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Objective: To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss., Design: Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss., Study Sample: A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists., Results: Overall, participants rated all of the approaches highly on both benefit and likelihood of use ; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales., Conclusions: Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals).

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Purpose The aim of the study was to learn (a) how datalogging information is being used in clinical practice by hearing care providers (HCPs) in the United States and (b) HCPs' opinions about how information collected through the hearing aids could be broadened in clinical application. Method A mixed-method approach was undertaken consisting of an online quantitative survey and qualitative structured telephone interviews. Survey data were analyzed using descriptives and chi-square analyses. The interview data were transcribed and analyzed using inductive content analysis. Results In total, 154 HCPs completed the survey, of whom 10 also completed an interview. Survey data showed that most HCPs use datalogging for conventional applications, such as counseling and fine-tuning during a hearing aid trial. Interview data highlighted four additional desirable datalogging features: (a) data about the sound environment, (b) details about operational aspects of hearing aid use, (c) data about use and nonuse, and (d) automated diagnosis of a hearing aid malfunction. HCPs also envisaged using datalogging in novel ways, such as for demonstrating hearing aid value and supporting decision making. Conclusions Today, datalogging is primarily used as a tool for counseling clients about hours and patterns of hearing aid use and for troubleshooting and fine-tuning. However, HCPs suggested novel and more ambitious uses of datalogging such as for sending alerts about nonuse, for automated diagnosis of a hearing aid malfunction, and for helping the client in their decision making. It remains to be seen whether in the future these will be implemented into clinical practice.

Purpose The clinical data stored in electronic health records (EHRs) provide unique opportunities for audiological clinical research. In this article, we share insights from our experience of working with a large clinical database of over 730,000 cases. Method Under a framework outlining the process from patient care to researcher data use, we describe issues that can arise in each step of this process and how we overcame specific issues in our data set. Results Correct interpretation of findings depends on an understanding of the data source and structure, and efforts to establish confidence in the data through the processes are discussed under the framework. Conclusion We conclude that EHRs have considerable utility in audiological research, though researchers must exhibit caution and consideration when working with EHRs.

Ideally, public health policies are formulated from scientific data; however, policy-specific data are often unavailable. Big data can generate ecologically-valid, high-quality scientific evidence, and therefore has the potential to change how public health policies are formulated. Here, we discuss the use of big data for developing evidence-based hearing health policies, using data collected and analyzed with a research prototype of a data repository known as EVOTION (EVidence-based management of hearing impairments: public health pOlicy-making based on fusing big data analytics and simulaTION), to illustrate our points. Data in the repository consist of audiometric clinical data, prospective real-world data collected from hearing aids and an app, and responses to questionnaires collected for research purposes. To date, we have used the platform and a synthetic dataset to model the estimated risk of noise-induced hearing loss and have shown novel evidence of ways in which external factors influence hearing aid usage patterns. We contend that this research prototype data repository illustrates the value of using big data for policy-making by providing high-quality evidence that could be used to formulate and evaluate the impact of hearing health care policies.

Purpose The EU-funded research project EVOTION has brought together clinical, technical, and public health experts with the aim to offer a solution for the holistic management of hearing loss. This report presents the challenges, strengths, and key take-home messages of working in this multidisciplinary consortium. Method Fifteen consortium members completed an online survey with 6 open-ended questions. Responses were analyzed using a thematic approach. Results Analysis identified 4 main themes: (a) communication , that is, cross-disciplinary communication difficulties but also range of expertise; (b) opportunities , that is, innovation, learning, and collaborations; (c) technology , that is, technical requirements and data collection and management issues; and (d) local constraints , that is, institutional limitations, resources, and planning. Conclusions Although the challenges reported differed by country and specialty, there was consensus about the value, expertise, and opportunities of the project. It is recommended that in future similar multidisciplinary projects in audiology, researchers establish a common language and assess technical requirements and local constraints prior to initiating research activities.

Objective: This study evaluates the content validity (i.e. domains assessed) and readability levels of patient-reported questionnaire instruments using internationally recognised procedures and tools. Design: A review of the literature to identify candidate instruments and a synthesis of information including mapping extracted items onto the World Health Organisation's - International Classification of Functioning, Disability, and Health (WHO-ICF) and estimating readability. Study sample: 14 patient-reported questionnaire instruments. Results: In general, item content focussed on body function and on activity limitations and participation restrictions, with less emphasis on environmental and personal factors and with different emphases across instruments. Many items did not clearly map onto any of the WHO-ICF categories (i.e. not coded items ranged from 3.7 to 39.1% across the 14 questionnaires). All 14 instruments exceeded the sixth-grade reading level when calculated according to the FORCAST formula which is appropriate for assessing a non-narrative text. Conclusions: Clinical assessment of hearing disability is only as comprehensive as the items covered by the chosen measurement instrument. Our findings confirmed the diversity of domains covered by hearing disability instruments and gaps in assessment. Some concern is raised about whether the item content is appropriate for those respondents with poor literacy.

Importance: Hearing loss is highly prevalent in the rapidly growing and aging Hispanic/Latino population in the United States. However, little is known or understood about hearing aid use among US adults from Hispanic/Latino backgrounds., Objective: To describe hearing aid prevalence and factors associated with hearing aid use among US adults of Hispanic/Latino backgrounds., Design, Setting, and Participants: Cross-sectional data were collected between 2008 and 2011 from 4 field centers (Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California) as part of the multisite Hispanic Community Health Study/Study of Latinos. Included individuals were adults aged 45 to 76 years with hearing loss (pure-tone average ≥25 dB HL) from randomly selected households in the 4 field centers and were from self-reported Hispanic/Latino backgrounds, including Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and mixed or other backgrounds. Analysis, including age- and background-weighted prevalence estimates and multivariate logistic regression using survey methodology, was conducted from 2017 to 2018., Main Outcomes and Measures: The primary outcome of interest was self-reported hearing aid use. The a priori hypothesis was that hearing aid prevalence estimates among included Hispanic/Latino adults would be less than recently published estimates of the general US population, and that poorer hearing, higher perceived need, older age, and higher acculturation would be associated with hearing aid use., Results: Of 1898 individuals with hearing loss, 1064 (56.1%) were men, and the mean (SE) age was 60.3 (0.3) years. A total of 87 (4.6%) included individuals reported hearing aid use. Increased odds of self-reported use was associated with poorer measured hearing (odds ratio [OR], 1.06; 95% CI, 1.03-1.09), higher Hearing Handicap Inventory-Screening scores (OR, 1.06; 95% CI, 1.03-1.08), access to health insurance coverage (OR, 2.30; 95% CI, 1.20-4.37), and place of residence (OR, 2.42; 95% CI, 1.17-5.02) in an adjusted logistic regression model., Conclusions and Relevance: Findings revealed underuse of hearing aids among adults from Hispanic/Latino backgrounds. A primary factor related to use was lack of health insurance, which suggests that access influenced hearing aid use. Changes to policy and clinical service provision are needed to increase hearing aid use among aging Hispanic/Latino adults in the United States.

Background: Photovoice is a participatory action research method in which people take photographs to represent real-world experiences, so that issues of interest/concern can be documented. There are no published studies in which photovoice has been used in audiological rehabilitation (AR). The purpose of this feasibility study was to examine whether photovoice could have application in audiology., Purpose: A feasibility study was designed to determine whether photovoice could be adapted for use as a clinical auditory rehabilitation tool (1) to facilitate provision of tailored communication strategy counseling, (2) as a post-hearing aid fitting counseling tool, (3) to enhance communication between partners regarding hearing loss, and (4) to provide an understanding of the emotional impacts of hearing loss., Research Design: In this combined qualitative and quantitative feasibility study, a photovoice intervention was given to four groups of participants., Study Sample: Twenty-four individuals were recruited from a research subject data repository at the National Center for Rehabilitative Auditory Research., Data Collection and Analysis: The study involved two visits to the laboratory during which participants received instruction in photovoice methodology (visit 1) and then, one to two weeks later, discussed their photographs during a debriefing session (visit 2)., Results: The mean number of photographs taken by participants was 12.6 (range: 4-29); the mean duration of the debriefing sessions was 40:39 min:sec (range: 14:30-66:22 min:sec). Participants reported that participating had made them think more about their hearing problems, appreciate their hearing aids more, and be more aware of the situations in which their hearing aids did and did not help. The taking and discussion of the photographs was also described as a learning tool, and it had facilitated conversations with others about hearing problems. Participants who completed the study with their communication partner (use case 3) said it had assisted with problem-solving and gave insight into the perspective of their partner. The research team noted that photovoice facilitated highly tailored counseling and provision of evidence-based recommendations for hearing assistive technology, enhanced interaction between communication partners, provided insight into participants' lifestyle and communication needs, and seemed to generate rapport and trust., Conclusions: This feasibility study indicated that participants were willing to engage in photovoice and that it could be used to guide selection of rehabilitation recommendations and for postfitting counseling. Its application in audiological practice would seem timely and valuable for improving patient-centered and family-centered AR., (American Academy of Audiology.)

Objective: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults' behaviours towards seeking a hearing test., Design: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores., Study Sample: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings., Results: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not., Conclusions: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.

Background: Adults typically wait 7-10 yr after noticing hearing problems before seeking help, possibly because they are unaware of the extent of their impairment. Hearing screenings, frequently conducted at health fairs, community events, and retirement centers can increase this awareness. To our knowledge, there are no published studies in which testing conditions and outcomes have been examined for multiple "typical screening events.", Purpose: The purpose of this article is to report hearing screening outcomes for pure tones and self-report screening tests and to examine their relationship with ambient noise levels in various screening environments., Study Sample: One thousand nine hundred fifty-four individuals who completed a hearing screening at one of 191 community-based screening events that took place in the Portland, OR, and Tampa, FL, metro areas., Data Collection and Analysis: The data were collected during the recruitment phase of a large multisite study. All participants received a hearing screening that consisted of otoscopy, pure-tone screening, and completion of the Hearing Handicap Inventory-Screening Version (HHI-S). In addition, ambient sound pressure levels were measured just before pure-tone testing., Results: Many more individuals failed the pure-tone screening (n = 1,238) and then failed the HHI-S (n = 796). The percentage of individuals who failed the pure-tone screening increased linearly with age from <20% for ages <45 yr to almost 100% for individuals aged ≥85 yr. On the other hand, the percentage of individuals who failed the HHI-S remained unchanged at approximately 40% for individuals aged ≥55 yr. Ambient noise levels varied considerably across the hearing screening locations. They impacted the pure-tone screen failure rate but not the HHI-S failure rate., Conclusions: It is important to select screening locations with a quiet space for pure-tone screening, use headphones with good passive attenuation, measure sound levels regularly during hearing screening events, halt testing if ambient noise levels are high, and/or alert individuals to the possibility of a false-positive screening failure. The data substantiate prior findings that the relationship between pure-tone sensitivity and reported hearing loss changes with age. Although it might be possible to develop age-specific HHI-S failure criteria to adjust for this, such an endeavor is not recommended because perceived difficulties are the best predictor of hearing health behaviors. Instead, it is proposed that a public health focus on education about hearing and hearing loss would be more effective., (American Academy of Audiology.)

Purpose: In this introduction, the four members of the scientific committee for the Third International Meeting on Internet and Audiology describe the meeting that took place at the University of Louisville on July 27-28, 2017., Method: This special issue, with a decidedly clinical focus, includes 14 articles that arose from presentations given at the Third International Meeting on Internet and Audiology. All touch upon the theme of innovation as it pertains to teleaudiology and mobile health (mHealth), application of Big Data to audiology, and ethics of internet and telemedicine., Conclusion: Innovations in teleaudiology, mHealth, and Internet-based audiology are developing at a rapid pace and thus research in the field must continue. We invite readers to the next International Meeting on Internet and Audiology that will take place in Southampton, England, June 17-18, 2019.

Background: There have been numerous recent reports on the association between hearing impairment and cognitive function, such that the cognition of adults with hearing loss is poorer relative to the cognition of adults with normal hearing (NH), even when amplification is used. However, it is not clear the extent to which this is testing artifact due to the individual with hearing loss being unable to accurately hear the test stimuli., Purpose: The primary purpose of this study was to examine whether use of amplification during cognitive screening with the Montreal Cognitive Assessment (MoCA) improves performance on the MoCA. Secondarily, we investigated the effects of hearing ability on MoCA performance, by comparing the performance of individuals with and without hearing impairment., Study Sample: Participants were 42 individuals with hearing impairment and 19 individuals with NH. Of the individuals with hearing impairment, 22 routinely used hearing aids; 20 did not use hearing aids., Data Collection and Analysis: Following a written informec consent process, all participants completed pure tone audiometry, speech testing in quiet (Maryland consonant-nucleus-consonant [CNC] words) and in noise (Quick Speech in Noise [QuickSIN] test), and the MoCA. The speech testing and MoCA were completed twice. Individuals with hearing impairment completed testing once unaided and once with amplification, whereas individuals with NH completed unaided testing twice., Results: The individuals with hearing impairment performed significantly less well on the MoCA than those without hearing impairment for unaided testing, and the use of amplification did not significantly change performance. This is despite the finding that amplification significantly improved the performance of the hearing aid users on the measures of speech in quiet and speech in noise. Furthermore, there were strong correlations between MoCA score and the four frequency pure tone average, Maryland CNC score and QuickSIN, which remain moderate to strong when the analyses were adjusted for age., Conclusions: It is concluded that the individuals with hearing loss here performed less well on the MoCA than individuals with NH and that the use of amplification did not compensate for this performance deficit. Nonetheless, this should not be taken to suggest the use of amplification during testing is unnecessary because it might be that other unmeasured factors, such as effort required to perform or fatigue, were decreased with the use of amplification., (American Academy of Audiology.)

Background: The ability to manage hearing aids is crucial for successful outcomes and for maintaining hearing aid use. It is therefore important to have a tool that can effectively identify which hearing aid management skills are lacking so that the audiologist can provide additional education and training on that skill. Such a tool can also provide useful quantitative data for researchers., Purpose: To collect normative data (Experiment 1) and assess inter- and intrarater reliability (Experiment 2) for a hearing aid management assessment tool known as the Hearing Aid Skills and Knowledge (HASK) test., Study Sample: Two hundred thirty-six new hearing aid users recruited from the VA Portland Health Care System and 126 experienced hearing aid users recruited from the local Portland community participated in Experiment 1. The veteran participants were taking part in a larger hearing aid study, and the community participants were recruited at community events that took place around Portland, OR. Three clinical audiologists and two AuD students completing their fourth year externship participated in Experiment 2., Data Collection and Analysis: In Experiment 1, HASK data were collected from the new hearing aid users at 4-8 wk and 6-8 mo after the fitting of their first pair of hearing aids, and from experienced users on a single occasion. In addition, self-reported hearing aid use, benefit, and satisfaction were assessed for all participants. The audiologists/students in Experiment 2 watched and independently scored videos of six individuals completing the HASK. Intraclass correlation coefficients (ICCs) across audiologists were computed for HASK scores. Three audiologists/students rated at least one video on two occasions to provide interrater reliability data., Results: Mean performance on the HASK was about 70% for knowledge and 80% for skills for both the new and experienced hearing aid users. Performance did not change among the new users between the 4-8 wk and 6-8 mo administration. The specific skills lacking were associated with advanced management abilities (cleaning and troubleshooting). Experiment 2 revealed ICCs for inter- and intrarater reliability for HASK to range from 0.76 to 0.94, showing acceptable to excellent reliability., Conclusions: The HASK is a quick and easy test with good-to-excellent inter- and intrarater reliability. It can effectively identify which hearing aid management skills are lacking so that the audiologist can provide additional education and training on those skills. Data show performance is ∼70% for knowledge and 80% for skills and this does not change with hearing aid experience. The significant positive correlations between HASK scores and hearing aid use and satisfaction highlight the notion that ability to manage hearing aids successfully is integral to good hearing aid outcome., (American Academy of Audiology)

Background: Blast exposure is a major source of injury among Service members in the Iraq and Afghanistan conflicts. Many of these blast-exposed veterans report hearing-related problems such as difficulties understanding speech in noise and rapid speech, and following instructions and long conversations that are disproportionate to their measured peripheral hearing sensitivity. Evidence is mounting that these complaints result from damage to the central auditory processing system., Purpose: To evaluate the effectiveness of audiological rehabilitative interventions for blast-exposed veterans with normal or near-normal peripheral hearing and functional hearing difficulties., Research Design: A randomized controlled trial with four intervention arms., Study Sample: Ninety-nine blast-exposed veterans with normal or near-normal peripheral hearing who reported functional hearing difficulties., Intervention: Four interventions were compared: compensatory communication strategies (CCS) education, CCS and use of a personal frequency modulation system (FM + CCS), CCS and use of an auditory training program (AT + CCS), and use of all three interventions combined (FM + AT + CCS)., Data Collection and Analysis: All participants tested before, and immediately following an 8-week intervention period. The primary outcome measures upon which the study was powered assessed speech understanding in noise and self-reported psychosocial impacts of the intervention. In addition, auditory temporal processing, auditory working memory, allocation of attention, and hearing and cognitive self-report outcomes were assessed., Results: Use of FM + CCS resulted in significant benefit for speech understanding in noise and self-reported hearing benefits, and FM + AT + CCS provided more self-reported cognitive benefits than FM + CCS, AT + CCS, or CCS. Further, individuals liked and reported using the FM system, but there was poor adherence to and high attrition among individuals assigned to receive AT., Conclusions: It is concluded that a FM system (or remote microphone via Bluetooth system) is an effective intervention for blast-exposed veterans with normal or near-normal hearing and functional hearing difficulties and should be routinely considered as an intervention approach for this population when possible., (American Academy of Audiology)

Posttraumatic stress disorder (PTSD) is a leading cause of impairments in quality of life and functioning among Veterans. Service dogs have been promoted as an effective adjunctive intervention for PTSD, however published research is limited and design and implementation flaws in published studies limit validated conclusions. This paper describes the rationale for the study design, a detailed methodological description, and implementation challenges of a multisite randomized clinical trial examining the impact of service dogs on the on the functioning and quality of life of Veterans with PTSD. Trial design considerations prioritized participant and intervention (dog) safety, selection of an intervention comparison group that would optimize enrollment in all treatment arms, pragmatic methods to ensure healthy well-trained dogs, and the selection of outcomes for achieving scientific and clinical validity in a Veteran PTSD population. Since there is no blueprint for conducting a randomized clinical trial examining the impact of dogs on PTSD of this size and scope, it is our primary intent that the successful completion of this trial will set a benchmark for future trial design and scientific rigor, as well as guiding researchers aiming to better understand the role that dogs can have in the management of Veterans experiencing mental health conditions such as PTSD., (Published by Elsevier Inc.)

Background: Health behavior theories can provide an understanding of hearing health behaviors and, more importantly, can be used to develop theoretically based strategies to change these health behaviors., Purpose: To develop a theory-based brief intervention to increase help-seeking for adult hearing loss and to conduct a pilot study to evaluate its feasibility, effectiveness, and impact on hearing beliefs and behaviors., Research Design: An intervention was designed that could be easily administered by a health-care provider who does not have expertise in audiology-such as a primary care physician, community nurse, or social worker. The intervention aims to alter perceived benefit, severity, cues to action, and self-efficacy for seeking help by providing experiential/affective messaging and simultaneously providing intrinsic motivation for the recipient to seek hearing help. To first determine whether this intervention changed beliefs and increased help-seeking behavior, this study was conducted in a hearing research laboratory setting., Study Sample: A total of 101 adults aged 50-89 yr were recruited within 6 months of having attended an appointment at a primary care clinic at the VA Portland Health Care System. All were sent a letter inviting them to participate in a study if they had trouble with their hearing but had not had a scheduled hearing test or worn hearing aids in the prior 5 yr and also had functional oral and written English. Data from 87 individuals were available for analysis., Intervention: The intervention is designed for use in any health-care setting in which a health-care provider can facilitate a conversation about hearing. On arrival at a health-care facility, recipients are provided with nine emotionally evocative color photographs to prompt reflection on ways in which hearing difficulties impact them. A discussion with a health-care provider (facilitator) follows, during which recipients may identify the negative impacts of their hearing loss. If the recipient identifies negative impacts, the facilitator suggests that he or she consider having a hearing test and provides a list of local hearing-health professionals., Data Collection and Analysis: Participants completed baseline questionnaires assessing hearing beliefs and attitudes. They were then randomly assigned either to the group receiving the study intervention or to a control group. Six months after study enrollment, participants reported whether they had sought help for their hearing and completed a second set of questionnaires., Results: Twelve of 41 individuals (29.3%) in the intervention group and 7 of 46 individuals (15.2%) in the control group sought help within the 6-month follow-up period. A χ² test showed these numbers did not differ significantly; however, the odds ratio of having had a hearing test were 2.3 times greater for those who received the intervention than for those who did not., Conclusions: Despite not reaching statistical significance, the odds ratio suggests that the theory-based brief intervention is worthy of additional examination. We intend to work with health-care providers to conduct a larger study to investigate whether the intervention has value in the real world., (American Academy of Audiology)

Objective: Describe how the burden on the communication partner (CP) from the patient's hearing loss, as perceived by both the patient and their CP, influences a patient's pursuit of hearing evaluation., Design: Cross-sectional design. Demographics, perception of patient's hearing loss, and associated burden on the CP were collected from both patient and CP via online questionnaires. Patients and their CPs from Duke University Medical Center Otolaryngology Clinic, 55 to 75 years of age, being seen for any reason, who indicated a CP has expressed concern about their hearing. Final sample was 245 matched pairs., Results: Based on completed questionnaires, on average, patients perceived their own hearing loss as more burdensome to the CP than the CP did. However, CPs of patients who believed themselves to have no hearing handicap scored the patient's hearing loss 54.3% higher than the patient. The patient's perspective about the amount of burden their hearing loss placed on the CP predicted patients seeking a hearing evaluation., Conclusions: Recognition of early stage hearing loss and associated burden on CPs may be delayed in patients; CPs may help elucidate unrecognized concerns. Educational approaches that raise awareness of burden of hearing loss on CPs along with hearing loss indications could be a feasible, multidimensional strategy to promote help seeking behaviors.

Background: Though migraine is disabling and affects 12%-15% of the population, there are few drugs that have been developed specifically for migraine prevention. Valproic acid (VPA) is a broad-spectrum antiepileptic drug (AED) that is also used for migraine prophylaxis, but its clinical use is limited by its side effect profile. sec-Butylpropylacetamide (SPD) is a novel VPA derivative, designed to be more potent and tolerable than VPA, that has shown efficacy in animal seizure and pain models., Methods: We evaluated SPD's antimigraine potential in the cortical spreading depression (CSD) and nitroglycerin (NTG) models of migraine. To evaluate SPD's mechanism of action, we performed whole-cell recordings on cultured cortical neurons and neuroblastoma cells., Results: In the CSD model, the SPD-treated group showed a significantly lower median number of CSDs compared to controls. In the NTG-induced mechanical allodynia model, SPD dose-dependently reduced mechanical sensitivity compared to controls. SPD showed both a significant potentiation of GABA-mediated currents and a smaller but significant decrease in NMDA currents in cultured cortical neurons. Kainic acid-evoked currents and voltage-dependent sodium channel currents were not changed by SPD., Conclusions: These results demonstrate SPD's potential as a promising novel antimigraine compound, and suggest a GABAergic mechanism of action., Competing Interests: Declaration of conflicting interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© International Headache Society 2015.)

Purpose: The purpose of this study was to determine if patient characteristics or clinical variables could predict who benefits from individual auditory training., Method: A retrospective series of analyses were performed using a data set from a large, multisite, randomized controlled clinical trial that compared the treatment effects of at-home auditory training programs in bilateral hearing aid users. The treatment arms were (a) use of the 20-day computerized Listening and Communication Enhancement program, (b) use of the 10-day digital versatile disc Listening and Communication Enhancement program, (c) use of a placebo "books-on-tape" training, and (d) educational counseling (active control). Multiple linear regression models using data from 263 participants were conducted to determine if patient and clinical variables predicted short-term improvement on word-recognition-in-noise abilities, self-reported hearing handicap, and self-reported hearing problems., Results: Baseline performance significantly predicted performance on each variable, explaining 11%-17% of the variance in improvement. The treatment arm failed to emerge as a significant predictor with other clinical variables explaining less than 9% of the variance., Conclusion: These results suggest that hearing aid users who have poorer aided word-recognition-in-noise scores and greater residual activity limitations and participation restrictions will show the largest improvement in these areas.

Objective: To examine the effectiveness of the Listening and Communication Enhancement (LACE) program as a supplement to standard-of-care hearing aid intervention in a Veteran population., Design: A multisite randomized controlled trial was conducted to compare outcomes following standard-of-care hearing aid intervention supplemented with (1) LACE training using the 10-session DVD format, (2) LACE training using the 20-session computer-based format, (3) placebo auditory training (AT) consisting of actively listening to 10 hr of digitized books on a computer, and (4) educational counseling-the control group. The study involved 3 VA sites and enrolled 279 veterans. Both new and experienced hearing aid users participated to determine if outcomes differed as a function of hearing aid user status. Data for five behavioral and two self-report measures were collected during three research visits: baseline, immediately following the intervention period, and at 6 months postintervention. The five behavioral measures were selected to determine whether the perceptual and cognitive skills targeted in LACE training generalized to untrained tasks that required similar underlying skills. The two self-report measures were completed to determine whether the training resulted in a lessening of activity limitations and participation restrictions. Outcomes were obtained from 263 participants immediately following the intervention period and from 243 participants 6 months postintervention. Analyses of covariance comparing performance on each outcome measure separately were conducted using intervention and hearing aid user status as between-subject factors, visit as a within-subject factor, and baseline performance as a covariate., Results: No statistically significant main effects or interactions were found for the use of LACE on any outcome measure., Conclusions: Findings from this randomized controlled trial show that LACE training does not result in improved outcomes over standard-of-care hearing aid intervention alone. Potential benefits of AT may be different than those assessed by the performance and self-report measures utilized here. Individual differences not assessed in this study should be examined to evaluate whether AT with LACE has any benefits for particular individuals. Clinically, these findings suggest that audiologists may want to temper the expectations of their patients who embark on LACE training.

Objective: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework., Design: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires., Study Sample: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved., Results: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001)., Conclusions: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

Objective: To understand hearing behaviors of adults seeking help for the first time through the application of two models of health behavior change: the transtheoretical model and the health belief model., Design: The relationships between attitudes and beliefs were examined relative to hearing-aid uptake and outcomes six months later., Study Sample: One hundred and sixty adults completed the University of Rhode Island change assessment (targeting the transtheoretical model), and the hearing beliefs questionnaire (targeting the health belief model), as well as the hearing handicap inventory and the psychosocial impact of hearing loss scale, within two months of an initial hearing assessment. Six months later, participants completed these same questionnaires, while those who had taken up hearing aids also completed hearing-aid outcome questionnaires., Results: (1) Attitudes and beliefs were associated with future hearing-aid uptake, and were effective at modeling this behavior; (2) attitudes and beliefs changed following behavior change, and (3) attitudes and beliefs following behavior change were better predictors of hearing-aid outcomes than pre-behavior change attitudes and beliefs., Conclusion: A counseling-based intervention targeting the attitudes and beliefs assessed by the transtheoretical model and the health belief model has the potential to increase uptake of hearing health care.

Objectives: Several models of health behavior change are commonly used in health psychology. This study applied the constructs delineated by two models-the transtheoretical model (in which readiness for health behavior change can be described with the stages of precontemplation, contemplation and action) and the health belief model (in which susceptibility, severity, benefits, barriers, self-efficacy, and cues to action are thought to determine likelihood of health behavior change)-to adults seeking hearing help for the first time., Design: One hundred eighty-two participants (mean age: 69.5 years) were recruited following an initial hearing assessment by an audiologist. Participants' mean four-frequency pure-tone average was 35.4 dB HL, with 25.8% having no hearing impairment, 50.5% having a slight impairment, and 23.1% having a moderate or severe impairment using the World Health Organization definition of hearing loss. Participants' hearing-related attitudes and beliefs toward hearing health behaviors were examined using the University of Rhode Island Change Assessment (URICA) and the health beliefs questionnaire (HBQ), which assess the constructs of the transtheoretical model and the health belief model, respectively. Participants also provided demographic information, and completed the hearing handicap inventory (HHI) to assess participation restrictions, and the psychosocial impact of hearing loss (PIHL) to assess the extent to which hearing impacts competence, self-esteem, and adaptability., Results: Degree of hearing impairment was associated with participation restrictions, perceived competence, self-esteem and adaptability, and attitudes and beliefs measured by the URICA and the HBQ. As degree of impairment increased, participation restrictions measured by the HHI, and impacts of hearing loss, as measured by the PIHL, increased. The majority of first-time help seekers in this study were in the action stage of change. Furthermore, relative to individuals with less hearing impairment, individuals with more hearing impairment were at more advanced stages of change as measured by the URICA (i.e., higher contemplation and action scores relative to their precontemplation score), and they perceived fewer barriers and more susceptibility, severity, benefits and cues to action as measured by the HBQ. Multiple regression analyses showed participation restrictions (HHI scores) to be a highly significant predictor of stages of change explaining 30% to 37% of the variance, as were duration of hearing difficulty, and perceived benefits, severity, self-efficacy and cues to action assessed by the HBQ., Conclusions: The main predictors of stages of change in first-time help seekers were reported participation restrictions and duration of hearing difficulty, with constructs from the health belief model also explaining some of the variance in stages of change scores. The transtheoretical model and the health belief model are valuable for understanding hearing health behaviors and can be applied when developing interventions to promote help seeking.

Purpose of the Study: To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI])., Design and Methods: A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years., Results: Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care., Implications: Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To examine the daily noise exposure of baristas working in cafés, and to measure their knowledge, attitudes, and behaviors regarding hearing conservation and perceptions of noise in their work environment., Design: Fifteen baristas from six cafés in Portland completed the Knowledge, Attitudes and Behaviors questionnaire, a sound disturbance survey, and a structured interview to document perceptions of noise in the work environment. To measure daily noise exposure, a subset of eight participants wore a personal dosimeter for three different work shifts., Study Sample: A total of 11 females and four males, aged between 19 and 36 years old (mean: 26.3, SD: 4.6) recruited from independently owned cafés in the Portland metro area., Results: Dosimetry measurements revealed Leq measurements between 71 and 83 dBA, with noise doses ranging from 4% to 74%, indicating that baristas are not exposed to sound levels above the regulatory criterion. Questionnaire results indicated that baristas have low awareness about the hazards of noise, are not opposed to hearing conservation, and rarely use hearing protection when engaged in noisy activities., Conclusions: Baristas here lacked the pertinent education and motivation to commit to invaluable hearing conservation practices.

Background: Tele-audiology provides a means to offer audiologic rehabilitation (AR) in a cost-, resource-, and time-effective manner. If designed appropriately, it also has the capability of personalizing rehabilitation to the user in terms of content, depth of detail, etc., thus permitting selection of the best content for a particular individual. Synchronous/real-time data collection, store and forward telehealth, remote monitoring and mobile health using smartphone applications have each been applied to components of audiologic rehabilitation intervention (sensory management, instruction in the use of technology and control of the listening environment, perceptual and communication strategies training, and counseling). In this article, the current state of tele-audiological rehabilitation interventions are described and discussed., Results: The provision of AR via tele-audiology potentially provides a cost-effective mechanism for addressing barriers to the routine provision of AR beyond provisions of hearing technology. Furthermore, if designed appropriately, it has the capability of personalizing rehabilitation to the user in terms of content, depth of detail, etc., thus permitting selection of the best content for a particular individual. However, effective widespread implementation of tele-audiology will be dependent on good education of patients and clinician alike, and researchers must continue to examine the effectiveness of these new approaches to AR in order to ensure clinicians provide effective evidence-based rehabilitation to their patients., Conclusions: While several barriers to the widespread use of tele-audiology for audiologic rehabilitation currently exist, it is concluded that through education of patients and clinicians alike, it will gain greater support from practitioners and patients over time and will become successfully and widely implemented., (American Academy of Audiology.)

Objective: To determine which features make a computer-based hearing health education intervention effective, easy to use, and enjoyable. The study examined which features of a multimedia self-administered computerized hearing loss prevention program, developed by the National Center for Rehabilitative Auditory Research (referred to as the NCRAR-HLPP), users liked and disliked, and the reasons why., Design: A formative evaluation was conducted in which participants completed a questionnaire to assess knowledge and attitudes towards hearing and hearing loss prevention, used the NCRAR-HLPP, completed the questionnaire for a second time, and were interviewed to learn their opinions about the NCRAR-HLPP., Study Sample: Twenty-five male and four female Veterans recruited from the Portland VA Medical Center who were aged between 25 and 65 years., Results: Participants reported that using the NCRAR-HLPP was a positive experience. Ease of use, multimedia content, personal relevance, and use of emotion were positive features of the program. The questionnaire showed increased knowledge and improved attitude scores following use of the program., Conclusion: This formative evaluation showed changes designed to target user preferences and improve user instructions will be made in future versions of the program.

Unlabelled: Vast numbers of blast-injured Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn personnel report postconcussive symptoms that include headache, dizziness, poor memory, and difficulty concentrating. In addition, many report hearing problems, such as difficulty understanding speech in noise, yet have no measureable peripheral auditory deficits. In this article, self-report and performance-based measures were used to assess 99 blast-exposed Veterans. All participants reported auditory problems in difficult listening situations but had clinically normal hearing. Participants' scores on self-report questionnaires of auditory difficulties were more similar to scores of older individuals with hearing impairment than to those of younger individuals with normal hearing. Participants showed deficits relative to published normative data on a number of performance-based tests that have demonstrated sensitivity to auditory processing deficits. There were several measures on which more than the expected number of participants (15.9%) performed one or more standard deviations below the mean. These were assessments of speech understanding in noise, binaural processing, temporal resolution, and speech segregation. Performance was not universally poor, with approximately 53% of participants performing abnormally on between 3 and 6 of the 10 measures. We concluded that participants exhibited task-specific deficits that add to the evidence suggesting that blast injury results in damage to the central auditory system., Clinical Trials Registration: ClinicalTrials.gov; Approaches to Auditory Rehabilitation for Mild Traumatic Brain Injury (mTBI); NCT00930774; https://clinicaltrials.gov/ct2/show/NCT00930774?term=NCT00930774&rank=1.

Objective: To develop and evaluate a questionnaire assessing knowledge, attitudes, and behaviors (KAB) as they pertain to hearing conservation, using the constructs of the health belief model (HBM)., Design: The KAB was completed by 235 participants. Relationships between knowledge and attitudes about hearing and hearing conservation, participation in noisy activities, and use of hearing protection were examined., Study Sample: 117 males and 118 females aged between 18 and 80 years (mean = 42.3, SD = 4.1) recruited from the Portland VA Medical Center, local universities, and a community college., Results: Knowledge scores ranged from 15.6% to 93.8%. Factor analyses revealed six attitude factors, interpreted as measuring perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and cues to action. Over 95% of participants routinely participated in at least one noisy activity but few used hearing protection while doing so. The attitude scores of individuals who used hearing protection differed significantly from the scores of those who did not., Conclusions: Significant relationships between use of hearing protection and scores on the KAB provide validation that the HBM is a valuable framework for understanding hearing health behaviors, and evidence that the KAB is a valid tool for assessing these attitudes and behaviors.

Purpose: To examine the role of compliance in the outcomes of computer-based auditory training with the Listening and Communication Enhancement (LACE) program in Veterans using hearing aids., Method: The authors examined available LACE training data for 5 tasks (i.e., speech-in-babble, time compression, competing speaker, auditory memory, missing word) from 50 hearing-aid users who participated in a larger, randomized controlled trial designed to examine the efficacy of LACE training. The goals were to determine: (a) whether there were changes in performance over 20 training sessions on trained tasks (i.e., on-task outcomes); and (b) whether compliance, defined as completing all 20 sessions, vs. noncompliance, defined as completing less than 20 sessions, influenced performance on parallel untrained tasks (i.e., off-task outcomes)., Results: The majority, 84% of participants, completed 20 sessions, with maximum outcome occurring with at least 10 sessions of training for some tasks and up to 20 sessions of training for others. Comparison of baseline to posttest performance revealed statistically significant improvements for 4 of 7 off-task outcome measures for the compliant group, with at least small (0.2 < d < 0.3) Cohen's d effect sizes for 3 of the 4. There were no statistically significant improvements observed for the noncompliant group., Conclusion: The high level of compliance in the present study may be attributable to use of systematized verbal and written instructions with telephone follow-up. Compliance, as expected, appears important for optimizing the outcomes of auditory training. Methods to improve compliance in clinical populations need to be developed, and compliance data are important to report in future studies of auditory training.

Objective: To develop a hearing beliefs questionnaire (HBQ) that assesses hearing beliefs within the constructs of the health belief model, and to investigate whether HBQ scores are associated with hearing health behaviors., Design: A 60-item version of the questionnaire was developed and completed by 223 participants who also provided information about their hearing health behaviors (help seeking, hearing-aid acquisition, and hearing-aid use)., Study Sample: Individuals aged between 22 and 90 years recruited from a primary care waiting area at a Veterans hospital. Seventy-six percent were male, 80% were Veterans., Results: A 26-item version of the HBQ with six scales was derived using factor analysis and reliability analyses. The scales measured: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and cues to action. HBQ scores differed significantly between individuals with different hearing health behaviors. Logistic regression analyses resulted in robust models of hearing health behaviors that correctly classified between 59% and 100% of participant hearing health behaviors., Conclusions: The HBM appears to be an appropriate framework for examining hearing health behaviors, and the HBQ is a valuable tool for assessing hearing health beliefs and predicting hearing health behaviors.

Purpose: To review the current literature on help seeking for hearing health care among older adults., Method: The authors conducted a literature review regarding help seeking for hearing-related communication difficulties as well as for other chronic medical conditions., Results: Untreated hearing loss can lead to numerous negative secondary consequences; uptake and use of hearing aids remain low, despite the fact that hearing aids provide an effective treatment option for older adults with hearing loss. The authors describe models relevant to understanding the help-seeking and decision-making behaviors of older adults with hearing loss and discuss recommendations for future research., Conclusion: Because of the considerable overlap in factors associated with help-seeking behaviors across chronic medical conditions and because help-seeking behaviors are complex, help seeking should be examined within the framework of a multifactorial model, such as the health belief model or the transtheoretical stages of change model.

Objective: Hearing-aid counseling can improve outcome but programs are often too resource-intensive to be clinically practical. Here we examined the effectiveness of single-session informational counseling with single-session performance-perceptual counseling., Design: Two forms of counseling were compared: informational counseling (IC) and performance-perceptual counseling (PPC). IC focused on discussing communication strategies and tips for hearing-aid use. PPC addressed the discrepancy between measured and perceived ability to understand speech. Outcomes were measured eight-to-ten weeks post-counseling using quantitative and qualitative measures: Hearing handicap inventory, abbreviated profile of hearing aid benefit, psychosocial impact of assistive devices scale (PIADS), international outcome inventory for hearing aids, and a semi-structured exit interview., Study Sample: Seventy-four hearing aid-users with symmetrical sensorineural hearing loss participated., Results: Scores on the hearing questionnaires showed no change following either form of counseling. Scores on the PIADS improved for participants as a whole, and the semi-structured interview revealed increased hearing-aid use, better understanding and acceptance of hearing loss, increased use of communication strategies, and improved ability to explain hearing difficulties to others., Conclusions: A single session of hearing-aid counseling can improve hearing-aid use and satisfaction. Open-ended interview and/or quality of life measures are more sensitive to these benefits than hearing questionnaires.

Combat exposures to blast can result in both peripheral damage to the ears and eyes and central damage to the auditory and visual processing areas in the brain. The functional effects of the latter include visual, auditory, and cognitive processing difficulties that manifest as deficits in attention, memory, and problem solving--symptoms similar to those seen in individuals with visual and auditory processing disorders. Coexisting damage to the auditory and visual system is referred to as dual sensory impairment (DSI). The number of Operation Iraqi Freedom/Operation Enduring Freedom Veterans with DSI is vast; yet currently no established models or guidelines exist for assessment, rehabilitation, or service-delivery practice. In this article, we review the current state of knowledge regarding blast exposure and DSI and outline the many unknowns in this area. Further, we propose a model for clinical assessment and rehabilitation of blast-related DSI that includes development of a coordinated team-based approach to target activity limitations and participation restrictions in order to enhance reintegration, recovery, and quality of life.

Many of the drugs used for chemotherapy treatments are known to be ototoxic, and can result in permanent hearing threshold shifts. The degree of ototoxic damage can be influenced by many factors including dosage, duration of exposure, genetics, and coadministration with other ototoxic agents. Cisplatin is known for its ototoxic effects on hearing thresholds, particularly in the high frequencies. Recent studies have indicated a synergistic relationship between Cisplatin administration and moderate to high noise level exposure starting between 70-85 dB SPL. This study measured the noise levels in the Portland Veteran's Affairs Medical Center's outpatient chemotherapy clinic. Average (LAeq) and peak (LCpeak) noise measures were recorded every minute from 7 am until 6 pm on the two busiest clinic days. Patients, visitors, and staff members filled out anonymous surveys regarding their reactions to noise levels. Cumulative noise levels were not at levels known to interact with Cisplatin for a significant period of time. Noise measurement analysis indicated that levels were at or above 70 dB SPL for less than ten minutes during the 11-hour recording window. The patient and visitor surveys indicated that both groups were unbothered by noise in the clinic. However, most staff members were bothered by or concerned about noise levels, and many felt that it caused stress and difficulty communicating on the phone.

Currently, there are more than 445,000 veterans receiving compensation for hearing loss associated with military service, and 395,000 receiving compensation for service-related tinnitus. In addition to compensation payments, service-related hearing disorders cost the US Department of Veterans Affairs in terms of provision of hearing aids, hearing aid-related services, and clinical services at its 220 facilities nationwide. It is imperative that hearing conservation among military personnel and veterans be addressed. In this paper, we describe the rationale for and the development of a multimedia Hearing Loss Prevention Program aimed at preventing the progression of hearing loss among veterans associated with social, recreational, and nonmilitary occupational noise exposure. The program was developed based on the principles outlined in the Health Belief Model of Rosenstock (1966) and the Health Promotion Model of Pender et al. (2002).

Dual sensory impairment (DSI) refers to the presence of both hearing loss and vision loss. The occurrence of DSI is particularly prevalent among the aging population, with studies showing between 9% and 21% of adults older than 70 years having some degree of DSI. Despite this, there is little direction regarding recommended clinical practice and rehabilitation of individuals with DSI. It is assumed that the problems encountered by individuals with DSI are considerably greater than the effects of vision impairment or hearing impairment alone, because when these two sensory impairments are combined, the individual is seriously deprived of compensatory strategies that make use of the nonimpaired sense. In this article, the literature available regarding DSI is summarized, and research needs regarding rehabilitation strategies are outlined and discussed. Simple suggestions for addressing DSI are provided that use available tools and technology.

Audiometric measurements are traditionally made in dB HL, which by definition are specified relative to the sound pressure level (SPL) in a coupler. Real-ear dB SPL is then estimated by applying an average ear transform to the coupler value. However, individual variation in ear canal acoustics and variations in transducer placement strongly influence the dB SPL of signals arriving at the eardrum. In this paper, data from 1814 ears are presented, showing that the distribution of eardrum dB SPL for a fixed signal level varies across ears and across frequency by as much as 40 dB. The impact of this variance upon hearing aid targets computed with the NAL-NL1 fitting algorithm is examined by comparing the targets obtained from using an average transform with those obtained when audiometric data in dB SPL are obtained by applying individually measured real-ear-to-coupler difference (RECD) values to dB HL thresholds. The impact can be considerable.

Microphone arrays can improve speech recognition in the noise for hearing-impaired listeners by suppressing interference coming from other than desired signal direction. In a previous paper [J. M. Kates and M. R. Weiss, J. Acoust. Soc. Am. 99, 3138-3148 (1996)], several array-processing techniques were evaluated in two rooms using the AI-weighted array gain as the performance metric. The array consisted of five omnidirectional microphones having uniform 2.5-cm spacing, oriented in the endfire direction. In this paper, the speech intelligibility for two of the array processing techniques, delay-and-sum beamforming and superdirective processing, is evaluated for a group of hearing-impaired subjects. Speech intelligibility was measured using the speech reception threshold (SRT) for spondees and speech intelligibility rating (SIR) for sentence materials. The array performance is compared with that for a single omnidirectional microphone and a single directional microphone having a cardioid response pattern. The SRT and SIR results show that the superdirective array processing was the most effective, followed by the cardioid microphone, the array using delay-and-sum beamforming, and the single omnidirectional microphone. The relative processing ratings do not appear to be strongly affected by the size of the room, and the SRT values determined using isolated spondees are similar to the SIR values produced from continuous discourse.

Obscure Auditory Dysfunction (OAD) is explained by a combination of hearing-related deficits and personality factors Saunders & Haggard (1992). In this study, we determine which factors are associated specifically with OAD and which are associated with the seeking of medical attention in general. We achieved this by obtaining a second patient group with a parallel syndrome to OAD, called "chronic pelvic pain without obvious organic pathology" (CPPWOOP). CPPWOOP patients complain of lower abdominal pain that is not explainable by conventional medical tests. Fifteen CPPWOOPs underwent the OAD test battery. For the analyses they were retrospectively matched to 15 of the original OADs and their matched controls. The three groups were compared by analysis of variance and Kruskall-Wallis analyses. The CPPWOOPs and controls performed significantly better than OADs on hearing-related variables, but did not differ from each other, whereas the OADs and CPPWOOPs were significantly more anxious than the controls, but did not differ from each other. We conclude that anxiety-related traits are associated with the seeking of medical attention in general, whereas the hearing-related deficits we measured are associated specifically with OAD. Anxiety-related traits should, therefore, be considered when dealing with marginal pathologies, but in depth investigation may also reveal an organic basis; therefore, patients should not be dismissed as simply neurotic.

Evoked otoacoustic emissions (EOAE) are a sensitive indicator of subtle cochlear damage and hence might explain why some people complain of excessive difficulty understanding speech in a background of noise, despite having normal hearing thresholds. This phenomenon has been termed "Obscure Auditory Dysfunction" (OAD). Recorded EOAE waveforms from a group of 50 OAD patients were compared with those from a group of 50 matched controls. No significant difference could be found between the two groups across a range of objective and subjective descriptors of the EOAEs. Any cochlear component of OAD does not appear to affect the function of the outer hair cells sufficiently to modify EOAEs materially.

Obscure Auditory Dysfunction (OAD) is defined as a clinical referral for self-reported auditory disability with no audiometric abnormality by stringent criteria. In stage 2 of a case control study of OAD, we have confirmed the general finding of stage 1 that OAD is multifactorial; compared with controls, patients as a group have a genuine performance deficit for understanding speech in noise, accompanied by personality-related factors. Paired logistic regression analysis optimally differentiated the 50 patients from their 50 matched controls on the basis of variables from three different domains: masked thresholds (psychoacoustic domain), dichotic listening ability (central/cognitive domain), and underestimation of own hearing ability (personality domain). A further and influential contributing variable was understanding of speech in noise supplementing the variables in both the psychoacoustic and the cognitive domains. With this model, 82.7% of the total group deviance was explained (i.e., the binary variable of case/control). A corresponding discriminant function analysis correctly classified 80% of patients and 90% of controls. When factors underlying the performance and personality-related variables were investigated with multiple linear regression within the two groups separately, relatively little of the within-group variance among OADs was explained. This is consistent with the multifactorial nature of OAD, in that the combinations of factors leading to OAD status differ between individuals. The research findings have been used to design a clinical test package to provide diagnostic information on the basis of OAD in individuals.