulating individualized suprathreshold auditory-processing abilities produced more accurate speech-intelligibility predictions than the audibility-based SII. Most of this advantage was realized by a linear model incorporating audiometric and STM-sensitivity information. Although more consistent with known physiological aspects of auditory processing, modeling level-dependent changes in frequency selectivity and gain did not result in more accurate predictions of speech-reception performance., (American Academy of Audiology.)

Background: Traditional audiometric measures, such as pure-tone thresholds or unaided word-recognition in quiet, appear to be of marginal use in predicting speech understanding by hearing-impaired (HI) individuals in background noise with or without amplification. Suprathreshold measures of auditory function (tolerance of noise, temporal and frequency resolution) appear to contribute more to success with amplification and may describe more effectively the distortion component of hearing. However, these measures are not typically measured clinically. When combined with measures of audibility, suprathreshold measures of auditory distortion may provide a much more complete understanding of speech deficits in noise by HI individuals., Purpose: The primary goal of this study was to investigate the relationship among measures of speech recognition in noise, frequency selectivity, temporal acuity, modulation masking release, and informational masking in adult and elderly patients with sensorineural hearing loss to determine whether peripheral distortion for suprathreshold sounds contributes to the varied outcomes experienced by patients with sensorineural hearing loss listening to speech in noise., Research Design: A correlational study., Study Sample: Twenty-seven patients with sensorineural hearing loss and four adults with normal hearing were enrolled in the study., Data Collection and Analysis: The data were collected in a sound attenuated test booth. For speech testing, subjects' verbal responses were scored by the experimenter and entered into a custom computer program. For frequency selectivity and temporal acuity measures, subject responses were recorded via a touch screen. Simple correlation, step-wise multiple linear regression analyses and a repeated analysis of variance were performed., Results: Results showed that the signal-to-noise ratio (SNR) loss could only be partially predicted by a listener's thresholds or audibility measures such as the Speech Intelligibility Index (SII). Correlations between SII and SNR loss were higher using the Hearing-in-Noise Test (HINT) than the Quick Speech-in-Noise test (QSIN) with the SII accounting for 71% of the variance in SNR loss for the HINT but only 49% for the QSIN. However, listener age and the addition of suprathreshold measures improved the prediction of SNR loss using the QSIN, accounting for nearly 71% of the variance., Conclusions: Two standard clinical speech-in-noise tests, QSIN and HINT, were used in this study to obtain a measure of SNR loss. When administered clinically, the QSIN appears to be less redundant with hearing thresholds than the HINT and is a better indicator of a patient's suprathreshold deficit and its impact on understanding speech in noise. Additional factors related to aging, spectral resolution, and, to a lesser extent, temporal resolution improved the ability to predict SNR loss measured with the QSIN. For the HINT, a listener's audibility and age were the only two significant factors. For both QSIN and HINT, roughly 25-30% of the variance in individual differences in SNR loss (i.e., the dB difference in SNR between an individual HI listener and a control group of NH listeners at a specified performance level, usually 50% word or sentence recognition) remained unexplained, suggesting the need for additional measures of suprathreshold acuity (e.g., sensitivity to temporal fine structure) or cognitive function (e.g., memory and attention) to further improve the ability to understand individual variability in SNR loss., (American Academy of Audiology.)

Background: In spite of early identification and intervention efforts achieved by Early Hearing Detection and Intervention (EHDI) programs, many infants with hearing loss experience delays in early vocabulary development in comparison to peers with normal hearing (Mayne, Yoshinaga-Itano, Sedey, 2000a; Mayne, Yoshinaga-Itano, Sedey, Carey, 2000b; Moeller et al, 2007a, 2007b). One of the several factors that may contribute to individual differences in outcomes is inconsistent hearing aid use in this age group. This may be associated with the physical fit when using traditional behind-the-ear (BTE) hearing aids, since they are relatively large in comparison with the small and soft ear of an infant. Receiver-in-the-ear (RITE) hearing aids may be advantageous for use in pediatric fittings, since they are very tiny and lightweight and therefore sit comfortably on a small soft ear., Purpose: To evaluate the use of a RITE hearing aid with an instant ear-tip especially developed for infants in terms of physical fit, stability, safety, and security of the device, as well as the use of retention tools (remedies for keeping the hearing aid securely on the ear) with this age group., Research Design: A longitudinal study with hearing impaired infants fitted with RITE hearing aids was performed., Study Sample: Eighteen infants with mild to moderate/severe hearing loss participated in the study. The age range was 2-36 mo. Sixteen infants had worn hearing aids prior to their participation in the study., Intervention: Each hearing impaired infant was fitted with the RITE hearing aid and an instant ear-tip, the size of which was chosen by the audiologist. The infants used the device for a period of 2-5 mo., Data Collection and Analysis: Audiologists and parents completed questionnaires at every visit (5-7 visits in total). Responses were obtained using a category rating scale (Stevens, 1975) from 0 to 10. The data were analyzed using descriptive statistics and nonparametric statistics., Results: Sixteen of the 18 children completed the study. At the end of the study, 11 of the 16 children were using the instant ear-tip, whereas five children were fitted with the receiver mounted in a custom earmold. The audiologists rated the RITE solution to provide a safe, stable, and secure fit. The general trend was that ratings improved over time. At the final follow-up session, all median ratings were between 8 and 10., Conclusions: Based on the positive results obtained in the study, the use of an appropriately designed RITE hearing aid is recommended for infants., (American Academy of Audiology.)

Background: Johnson and Dillon (2011) provided a model-based comparison of current generic hearing aid prescriptive methods for adults with hearing loss based on the attributes of speech intelligibility, loudness, and bandwidth., Purpose: This study compared the National Acoustic Laboratories-Non-linear 2 (NAL-NL2) and Cambridge Method for Loudness Equalization 2-High-Frequency (CAM2) prescriptive methods using adult participants with less high-frequency hearing loss than Johnson and Dillon (2011). Of study interest was quantification of prescribed audibility, speech intelligibility, and loudness. The preferences of participants for either NAL-NL2 or CAM2 and preferred deviations from prescribed settings are also reported., Research Design: Using a single-blind, counter-balanced, randomized design, preference judgments for the prescriptive methods with regard to sound quality of speech and music stimuli were obtained. Preferred gain adjustments from the prescription within the 4-10 kHz frequency range were also obtained from each participant. Speech intelligibility and loudness model calculations were completed on the prescribed and adjusted amplification., Study Sample: Fourteen male Veterans, whose average age was 65 yr and whose hearing sensitivity averaged normal to borderline normal through 1000 Hz sloping to a moderately severe sensorineural loss, served as participants., Data Collection and Analysis: Following a brief listening time (~10 min), typical of an initial fitting visit, the participants made paired comparison of sound quality between the NAL-NL2 and CAM2 prescriptive settings. Participants were also asked to modify each prescription in the range of 4-10 kHz using an overall gain control and make subsequent comparisons of sound quality preference between prescriptive and adjusted settings. Participant preferences were examined with respect to quantitative analysis of loudness modeling, speech intelligibility modeling, and measured high-frequency bandwidth audibility., Results: Consistent with the lack of difference in predicted speech intelligibility between the two prescriptions, sound quality preferences on the basis of clarity were split across participants while some participants did not have a discernable preference. Considering sound quality judgments of pleasantness, the majority of participants preferred the sound quality of the NAL-NL2 (8 of 14) prescription instead of the CAM2 prescription (2 of 14). Four of the 14 participants showed no preference on the basis of pleasantness for either prescription. Individual subject preferences were supported by loudness modeling that indicated NAL-NL2 was the softer of the two prescriptions and CAM2 was the louder. CAM2 did provide more audibility to the higher frequencies (5-8 kHz) than NAL-NL2. Participants turned the 4-10 kHz gain recommendation of CAM2 lower, on average, by a significant amount of 4 dB when making adjustments while no significant adjustment was made to the initial NAL-NL2 recommendation., Conclusions: NAL-NL2 prescribed gains were more often preferred at the initial fitting by the majority of participating veterans. For those patients with preference for a louder fitting than NAL-NL2, CAM2 is a good alternative. When the participant adjustment from the prescription between 4 and 10 kHz exceeded 4 dB from either NAL-NL2 (2 of 14) or CAM2 (11 of 14), the participants demonstrated a later preference for that adjustment 69% of the time. These findings are viewed as limited evidence that some individuals may have a preference for high-frequency gain that differs from the starting prescription., (American Academy of Audiology.)

Background: Xylene is an organic solvent, widely used in histology laboratories and other occupational settings. Research in animals has demonstrated that xylene induces outer hair cell damage. Evidence regarding the effects of xylene in humans is only available from studies investigating workers exposed to mixtures of solvents containing xylene. These data indicate that mixtures of solvents containing xylene may induce hearing loss and central auditory dysfunction., Purpose: To comprehensively evaluate the peripheral and central auditory system of a histology laboratory worker exposed to xylene, who had presented with bilateral mild sensorineural hearing loss at an initial assessment., Research Design: A case report of a male histology laboratory worker who has been exposed to xylene for over 20 yr., Results: A diagnosis of bilateral mild sensorineural hearing loss of cochlear origin was made on the basis of otological, neuroimaging, and audiological examinations. Results indicating the absence of transient-evoked otoacoustic emissions, and auditory brainstem responses as expected for a mild cochlear hearing loss, were obtained., Conclusions: The observed bilateral mild sensorineural hearing loss was considered to have been induced by xylene exposure, due to the absence of any other etiological factors related to the onset of hearing loss. The results found in this patient are in agreement with animal data indicating xylene-induced ototoxicity. Xylene-exposed individuals should be audiologically monitored on a regular basis., (American Academy of Audiology.)

Background: The Revised Speech Perception in Noise Test (R-SPIN; Bilger, 1984b) is composed of 200 target words distributed as the last words in 200 low-predictability (LP) and 200 high-predictability (HP) sentences. Four list pairs, each consisting of two 50-sentence lists, were constructed with the target word in a LP and HP sentence. Traditionally the R-SPIN is presented at a signal-to-noise ratio (SNR, S/N) of 8 dB with the listener task to repeat the last word in the sentence., Purpose: The purpose was to determine the practicality of altering the R-SPIN format from a single SNR paradigm into a multiple SNR paradigm from which the 50% points for the HP and LP sentences can be calculated., Research Design: Three repeated measures experiments were conducted., Study Sample: Forty listeners with normal hearing and 184 older listeners with pure-tone hearing loss participated in the sequence of experiments., Data Collection and Analysis: The R-SPIN sentences were edited digitally (1) to maintain the temporal relation between the sentences and babble, (2) to establish the SNRs, and (3) to mix the speech and noise signals to obtain SNRs between -1 and 23 dB. All materials were recorded on CD and were presented through an earphone with the responses recorded and analyzed at the token level. For reference purposes the Words-in-Noise Test (WIN) was included in the first experiment., Results: In Experiment 1, recognition performances by listeners with normal hearing were better than performances by listeners with hearing loss. For both groups, performances on the HP materials were better than performances on the LP materials. Performances on the LP materials and on the WIN were similar. Performances at 8 dB S/N were the same with the traditional fixed level presentation and the descending presentation level paradigms. The results from Experiment 2 demonstrated that the four list pairs of R-SPIN materials produced good first approximation psychometric functions over the -4 to 23 dB S/N range, but there were irregularities. The data from Experiment 2 were used in Experiment 3 to guide the selection of the words to be used at the various SNRs that would provide homogeneous performances at each SNR and would produce systematic psychometric functions. In Experiment 3, the 50% points were in good agreement for the LP and HP conditions within both groups of listeners. The psychometric functions for List Pairs 1 and 2, 3 and 4, and 5 and 6 had similar characteristics and maintained reasonable separations between the HP and LP functions, whereas the HP and LP functions for List Pair 7 and 8 bisected one another at the lower SNRs., Conclusions: This study indicates that the R-SPIN can be configured into a multiple SNR paradigm. A more in-depth study with the R-SPIN materials is needed to develop lists that are systematic and reasonably equivalent for use on listeners with hearing loss. The approach should be based on the psychometric characteristics of the 200 HP and 200 LP sentences with the current R-SPIN lists discarded. Of importance is maintaining the synchrony between the sentences and their accompanying babble., (American Academy of Audiology.)

Background: In certain masking paradigms, the masker can have two components, energetic and informational. Energetic masking is the traditional peripheral masking, whereas informational masking involves confusions (uncertainty) between the signal and masker that originate more centrally in the auditory system. Sperry et al (1997) used Northwestern University Auditory Test No. 6 (NU-6) words in multitalker babble to study the differential effects of energetic and informational masking using babble played temporally forward (FB) and backward (BB). The FB and BB are the same except BB is void of the contextual and semantic content cues that are available in FB. It is these informational cues that are thought to fuel informational masking. Sperry et al found 15% better recognition performance (∼3 dB) on BB than on FB, which can be interpreted as the presence of informational masking in the FB condition and not in the BB condition (Dirks and Bower, 1969). The Words-in-Noise Test (WIN) (Wilson, 2003; Wilson and McArdle, 2007) uses NU-6 words as the signal and multitalker babble as the masker, which is a combination of stimuli that potentially could produce informational masking. The WIN presents 5 or 10 words at each of seven signal-to-noise ratios (S/N, SNR) from 24 to 0 dB in 4 dB decrements with the 50% correct point being the metric of interest. The same recordings of the NU-6 words and multitalker babble used by Sperry et al are used in the WIN., Purpose: To determine whether informational masking was involved with the WIN., Research Design: Descriptive, quasi-experimental designs were conducted in three experiments using FB and BB in various paradigms in which FB and BB varied from 4.3 sec concatenated segments to essentially continuous., Study Sample: Eighty young adults with normal hearing and 64 older adults with sensorineural hearing losses participated in a series of three experiments., Data Collection and Analysis: Experiment 1 compared performance on the normal WIN (FB) with performance on the WIN in which the babble segment with each word was reversed temporally (BB). Experiment 2 examined the effects of continuous FB and BB segments on WIN performance. Experiment 3 replicated the Sperry et al (1997) experiment at 4 and 0 dB S/N using NU-6 words in the FB and BB conditions., Results: Experiment 1-with the WIN paradigm, recognition performances on FB and BB were the same for listeners with normal hearing and listeners with hearing loss, except at the 0 dB S/N with the listeners with normal hearing at which performance was significantly better on BB than FB. Experiment 2-recognition performances on FB and BB were the same at all SNRs for listeners with normal hearing using a slightly modified WIN paradigm. Experiment 3-there was no difference in performances on the FB and BB conditions with either of the two SNRs., Conclusions: Informational masking was not involved in the WIN paradigm. The Sperry et al results were not replicated, which is thought to be related to the way in which the Sperry et al BB condition was produced., (American Academy of Audiology.)

The developing auditory cortex is highly plastic. As such, the cortex is both primed to mature normally and at risk for reorganizing abnormally, depending upon numerous factors that determine central maturation. From a clinical perspective, at least two major components of development can be manipulated: (1) input to the cortex and (2) the timing of cortical input. Children with sensorineural hearing loss (SNHL) and auditory neuropathy spectrum disorder (ANSD) have provided a model of early deprivation of sensory input to the cortex and demonstrated the resulting plasticity and development that can occur upon introduction of stimulation. In this article, we review several fundamental principles of cortical development and plasticity and discuss the clinical applications in children with SNHL and ANSD who receive intervention with hearing aids and/or cochlear implants., (American Academy of Audiology.)

This is a case report of a 53-yr-old female who experienced sudden sensorineural hearing loss (SSNHL) accompanied by roaring tinnitus in her right ear. The patient's hearing partially improved in the low frequencies in response to intratympanic injections. Given that her hearing loss did not improve further, the patient was fitted with a hearing aid to mask the tinnitus and restore a sense of balance between the two ears. Approximately 9 mo postonset of the SSNHL, a complete spontaneous recovery of hearing occurred. Such a delayed and complete recovery is highly unusual. This case highlights that the spontaneous recovery in hearing indicates that the pathological cause for the SSNHL involved a process that was capable of repair or regeneration, thus ruling out pathologies related to cochlear hair cell destruction or nerve fiber loss. This leaves a possibility that the event causing the onset of the SSNHL resulted in a disruption of the ion homeostatic properties of the cochlea via the production of the endocochlear potential., (American Academy of Audiology.)

These two cases illustrate several important areas of vestibular evaluation with children. The two case reports represent two children who display very different vestibular findings despite having significant sensorineural hearing loss. These case reports highlight that pediatric findings can differ significantly from adult findings, stressing the importance of comparing pediatric results with pediatric normative data. These two cases also highlight that vestibular techniques may successfully be adapted for use with hearing-impaired children. That is, rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials can be adapted to use with children, including those who demonstrate significant sensorineural hearing loss. Although there is a paucity of research and clinical work in this area, some investigators (Eviatar and Eviatar, 1977; Buchman et al, 2004; Jacot et al, 2009) have reported very rapid recovery from pediatric vestibular deficits. However, it is important for audiologists to be aware that techniques may successfully be adapted for children and that many children should undergo thorough vestibular evaluation., (American Academy of Audiology.)

This case study summarizes findings in an adult male, aged 57, who presented to the Adult Audiology Clinic with aural atresia in the right ear resulting in a conductive hearing loss and a sudden sensorineural hearing loss in the left ear. Treatment options included reconstruction surgery in the right ear, bone anchored hearing aid in the right ear to overcome the conductive hearing loss, bone anchored hearing aid in the left ear for single sided deafness, and intratympanic steroid injections in the left ear to salvage hearing. This case study highlights that when a patient is educated on all available options the patient is then able to make a decision comfortable to him and to help improve his hearing., (American Academy of Audiology.)

A 79-yr-old male was evaluated by the authors 4-6 wk following a rapid decline in perceived hearing in the right ear. Initial treatment with self-administered external ear canal irrigations and topical antibiotic prescribed by the patient's primary care physician resulted in no apparent improvement. The initial hearing evaluation revealed a mild-to-severe sloping sensorineural loss above 1000 Hz in the left ear and a moderately severe to severe sensorineural loss with a "flat" configuration in the right ear. There was normal word recognition in the left ear, with no measurable word recognition in the right ear. Initial treatment with oral steroids suggested some subjective improvement, and an intratympanic dexamethasone injection was performed. A repeat audiogram obtained approximately 1 mo postinjection showed significant improvement in pure tone thresholds and significant improvement in the word recognition score in the right ear. One week later a second intratympanic injection was completed, again, with follow-up in 1 mo. This case report reviews treatment options for idiopathic sudden sensorineural hearing loss (ISSNHL), including usual time lines for treatment and expected outcomes and the specific treatments and evaluation results for this patient for whom delayed treatment was unusually effective., (American Academy of Audiology.)

Background: The auditory steady state response (ASSR) is an auditory evoked potential (AEP) that can be used to objectively estimate hearing sensitivity in individuals with normal hearing sensitivity and with various degrees and configurations of sensorineural hearing loss (SNHL). For this reason, many audiologists want to learn more about the stimulus and recording parameters used to successfully acquire this response, as well as information regarding how accurately this response predicts behavioral thresholds across various clinical populations., Purpose: The scientific goal is to create a tutorial on the ASSR for doctor of audiology (Au.D.) students and audiologists with limited (1-5 yr) clinical experience with AEPs. This tutorial is needed because the ASSR is unique when compared to other AEPs with regard to the type of terminology used to describe this response, the types of stimuli used to record this response, how these stimuli are delivered, the methods of objectively analyzing the response, and techniques used to calibrate the stimuli. A second goal is to provide audiologists with an understanding of the accuracy with which the ASSR is able to estimate pure tone thresholds in a variety of adult and pediatric clinical populations., Design: This tutorial has been organized into various sections including the history of the ASSR, unique terminology associated with this response, the types of stimuli used to elicit the response, two common stimulation methods, methods of objectively analyzing the response, technical parameters for recording the ASSR, and the accuracy of ASSR threshold prediction in the adult and pediatric populations. In each section of the manuscript, key terminology/concepts associated with the ASSR are bolded in the text and are also briefly defined in a glossary found in the appendix. The tutorial contains numerous figures that are designed to walk the reader through the key concepts associated with this response. In addition, several summary tables have been included that discuss various topics such as the effects of single versus multifrequency stimulation techniques on the accuracy of estimating behavioral thresholds via the ASSR; differences, if any, in monaural versus binaural ASSR thresholds; the influence of degree and configuration of SNHL on ASSR thresholds; test-retest reliability of the ASSR; the influence of neuro-maturation on ASSR thresholds; and the influence of various technical factors (i.e., oscillator placement, coupling force, and the number of recording channels) that affect bone conducted ASSRs., Conclusion: Most researchers agree that, in the future, ASSR testing will play an important role in clinical audiology. Therefore, it is important for clinical audiologists and Au.D. students to have a good basic understanding of the technical concepts associated with the ASSR, a knowledge of optimal stimulus and recording parameters used to accurately record this response, and an appreciation of the current role and/or limitations of using the ASSR to estimate behavioral thresholds in infants with various degrees and configurations of hearing loss., (American Academy of Audiology.)

Background: The Words-in-Noise Test (WIN) was developed as an instrument to quantify the ability of listeners to understand monosyllabic words in background noise using multitalker babble (Wilson, 2003). The 50% point, which is calculated with the Spearman-Kärber equation (Finney, 1952), is used as the evaluative metric with the WIN materials. Initially, the WIN was designed as a 70-word instrument that presented ten unique words at each of seven signal-to-noise ratios from 24 to 0 dB in 4 dB decrements. Subsequently, the 70-word list was parsed into two 35-word lists that achieved equivalent recognition performances (Wilson and Burks, 2005). This report involves the development of a third list (WIN List 3) that was developed to serve as a practice list to familiarize the participant with listening to words presented in background babble., Purpose: To determine-on young listeners with normal hearing and on older listeners with sensorineural hearing loss-the psychometric properties of the WIN List 3 materials., Research Design: A quasi-experimental, repeated-measures design was used., Study Sample: Twenty-four young adult listeners (M = 21.6 yr) with normal pure-tone thresholds (≤ 20 dB HL at 250 to 8000 Hz) and 24 older listeners (M = 65.9 yr) with sensorineural hearing loss participated., Data Collection and Analysis: The level of the babble was fixed at 80 dB SPL with the level of the words varied from 104 to 80 dB SPL in 4 dB decrements., Results: For listeners with normal hearing, the 50% points for Lists 1 and 2 were similar (4.3 and 5.1 dB S/N, respectively), both of which were lower than the 50% point for List 3 (7.4 dB S/N). A similar relation was observed with the listeners with hearing loss, 50% points for Lists 1 and 2 of 12.2 and 12.4 dB S/N, respectively, compared to 15.8 dB S/N for List 3. The differences between Lists 1 and 2 and List 3 were significant. The relations among the psychometric functions and the relations among the individual data both reflected these differences., Conclusions: The significant ∼3 dB difference between performances on WIN Lists 1 and 2 and on WIN List 3 by the listeners with normal hearing and the listeners with hearing loss dictates caution with the use of List 3. The use of WIN List 3 should be reserved for ancillary purposes in which equivalent recognition performances are not required, for example, as a practice list or a stand alone measure., (American Academy of Audiology.)

Background: Best practices concerning the audiological management of the child diagnosed with auditory neuropathy spectrum disorder (ANSD) have not been definitively defined nor fully understood. One reason is that previous studies have demonstrated conflicting findings regarding the outcomes of cochlear implantation for children with ANSD. Thus, the question remains whether children with ANSD are able to achieve similar outcomes following cochlear implantation as those children with sensorineural hearing loss (SNHL)., Purpose: To assess speech perception outcomes for children with cochlear implants who have a diagnosis of ANSD as well as their age-matched peers who have sensorineural hearing loss., Research Design: Retrospective study, Study Sample: Thirty-five subject pairs (n = 70) ranging in age at implant activation from to 10 to 121 mo (mean 39.2 mo) were included in this retrospective study. Subjects were matched on variables including age at initial implant activation and months of implant use at postoperative test point., Data Collection and Analysis: Speech recognition scores for monosyllabic and multisyllabic stimuli were compared across the subject groups. For those not developmentally and/or linguistically ready for completion of open-set speech recognition testing with recorded stimuli, GASP (Glendonald Auditory Screening Procedure) word recognition and/or questionnaire data using either the LittlEARS or Meaningful Auditory Integration Scale were compared across the groups. Statistical analysis using a repeated-measures analysis of variance (ANOVA) evaluated the effects of etiology (ANSD or SNHL) on postoperative outcomes., Results: The results of this study demonstrate that children with ANSD can clearly benefit from cochlear implantation and that their long-term outcomes are similar to matched peers with SNHL on measures of speech recognition. There were no significant differences across the ANSD and SNHL groups on any of the tested measures., Conclusion: Cochlear implantation is a viable treatment option for children with a diagnosis of ANSD who are not making auditory progress with hearing aids that have been fit using the Desired Sensation Level method (DSL v5.0). Expected outcomes of cochlear implantation for children with ANSD, excluding children with cochlear nerve deficiency, are no different than for children with non-ANSD SNHL. These results are important for counseling families on the expected outcomes and realistic expectations following cochlear implantation for children with ANSD who demonstrate no evidence of cochlear nerve deficiency., (American Academy of Audiology.)

Background: Directional microphones have been shown to improve a listener's ability to communicate in noise by improving the signal to noise ratio. However, their efficacy may be questioned in situations where the listener needs to understand speech originating from the back., Purpose: The goal of the study was to examine the performance of a directional microphone mode that has an automatic reverse cardioid polar pattern., Research Design: A single-blinded, factorial repeated-measures design was used to study the effect of microphone modes (reverse cardioid, omnidirectional, and front hypercardioid) and stimulus azimuths (front and back) on three outcome variables (aided thresholds, nonsense syllable identification in quiet, and sentence recognition in noise)., Study Sample: Twenty adults with a mild-to-severe bilaterally symmetrical (±5 dB) sensorineural hearing loss participated., Intervention: Audibility in quiet was evaluated by obtaining aided sound field thresholds and speech identification at an input level of 50 dB SPL presented at 0 and 180° azimuths. In addition, speech understanding in noise was also assessed with the Hearing In Noise Test (HINT) sentences presented at both azimuths (0 and 180°) with a diffuse noise., Data Collection and Analysis: Repeated-measures analyses of variance (ANOVAs) were conducted to examine the effects of microphone mode (omnidirectional, front hypercardioid, reverse cardioid) and stimulus azimuth (0°, 180°) on aided thresholds, nonsense syllable identification, and HINT performance., Results: Results with the reverse cardioid directional microphone in both quiet conditions were similar to the omnidirectional microphone. The results of the reverse cardioid microphone in noise were significantly better than the omnidirectional microphone and front hypercardioid microphone when speech was presented from the back (p < 0.001)., Conclusions: These results support the possible benefits of a reverse cardioid directional microphone when used in specific listening situations., (American Academy of Audiology.)

Background: Auditory disorders associated with substance abuse are rare. Hearing loss secondary to heroin and hydrocodone abuse has been described variously as not always responsive to steroid management, as not always reversible, and in some cases, as nonresponsive profound sensorineural hearing loss requiring cochlear implantation. We present a case of a teenager with sudden-onset moderate to severe bilateral sensorineural hearing loss after documented polysubstance "binging." The hearing loss improved substantially after high-dose steroid and vasoactive therapy., Purpose: The purpose of this report is to describe the hearing disorder of a patient who had awakened with a bilateral severe hearing loss following a night of recreational drug abuse., Research Design: Case report and review of the literature., Data Collection and Analysis: The subject of this report is an 18-yr-old patient with a history of substance abuse. Data collected were magnetic resonance /computed tomography brain imaging; metabolic, infectious disease, and autoimmune evaluation; and extensive audiologic evaluation, including pure-tone and speech audiometry, immittance measures, distortion-product otoacoustic emissions, and auditory brainstem response testing. Serial audiograms were collected for 10 mo following the onset of symptoms., Results: Two days of polysubstance abuse (heroin, benzodiazepine, alcohol, and crack [smoked cocaine]) resulted in moderately severe sensorineural hearing loss bilaterally. The loss responded to a 1 mo course of high-dose prednisone and a 10 mo course of pentoxifylline. Hearing sensitivity subsequently improved, leaving only residual high-frequency sensorineural hearing loss., Conclusions: This case report highlights the importance of "recreational" drug abuse in the evaluation of sudden hearing loss. Potential etiologies include altered pharmacokinetics, vascular spasm/ischemia, encephalopathy, acute intralabyrinthine hemorrhage, and genetic polymorphisms of drug-metabolizing enzymes., (American Academy of Audiology.)

Background: Sensory hearing loss is predominantly caused by the destruction of cochlear outer hair cells (OHCs), inner hair cells (IHCs), or spiral ganglion cells (SGCs). There have been a number of attempts to differentiate between these etiologies of hearing loss, using various psychoacoustic and physiologic paradigms., Purpose: Here we investigate the potential of the auditory brainstem response (ABR) input/output function for such differential diagnosis. On the basis of the saturation of the OHC-based cochlear amplifier, it was hypothesized that selective impairment of OHCs would reduce ABR amplitudes at low to moderate but not at high sound levels. Selective impairment of IHCs or SGCs would reduce ABR amplitudes more or less uniformly across sound level. Finally, a mix of OHC and IHC or SGC impairment would reduce ABR amplitudes at all sound levels but less so at high levels depending on the relative contribution of OHC impairment to the hearing loss., Research Design: To test these hypotheses, normal-hearing adult guinea pigs were intravenously injected with either salicylate, furosemide, or quinine, under ketamine anesthesia. ABRs, as well as distortion-product otoacoustic emissions (DPOAEs), were measured as a function of the sound stimulus level before and after drug injection., Results: Following salicylate injection, ABR amplitudes were reduced only at low-moderate stimulus levels. Following furosemide or quinine injection, ABR amplitudes were reduced at all levels but less so at high ones. This is in accord with the expectation that acute salicylate administration selectively affects the OHCs, while furosemide and quinine affect both OHCs and IHCs/SGCs. Such differential diagnosis was not possible solely on the basis of DPOAE amplitudes, which were unchanged at high stimulus levels after the injection of each of the three drugs. Comparison of ABR and DPOAE threshold shifts could also differentiate the effects of salicylate from those of furosemide and quinine but could not, for example, unequivocally point to salicylate's selective impairment of OHCs., Conclusions: ABR amplitudes appear suitable for differentiating between damage to OHCs and IHCs/SGCs, at least in a controlled experimental setting where pre- and postmanipulation data are available. This could be useful for noninvasively testing the effects of drugs or acoustic overstimulation on the cochlea, at least in the laboratory. Clinical applicability would seem to be limited by the high variability in ABR amplitudes among normal-hearing humans but might be feasible in the future if regular ABR testing entered into routine clinical practice., (American Academy of Audiology.)

Background: Accurate prescriptive gain results in a more accurate fit, lower return rate in hearing aids, and increased patient satisfaction. In situ threshold measurements can be used to determine required gain. The Widex Corporation uses an in situ threshold measurement strategy, called the Sensogram. Real-ear measurements determine if prescriptive gain targets have been achieved. Starkey Laboratories introduced an integrated real-ear measurement system in their hearing aids., Purpose: To determine whether the responses obtained using the Widex Sensogram were equivalent to those obtained using current clinical threshold measurement methods. To determine the accuracy of the Starkey IREMS™ (Integrated Real Ear Measurement System) in measuring RECD (real-ear to coupler difference) values compared to a dedicated real-ear measurement system., Research Design: A verification design was employed by comparing participant data measured from standard, benchmark equipment and procedures against new techniques offered by hearing-aid manufacturers., Study Sample: A total of 20 participants participated in this study. Ten participants with sensorineural hearing loss were recruited from the Ohio University Hearing, Speech, and Language Clinic participated in the first experiment. Ten participants with normal hearing were recruited from the student population at Ohio University participated in both experiments. The normal-hearing group had thresholds of 15 dB HL or better at the octave frequencies of 250-8000 Hz. The hearing-impaired group had thresholds of varying degrees and configurations with thresholds equal to or poorer than 25 dB HL three-frequency pure-tone average., Data Collection and Analysis: The order of measurement method for both experiments was counterbalanced. In Experiment 1, thresholds obtained via the Widex Sensogram were compared to thresholds obtained for each participant using a clinical audiometer and ER-3A insert ear phones. In Experiment 2, RECD values obtained via the Starkey IREMS were compared to RECD values obtained via the Audioscan Verifit™. A repeated-measures analysis of variance (ANOVA) was used for statistical analysis, and a Fisher's LSD (least significant difference) was used as a post hoc analysis tool., Results: A significant difference between Sensogram thresholds and conventional audiometric thresholds was found with the Sensogram method resulting in better threshold values at 0.5, 1.0, and 2.0 kHz for both groups. In Experiment 2, a significant difference between RECD values obtained by the Starkey IREMS and the Audioscan Verifit system was found with significant differences in RECD values found at 0.25, 0.5, 0.75, 1.5, 2.0, and 6.0 kHz., Conclusions: The Sensogram data differ significantly from traditional audiometry at several frequencies important for speech intelligibility. Real-ear measures are still required for verification of prescribed gain, however, calling into question any claims of shortened fitting time. The Starkey IREMS does perform real-ear measurements that vary significantly from benchmark equipment. These technologies represent a positive direction in prescribing accurate gain during hearing-aid fittings, but a stand-alone system is still the preferred method for real-ear measurements in hearing-aid fittings., (American Academy of Audiology.)

Background: The multiple auditory steady-state response (multiple ASSR) is a promising technique for determining thresholds for infants and children. However, there are few data for infants and young children with hearing loss where multiple-ASSR thresholds have been compared to frequency-specific gold standard (i.e., behavioral or tone-evoked auditory brainstem response [tone ABR]) measures., Purpose: The study compared multiple-ASSR and tone-ABR thresholds and assessed how well "normal" ASSR levels differentiate normal from elevated thresholds., Research Design: Multiple-ASSR and tone-ABR results (to air-conduction stimuli) were obtained in infants and young children with hearing loss or normal hearing., Study Sample: 98 infants with hearing loss (53 infants provided thresholds) and 34 infants with normal hearing., Data Collection and Analysis: Multiple-ASSR and tone-ABR results were typically completed on the same day. Correlations between ASSR and ABR thresholds, linear regressions, and ASSR-minus-ABR threshold difference scores were calculated for each group (normal or hearing loss), and for both groups combined., Results: Multiple-ASSR thresholds (dB HL) were strongly correlated (r = .97) with tone-ABR thresholds (dB nHL) for 500, 1000, 2000, and 4000 Hz. Mean (±1 SD) difference scores (ASSR-minus-ABR) were 10.7 ± 9.0, 9.5 ± 9.4, 9.2 ± 9.0, and 6.3 ± 9.5 dB for 500, 1000, 2000, and 4000 Hz, respectively. The previously published "normal" ASSR levels accurately differentiated normal from elevated thresholds. Out of 523 tests with elevated tone-ABR thresholds, the multiple ASSR was "normal" in only 22 tests. In these 13 infants, other ASSR frequencies were elevated, and thus the infants would not have "passed" the ASSR., Conclusions: There are few studies of infants and young children comparing ASSR thresholds to frequency-specific gold standard measures, especially using the multiple-ASSR technique. The present study, comparing multiple-ASSR to tone-ABR thresholds, nearly doubles the multiple-ASSR sample size in the literature. The results indicate that the multiple-ASSR and tone-ABR thresholds are strongly correlated, and the "normal" multiple-ASSR levels of 50, 45, 40, and 40 dB HL correctly classified children as having "normal" or "elevated" thresholds. However, due to the lack of air- and bone-conduction data in infants with different types and degrees of hearing loss, further ASSR research is needed., (American Academy of Audiology.)

Background: The International Outcome Inventory for Hearing Aids (IOI-HA) is a seven-item hearing-specific questionnaire. It was developed with the purpose of evaluating the efficacy of hearing aid rehabilitation. Few psychometric properties have been presented for a Swedish translation of the IOI-HA. Furthermore, previous studies have examined the IOI-HA in mainly sensorineural hearing losses, and we do not know how the type of hearing loss affects the outcome., Purpose: To evaluate the hearing aid fitting outcome measured in a clinical setting using a Swedish translation of the International Outcome Inventory for Hearing Aids (IOI-HA), to determine the psychometric properties of the translation, and to examine how a number of demographic variables such as type of hearing loss affect the outcome., Research Design: A descriptive and correlational study in a retrospective sample., Study Sample: Two hundred and twenty-four (107 females and 117 males; ages 27-94 yr with an average of 66.1 yr) first-time hearing aid users., Intervention: Mostly digital hearing aids (97.8%) were fitted monaurally (60%) or binaurally (40%) between 2007 and 2009., Data Collection and Analysis: The subjects were mailed the IOI-HA questionnaire six months after their final appointment, and the completed questionnaire was returned by mail to the clinic. The psychometric properties were evaluated and compared to previous studies using the IOI-HA. The associations between the outcome scores and a number of demographic variables (age, gender, degree of hearing loss, type of hearing loss, number of hearing aids, and type of hearing aids) were examined. Based on the pure tone audiograms, the subjects were divided into three groups; those with conductive hearing losses, sensorineural hearing losses, and mixed hearing losses. For these groups, the differences in outcome measured as IOI-HA were examined., Results: The psychometric properties of the present translation of the IOI-HA showed resemblance in many aspects to previous reports. Furthermore, the type of hearing loss seems to affect the IOI-HA outcome. Hearing loss increases with increasing age, and hearing aid use increases with increasing degree of hearing loss. Subjects with sensorineural hearing losses show significantly poorer scores on items concerning introspective aspects of the outcome in comparison to subjects with mixed hearing losses and subjects with conductive hearing losses. Monaurally fitted subjects tend to report lower scores on average, but monaural or binaural hearing aid fitting do not significantly affect the subjective outcome., Conclusions: The psychometric properties of the present Swedish translation of the IOI-HA show resemblance in many aspects to previous reports, but the differences observed could be due to differences in the study populations. Overall, the demographic variables examined could not be used as predictors for the hearing aid fitting outcome, and more reliable predictors need to be identified., (American Academy of Audiology.)

Background: A possible voicing cue used to differentiate voiced and voiceless cognate pairs is envelope onset asynchrony (EOA). EOA is the time between the onsets of two frequency bands of energy (in this study one band was high-pass filtered at 3000 Hz, the other low-pass filtered at 350 Hz). This study assessed the perceptual impact of manipulating EOA on voicing perception of initial stop consonants, and whether normal-hearing and hearing-impaired listeners were sensitive to changes in EOA as a cue for voicing., Purpose: The purpose of this study was to examine the effect of spectrally asynchronous auditory delay on the perception of voicing associated with initial stop consonants by normal-hearing and hearing-impaired listeners., Research Design: Prospective experimental study comparing the perceptual differences of manipulating the EOA cues for two groups of listeners., Study Sample: Thirty adults between the ages of 21 and 60 yr completed the study: 17 listeners with normal hearing and 13 listeners with mild-moderate sensorineural hearing loss., Data Collection and Analysis: The participants listened to voiced and voiceless stop consonants within a consonant-vowel syllable structure. The EOA of each syllable was varied along a continuum, and identification and discrimination tasks were used to determine if the EOA manipulation resulted in categorical shifts in voicing perception. In the identification task the participants identified the consonants as belonging to one of two categories (voiced or voiceless cognate). They also completed a same-different discrimination task with the same set of stimuli. Categorical perception was confirmed with a d-prime sensitivity measure by examining how accurately the results from the identification task predicted the discrimination results. The influence of EOA manipulations on the perception of voicing was determined from shifts in the identification functions and discrimination peaks along the EOA continuum. The two participant groups were compared in order to determine the impact of EOA on voicing perception as a function of syllable and hearing status., Results: Both groups of listeners demonstrated a categorical shift in voicing perception with manipulation of EOA for some of the syllables used in this study. That is, as the temporal onset asynchrony between low- and high-frequency bands of speech was manipulated, the listeners' perception of consonant voicing changed between voiced and voiceless categories. No significant differences were found between listeners with normal hearing and listeners with hearing loss as a result of the EOA manipulation., Conclusions: The results of this study suggested that both normal-hearing and hearing-impaired listeners likely use spectrally asynchronous delays found in natural speech as a cue for voicing distinctions. While delays in modern hearing aids are less than those used in this study, possible implications are that additional asynchronous delays from digital signal processing or open-fitting amplification schemes might cause listeners with hearing loss to misperceive voicing cues., (American Academy of Audiology.)

Background: With the advent of newborn hearing screening programs, the need to verify the fit of hearing aids in young infants has increased. The recording of cortical auditory evoked potentials (CAEPs) for this purpose is quite feasible, but rapid developmental changes that affect response morphology and the presence of electrophysiological noise can make subjective response detection challenging., Purpose: The purpose of this study was to investigate the effectiveness of an automated statistic versus experienced examiners in detecting the presence of infant CAEPs when stimuli were present and reporting the absence of CAEPs when no stimuli were present., Research Design: A repeated-measures design was used where infant-generated CAEPs were interpreted by examiners and an automated statistic., Study Sample: There were nine male and five female infants (mean age, 12 mo; SD, 3.4) who completed behavioral and electrophysiological testing using speech-based stimuli., Data Collection and Analysis: In total, 87 infant CAEPs were recorded to three sensation levels, 10, 20 and 30 dB relative to the behavioral thresholds and to nonstimulus trials. Three examiners were presented with these responses: (1) "in series," where waveforms were presented in order of decreasing stimulus presentation levels, and (2) "nonseries," where waveforms were randomized completely and presented as independent waveforms. The examiners were given no information about the stimulus levels and were asked to determine whether responses to auditory stimulation could be observed and their degree of certainty in making their decision. Data from the CAEP responses were also converted to multiple dependent variables and analyzed using Hotelling's T(2). Results from both methods of response detection were analyzed using a repeated measures ANOVA (analysis of variance) and parameters of signal detection theory known as d-prime (d') and the area under the receiver operating characteristic (ROC) curve., Results: Results showed that as the stimulus level increased, the sensitivity index, d', increased for both methods of response detection, but neither reached the maximum possible d' value with a sensation level of 30 dB. The examiners with the greatest experience and Hotelling's T(2) were equally sensitive in differentiating the CAEP from noise., Conclusions: Hotelling's T(2) appears to detect CAEPs from normal hearing infants at a rate equal to that of an experienced examiner. A clinical instrument that applies Hotelling's T(2) on-line, so that the likelihood of response detection can be assessed objectively, should be of particular benefit to the novice or less experienced examiner., (American Academy of Audiology.)

Background: Open canal hearing instruments differ in method of sound delivery to the ear canal, distance between the microphone and the receiver, and physical size of the devices. Moreover, RITA (receiver in the aid) and RITE (receiver in the ear) hearing instruments may also differ in terms of retention and comfort as well as ease of use and care for certain individuals. What remains unclear, however, is if any or all of the abovementioned factors contribute to hearing aid outcome., Purpose: To determine the effect of receiver location on performance and/or preference of listeners using open canal hearing instruments., Research Design: An experimental study in which subjects were exposed to a repeated measures design., Study Sample: Twenty-five adult listeners with mild sloping to moderately severe sensorineural hearing loss (mean age 67 yr)., Data Collection and Analysis: Participants completed two six-week trial periods for each device type. Probe microphone, objective, and subjective measures (quiet, noise) were conducted unaided and aided at the end of each trial period., Results: Occlusion effect results were not significantly different between the RITA and RITE instruments; however, frequency range was extended in the RITE instruments, resulting in significantly greater maximum gain for the RITE instruments than the RITA instruments at 4000 and 6000 Hz. Objective performance in quiet or in noise was unaffected by receiver location. Subjective measures revealed significantly greater satisfaction ratings for the RITE than for the RITA instruments. Similarly, preference in quiet and overall preference were significantly greater for the RITE than for the RITA instruments., Conclusions: Although no occlusion differences were noted between instruments, the RITE did demonstrate a significant difference in reserve gain before feedback at 4000 and 6000 Hz. Objectively; no positive benefit was noted between unaided and aided conditions on speech recognition tests. These results suggest that such testing may not be sensitive enough to determine aided benefit with open canal instruments. However, the subjective measures (Abbreviated Profile of Hearing Aid Benefit [APHAB] and subjective ratings) did indicate aided benefit for both instruments when compared to unaided. This further suggests the clinical importance of subjective measures as a way to measure aided benefit of open-fit devices., (American Academy of Audiology.)

Background: Despite the recognition that the directional microphone hearing aid (DMHA) is an important intervention aimed at helping older hearing-impaired adults understand speech in noisy environments, there is little evidence that older listeners can actually benefit from directional processing., Purpose: The objective of this study was to determine if older and younger adults can obtain and perceive comparable benefit afforded by DMHAs., Study Sample: Twenty-four hearing-impaired adults aged 36 through 79 yr were fit with switchable-microphone hearing aids and tested in the laboratory and the field., Data Collection and Analysis: In the laboratory, the listeners' directional benefit and preferences for microphone modes (directional vs. omnidirectional) were assessed using various speech-recognition-in-noise tests. In the four-week field trial, a paired-comparison technique and paper-and-pencil journals were used to determine the benefit provided by directional processing. The effects of age on directional benefit/preference were analyzed using generalized linear models with controlling for the effect of hearing loss., Results: The results revealed that age did not have a significant effect on directional benefit and preference as measured in the laboratory. However, the field data showed that older age was significantly associated with a lower preference for the directional mode., Conclusion: These results indicate that although listeners of different ages may obtain and perceive comparable benefit from DMHAs in laboratory testing, older users tend to perceive less benefit than do younger users in the real world. The implications of these findings are discussed.

Background: A dead region is a region in the cochlea where the inner hair cells and/or neurons are functioning very poorly, if at all. We have shown that, for people with sensorineural hearing loss, thresholds for detecting sinusoidal amplitude modulation (AM) of a sinusoidal carrier were lower for ears with high-frequency dead regions, as diagnosed using the threshold-equalizing noise test, calibrated in hearing level, than for ears without dead regions when the carrier frequency was below the edge frequency, fe, of the dead region., Purpose: To measure AM-detection thresholds for subjects with unilateral dead regions, using carrier frequencies both below and above fe., Research Design: Ten subjects with bilateral high-frequency hearing loss, but with unilateral high-frequency dead regions, were tested. The carriers were presented at sensation levels of 5, 10, or 15 dB. The values of fe were close to 1000, 1500, or 2000 Hz., Results: For carrier frequencies below fe, AM-detection thresholds were lower for the ears with dead regions than forthe ears without dead regions, replicating earlier findings. In contrast, for carrier frequencies above fe, AM-detection thresholds tended to be higher for ears with dead regions than for ears without dead regions., Conclusions: The reason why AM detection was poorer in the ears with dead regions for carrier frequencies above fe is unclear. However, this finding is consistent with the generally poor discrimination of sounds that has been reported previously for sounds with frequency components falling within a dead region. The results have implications for the ability of people with dead regions to use information from frequency components falling inside the dead region.