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Acoustic reflex thresholds (ART) obtained using pure-tone probe stimuli as part of a traditional immittance test battery can be used to evaluate site of lesion and provide a cross-check with behavioral results. ARTs obtained as part of a wideband acoustic immittance (WAI) test battery using a click as the probe stimulus can be used in the same way with the added benefit that they may provide lower ARTs than those obtained using a pure-tone probe. Another benefit of the WAI ART test is that it can be completed without requiring a hermetic seal or pressurizing the ear canal. A new adaptive method of obtaining ARTs using WAI techniques may cut test time in half, thus making this an attractive option for future clinical use. More advanced uses of WAI ART tests include the measurement of AR growth functions. These may be used to investigate the possible effects of synaptopathy related to high levels of noise exposure and possible auditory deficits related to ototoxicity. [ABSTRACT FROM AUTHOR]

Background: Wideband acoustic immittance (WAI) measures provide information about middle-ear function across the traditional audiometric frequency range from 0.25 to 8.0 kHz. Recent studies have found that WAI is effective in predicting the presence of conductive hearing loss (CHL). It is not known whether WAI can accurately estimate the degree of threshold shift caused by CHL. Purpose: The purpose of the present study was to evaluate the relationship between changes in pure-tone threshold and changes in wideband absorbance and acoustic conductance levels induced by positive and negative ear-canal static pressure. Study Sample: Twenty young adult subjects with normal hearing and a negative history of middle-ear disorders participated in the study. Data Collection and Analysis: Experimental pure-tone thresholds at 0.5 and 2.0 kHz were estimated by using a three-interval, three-alternative forced-choice adaptive psychometric procedure under three conditions: ambient ear-canal pressure, +200 daPa static pressure, and -200 daPa static pressure. Wideband absorbance and conductance were obtained in the same subjects by using a Welch Allyn prototype diagnostic middle ear analyzer. Changes in pure-tone threshold from the ambient pressure condition to the static pressure condition were evaluated by using a paired-samples t test and Pearson product-moment correlation. Results: Wideband middle-ear absorbance and conductance at ambient pressure in this study were consistent with published data in adults with normal hearing. The mean change in threshold at 0.5 and 2.0 kHz with +200 daPa or -200 daPa ear-canal static pressure was similar to the mean change in absorbance and conductance levels in the same conditions. However, there was one statistically significant difference between the shift in pure-tone threshold and the change in conductance level for the +200 daPa pressure condition for 2.0 kHz, with the change in threshold being 1.5 dB greater than the change in conductance level (t = 2.39, p = 0.03). In contrast to the good performance of WAI measures in predicting mean threshold shifts caused by ear-canal pressure, the shifts in WAI were not correlated with threshold shifts. Thus WAI was not well suited to predict individual threshold changes caused by ear-canal static pressure. Conclusions: For the conditions of this study, results suggest that mean change in absorbance or conductance level caused by ear-canal static pressure of +200 daPa or -200 daPa provides a good estimate of the change in pure-tone threshold in the same conditions. However, individual threshold change was not accurately predicted by the change in absorbance or conductance level. [ABSTRACT FROM AUTHOR]

Background: Wideband acoustic immittance measurements of the middle ear, such as wideband energy reflectance (ER), can provide information about how the middle ear functions across the traditional audiometric frequency range. These measurements are being investigated as a new means of evaluating conductive hearing disorders, and studies have been reported on a number of middle-ear disorders. However, the normative database for wideband ER is still being developed, and more information is needed about sources of test variability. Purpose: The purpose of the present study was to evaluate sources of variability in wideband ER measurements at baseline and across annual tests for up to 5 yr in subjects with normal hearing. Study Sample: The main group consisted of 112 subjects (187 ears), 24 females and 88 males, with normal hearing and normal 0.226-kHz admittance tympanometry. An additional 24 adults with abnormal 0.226-kHz tympanometry provided baseline comparison data. Research Design: A longitudinal design was used in obtaining annual measurements of audiometry, tympanometry, and wideband ER at ambient pressure in adults. Data Collection and Analysis: Clinical audiometry and tympanometry data and 1/3-octave wideband ER measurements were obtained at baseline and annually for up to four additional tests. Descriptive statistics and t-tests were used to explore differences in 1/3-octave baseline ER measures in terms of subject age, test ear, sex, and clinical tympanometry. Longitudinal mixed-effects linear regression models at 1.0, 2.0, and 4.0 kHz were used to examine the different sources of variance affecting ER over time. Results: There were small but statistically significant mean differences in ER for baseline measurements as a function of ear, sex, and age. Compared with these results, data for 29 ears with abnormal 0.226-kHz tympanometry differed from mean normal data across a broad frequency range by as much as 20%. ER varied as a function of peak compensated static acoustic admittance (Ytm) for measures at 1.0 kHz but was unrelated to Ytm at 2.0 and 4.0 kHz. ER also varied as a function of the test ear, with significantly higher ER on the left at 1.0 and 2.0 kHz, but was not significantly related to the test ear at 4.0 kHz. The standard deviation for test-retest variability was about 0.1 at each frequency, which is consistent with previous studies. Conclusions: Mean wideband ER at baseline showed small but significant differences related to sex, ear, and age. ER was significantly related to Ytm at 1.0 kHz in the longitudinal data but not at 2.0 or 4.0 kHz and to the test ear at 1.0 and 2.0 kHz but not at 4.0 kHz. When evaluated at ambient pressure, ER for ears with negative middle-ear pressure was similar to that of ears with abnormally low Ytm. Therefore it might be necessary to evaluate wideband acoustic immittance compensated for middle-ear pressure by using tympanometry to obtain an effective differential diagnosis of middle-ear disorders in adults. [ABSTRACT FROM AUTHOR]

This retrospective analysis of existing data was derived from 957 members of a population-based cohort who participated in a prior study of the prevalence of central auditory dysfunction. Word recognition scores (WRS) at three intensity levels were compared to predicted scores based on the Articulation Index (Al) and the Thornton-Raffin 95 percent critical differences. In 112 (11.7 percent) participants, one or more word recognition scores were significantly below the predicted score, which we consider a subtle sign of possible auditory neuropathy. In contrast, classic signs of retrocochlear dysfunction were found in only three people (0.3 percent) using rollover of the performance intensity function for phonetically balanced word lists, in two (0.2 percent) people using the guideline of Yellin et al (1989), and in 54 people (5.6%) using a 20-point difference between the Al (x 100) and the WRS. Subtle signs of possible auditory neuropathy were more frequent than the classic signs. Comparing WRS at several high presentation levels to the Al is suggested as a method to screen for subtle neuropathy. Elderly listeners whose WRS fall below the Thornton-Raffin 95 percent critical difference based on Al should be considered for further testing for age-related auditory neuropathy. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including wideband acoustic immittance (WAI) neonates data of Australian Aboriginal and Caucasian, the test variability measurement of WAI, and longitudinal analysis of wideband energy reflectance.

Assessment of middle ear impedance using noninvasive electroacoustic measurements has undergone successive developments since its first clinical application in the 1940s, and gained widespread adoption since the 1970s in the form of 226-Hz tympanometry, and applications in multifrequency tympanometry. More recently, wideband acoustic immittance (WAI) is allowing unprecedented assessments of the middle ear acoustic mechanics thanks to the ability to record responses over a wide range of frequencies. The purpose of this article is to present fundamental concepts for the assessment and interpretation of wideband measures, including a review of acoustic impedance and its relation to the mass, stiffness, and resistance components of the middle ear. Additionally, an understanding of the middle ear transfer function reveals the relationship between impedance and middle-ear gain as a function of frequency. Wideband power absorbance, a WAI measure, quantifies the efficiency of sound conduction through the middle ear over a wide range of frequencies, and can serve as an analogous clinical measure to the transfer function. The interpretation of absorbance measures in ears with or without a conductive condition using absorbance measured at ambient pressure and pressurized conditions (wideband tympanometry) is described using clinical case examples. This article serves as an introduction to the fundamental principles of WAI measurements. [ABSTRACT FROM AUTHOR]

Background The study examined follow-up rates for pursuing hearing health care (HHC) 6 to 8 months after participants self-administered one of three hearing screening methods: an automated method for testing of auditory sensitivity (AMTAS), a four-frequency pure-tone screener (FFS), or a digits-in-noise test (DIN), with and without the presentation of a 2-minute educational video about hearing. Purpose The study aims to determine if the type of self-administered hearing screening method (with or without an educational video) affects HHC follow-up rates. Research Design The study is a randomized controlled trial of three automated hearing screening methods, plus control group, with and without an educational video. The control group completed questionnaires and provided follow-up data but did not undergo a hearing screening test. Study Sample The study sample includes 1,665 participants (mean age 50.8 years; 935 males) at two VA Medical Centers and at university and community centers in Portland, OR; Bay Pines, FL; Minneapolis, MN; Mauston, WI; and Columbus,OH. Data Collection and Analysis HHC follow-up data at 6 to 8 months were obtained by contacting participants by phone or mail. Screening methods and participant characteristics were compared in relation to the probability of participants pursuing HHC during the follow-up period. Results The 2-minute educational video did not have a significant effect on HHC follow-up rates. When all participants who provided follow-up data are considered (n=1012), the FFS was the only test that resulted in a significantly greater percentage of HHC follow-up (24.6%) compared with the control group (16.8%); p=0.03. However, for participants who failed a hearing screening (n=467), follow-up results for all screening methods were significantly greater than for controls. The FFS resulted in a greater probability for HHC follow-up overall than the other two screening methods. Moreover, veterans had higher follow-up rates for all screening methods than non- veterans. Conclusion The FFS resulted in a greater HHC follow-up rate compared with the other screening methods. This self-administered test may be more motivational for HHC follow-up because participants who fail the screening are aware of sounds they could not hear which does not occur with adaptive assessments like AMTAS or the DIN test. It is likely that access to and reduced personal cost of audiological services for veterans contributed to higher HHC follow-up rates in this group compared with non-veteran participants. [ABSTRACT FROM AUTHOR]

Background: Although hearing loss is a common health issue, hearing healthcare (HHC) is poorly accessed. Screening to identify hearing loss is an important part of HHC access, specifically for those who screen positive for hearing loss and would benefit from seeing a HHC provider. New technologies can be automated to provide information and recommendations that are tailored to the needs of individual users, potentially enhancing rates of HHC access after positive screens. A greater understanding of the facilitators of postscreening HHC access that could be leveraged in such systems is needed. Purpose: The purpose of this project was to identify facilitators of postscreening HHC access that can be used in automated screening systems. Research Design: This qualitative study used focus groups (FGs) to understand perceived barriers, perceived benefits, and potential cues to action, as informed by the Health Belief Model, for accessing HHC after use of automated hearing screening systems. Study Sample: Fifty individuals participated in one of seven FGs. FGs were conducted separately with three types of stakeholders: four FGs included adults who reported some degree of perceived hearing loss and had recently completed a hearing screening; two FGs included adults who had recently sought HHC for the first time because of hearing loss; and one FG involved significant others/family members of individuals with hearing loss. Data Collection and Analysis: FGs were 60-90 minutes in length and were led by a trained facilitator following a discussion guide. A research audiologist was present at each FG and served as a notetaker. FGs were recorded and transcribed by research team members, and transcripts were then coded in an iterative process by multiple team members. Qualitative content analysis was used to reduce data and to identify salient themes and subthemes, following an inductive approach. We focused on identifying themes that were related to facilitators of HHC access after positive screens for hearing loss and, separately, potential enhancements to automated hearing screening systems that would leverage these facilitators to improve HHC access. Results: We identified five key themes related to HHC access after a positive screen for hearing loss, along with ideas for enhancing automated hearing screening systems based on these themes. The themes included knowledge, trust, access, quality of life, and interpersonal influence. Conclusions: The results of our work help inform the development of innovative hearing screening systems that can be automated to leverage individual facilitators of HHC access. [ABSTRACT FROM AUTHOR]

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, Ill, 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, Ill, 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. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wide-band reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis. Purpose: To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis. Research Design: A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group. Study Sample: The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female). Data Collection and Analysis: Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25-8 kHz), reflectance tests (0.25-8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1-8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears. Results: Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7-1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35-0.7 kHz, and at 2.8-4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC 5 0.95) was more accurate than ambient reflectance (AUC 5 0.88) in classifying ears as normal or otosclerotic. Conclusions: Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications. [ABSTRACT FROM AUTHOR]

Background: The sooner people receive treatment for hearing loss (HL), the quicker they are able to recognize speech and to master hearing aid technology. Unfortunately, a majority of people with HL wait until their impairments have progressed from moderate to severe levels before seeking auditory rehabilitation. To increase the number of individuals with HL who pursue and receive auditory rehabilitation, it is necessary to improve methods for identifying and informing these people via widely accessible hearing screening procedures. Screening for HL is the first in a chain of events that must take place to increase the number of patients who enter the hearing health-care system. New methods for hearing screening should be readily accessible through a common medium (e.g., telephone or computer) and should be relatively easy and quick for people to self-administer. Purpose. The purpose of this study was to assess a digits-in-noise (DIN) hearing screening test that was delivered via personal computer. Research Design: Participants completed the Hearing Handicap Inventory for Adults (HHIA) questionnaire, audiometric testing in a sound booth, and computerized DIN testing. During the DIN test, sequences of three spoken digits were presented in noise via headphones at varying signal-to-noise ratios (SNRs). Participants entered each three-digit sequence they heard using an on-screen keypad. Study Sample: Forty adults (16 females, 24 males) participated in the study, of whom 20 had normal hearing and 20 had HL (pure-tone average [PTA] thresholds for 0.5, 1, 2, and 4 kHz >25 dB HL). Data Collection and Analysis: DIN SNR and PTA data were analyzed and compared for each ear tested. Receiver operating characteristic curves based on these data were plotted. A measure of overall accuracy of a screening test is the area under the receiver operating characteristic curve (AUC). This measures the average true positive rate across false positives at varying DIN SNR cutoffs. Larger values of the AUC indicate, on average, more accurate screening tests. HHIA responses were analyzed and compared to PTA and DIN SNR results using Pearson correlation statistics. Results: HHIA scores were positively correlated with audiometric PTA and DIN SNR results (p < 0.001 for all correlations). For an HL criterion of one or more frequencies from 0.25 to 8 kHz >25 dB HL, the AUC for the DIN test was 0.95. When a criterion of heading level was set at one or more frequencies from 0.25 to 8 kHz >20 dB HL, the AUC for the DIN test was 0.96. Conclusions: The computer version of the DIN test demonstrated excellent sensitivity and specificity for our sample of 40 participants. AUC results (≥0.95) suggest that this DIN test administered via computer should be very useful for adult hearing screening. [ABSTRACT FROM AUTHOR]