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Despite high rates of bilateral hearing aid fitting globally, a number of adults continue to reject one hearing aid. The current study aimed to identify a clinically suitable tool for determining, pre-fitting, which clients might prefer one hearing aid. Study Sample: Ninety-five new adult hearing aid candidates, aged 49–87 years, were assessed prior to a first hearing aid fitting. Sixty-eight participants adhered to the prescribed protocol for both bilateral and unilateral hearing aid use. Performance was assessed on a modified version of the Listening in Spatialised Noise – Sentences test (LiSN-S), the Dichotic Digits difference Test, the Experiential Hearing Aid simulator, and the Grooved Pegboard Test. All participants were fitted bilaterally, but were instructed to alternate between unilateral and bilateral hearing aid use over fourteen weeks post-fitting. Participants’ wearing preferences were assessed via a short questionnaire. 78% of participants expressed an overall preference for bilateral hearing aid use. Only the LiSN-S bilateral advantage test outcomes significantly correlated with overall wearing preference. Although the LiSN-S bilateral advantage score related to overall wearing preference, the accuracy of the predictor was too low to warrant implementation of this test prior to hearing aid fitting. The current practice of recommending bilateral hearing aid use continues to be the best option for clinicians.

Ear infection or otitis media (OM) occurs in many Aboriginal and Torres Strait Islander children at a young age and tends to persist over a long period of time. Chronic OM is associated with conduc...

OBJECTIVES The purpose of this study was to (1) develop a Language-independent Test of Auditory Discrimination (LIT-AD) between speech sounds so that people with hearing loss who derive limited speech perception benefits from hearing aids (HAs) may be identified for consideration of cochlear implantation and (2) examine the relationship between the scores for the new discrimination test and those of a standard sentence test for adults wearing either HAs or cochlear implants (CIs). DESIGN The test measures the ability of the listener to correctly discriminate pairs of nonsense syllables, presented as sequential triplets in an odd-one-out format, implemented as a game-based software tool for self-administration using a tablet computer. Stage 1 included first a review of phonemic inventories in the 40 most common languages in the world to select the consonants and vowels. Second, discrimination testing of 50 users of CIs at several signal to noise ratios (SNRs) was carried out to generate psychometric functions. These were used to calculate the corrections in SNR for each consonant-pair and vowel combination required to equalize difficulty across items. Third, all items were individually equalized in difficulty and the overall difficulty set. Stage 2 involved the validation of the LIT-AD in English-speaking listeners by comparing discrimination scores with performance in a standard sentence test. Forty-one users of HAs and 40 users of CIs were assessed. Correlation analyses were conducted to examine test-retest reliability and the relationship between performance in the two tests. Multiple regression analyses were used to examine the relationship between demographic characteristics and performance in the LIT-AD. The scores of the CI users were used to estimate the probability of superior performance with CIs for a non-CI user having a given LIT-AD score and duration of hearing loss. RESULTS The LIT-AD comprises 81 pairs of vowel-consonant-vowel syllables that were equalized in difficulty to discriminate. The test can be self-administered on a tablet computer, and it takes about 10 min to complete. The software automatically scores the responses and gives an overall score and a list of confusable items as output. There was good test-retest reliability. On average, higher LIT-AD discrimination scores were associated with better sentence perception for users of HAs (r = -0.54, p

Background The Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study is a prospective study commenced in 2005 that was aimed to examine the effect of age of hearing loss identification and intervention on outcomes for children with hearing loss, such as language and psychosocial development. Permanent childhood hearing loss has a significant impact on child development. Methods 450 children identified with permanent sensorineural hearing loss prior to 3 years of age in New South Wales, Queensland and Victoria completed comprehensive speech, language and audiological assessments at defined age intervals. Multiple regression analysis and structural equation modelling (SEM) were completed to determine factors influencing outcomes at 5 and 9 years of age. Results Regression models indicated outcomes were significantly influenced by age of hearing loss intervention, nonverbal cognitive ability, maternal education level and communication mode. A significant predictive effect of early language skill was seen on later language development. SEM found that the impact of age of hearing loss intervention on language outcomes was mediated by its effect on cognitive development and speech perception. Language ability influenced psychosocial development. Conclusions Early identification and intervention of hearing loss improves language and psychosocial development, via its influence on cognitive development and speech perception. Key messages Early hearing loss identification and intervention improves language and psychosocial development for children with permanent sensorineural hearing loss. Evidence from the LOCHI study has guided clinical management guidelines of children with hearing loss.

Objectives: To investigate associations between auditory processing abilities, cognitive abilities, listening ability, and reading ability in children.Design: This was a cross-sectional study involving 155 children (105 referred for auditory processing assessment and 50 with no reported listening concerns) aged between 7 and 13 years. Each child was assessed on auditory processing tests, cognitive tests, and a reading test. Additional data on reading ability were provided by the reading score from a national test. Questionnaires about the child’s listening ability were completed by a parent, a teacher, and the child.Results: Structural equation models relating auditory processing abilities, cognitive abilities, listening ability, and reading ability were developed. There was evidence that listening and reading abilities were associated with cognitive abilities when adjusting for auditory processing abilities, but little evidence that listening and reading abilities were associated with auditory processing abilities when adjusting for cognitive abilities.Conclusions: It should not be assumed that auditory processing tests and cognitive tests measure separate abilities. When investigating the association between auditory processing abilities and real-world abilities, it is important to adjust for cognitive abilities. Children with listening difficulties should undergo cognitive assessments in addition to auditory processing assessments.

Objective: This study describes a new automated strategy to determine the detection status of an electrophysiological response.Design: Response, noise and signal-to-noise ratio of the cortical audi...

OBJECTIVE: This study investigated the factors influencing 5-year language, speech, and everyday functioning of children with congenital hearing loss. DESIGN: Standardised tests including PLS-4, PPVT-4 and DEAP were directly administered to children. Parent reports on language (CDI) and everyday functioning (PEACH) were collected. Regression analyses were conducted to examine the influence of a range of demographic variables on outcomes. STUDY SAMPLE: Participants were 339 children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS: Children’s average receptive and expressive language scores were approximately 1 SD below the mean of typically developing children, and scores on speech production and everyday functioning were more than 1 SD below. Regression models accounted for 70% to 23% of variance in scores across different tests. Higher nonverbal ability and earlier CI switch-on were associated with better outcomes in most domains. Earlier HA fitting and use of oral communication were associated with better outcomes on directly administered language assessments. Severity of hearing loss and maternal education influenced outcomes of children with HAs. The presence of additional disabilities affected outcomes of children with CIs. CONCLUSIONS: The findings provide strong evidence for the benefits of early HA fitting and early CI for improving children’s outcomes.

Background: Hearing aids and personal sound amplification products that are designed to be self-fitted by the user at home are becoming increasingly available in the online marketplace. While these devices are often marketed as a low-cost alternative to traditional hearing health-care, little is known about people’s ability to successfully use and manage them. Previous research into the individual components of a simulated self-fitting procedure has been undertaken, but no study has evaluated performance of the procedure as a whole using a commercial product. Purpose: To evaluate the ability of a group of adults with a hearing loss to set up a pair of commercially available self-fitting hearing aids for their own use and to investigate factors associated with a successful outcome. Research Design: An interventional study that used regression analysis to identify potential contributors to the outcome. Study Sample: Forty adults with mild to moderately severe hearing loss participated in the study: 20 current hearing aid users (the “experienced” group) and 20 with no previous amplification experience (the “new” group). Twenty-four participants attended with partners, who were present to offer assistance with the study task as needed. Data Collection and Analysis: Participants followed a set of written, illustrated instructions to perform a multistep self-fitting procedure with a commercially available self-fitting hearing aid, with optional assistance from a lay partner. Standardized measures of cognitive function, health literacy, locus of control, hearing aid self-efficacy, and manual dexterity were collected. Statistical analysis was performed to examine the proportion of participants in each group who successfully performed the self-fitting procedure, factors that predicted successful completion of the task, and the contributions of partners to the outcome. Results: Fifty-five percent of participants were able to successfully perform the self-fitting procedure. Although the same success rate was observed for both experienced and new participants, the majority of the errors relating to the hearing test and the fine-tuning tasks were made by the experienced participants, while all of the errors associated with physically customizing the hearing aids and most of the insertion errors were made by the new participants. Although the majority of partners assisted in the self-fitting task, their contributions did not significantly influence the outcome. Further, no characteristic or combination of characteristics reliably predicted which participants would be successful at the self-fitting task. Conclusions: Although the majority of participants were able to complete the self-fitting task without error, the provision of knowledgeable support by trained personnel, rather than a fellow layperson, would most certainly increase the proportion of users who are able to achieve success. Refinements to the instructions and the physical design of the hearing aid may also serve to improve the success rate. Further evaluation of the range of self-fitting hearing aids that are now on the market should be undertaken.

Purpose Hearing loss is associated with changes in brain volume in regions supporting auditory and cognitive processing. The purpose of this study was to determine whether there is a systematic association between hearing ability and brain volume in cross-sectional data from a large nonclinical cohort of middle-aged adults available from the UK Biobank Resource ( http://www.ukbiobank.ac.uk ). Method We performed a set of regression analyses to determine the association between speech reception threshold in noise (SRTn) and global brain volume as well as predefined regions of interest (ROIs) based on T1-weighted structural images, controlling for hearing-related comorbidities and cognition as well as demographic factors. In a 2nd set of analyses, we additionally controlled for hearing aid (HA) use. We predicted statistically significant associations globally and in ROIs including auditory and cognitive processing regions, possibly modulated by HA use. Results Whole-brain gray matter volume was significantly lower for individuals with poorer SRTn. Furthermore, the volume of 9 predicted ROIs including both auditory and cognitive processing regions was lower for individuals with poorer SRTn. The greatest percentage difference (−0.57%) in ROI volume relating to a 1 SD worsening of SRTn was found in the left superior temporal gyrus. HA use did not substantially modulate the pattern of association between brain volume and SRTn. Conclusions In a large middle-aged nonclinical population, poorer hearing ability is associated with lower brain volume globally as well as in cortical and subcortical regions involved in auditory and cognitive processing, but there was no conclusive evidence that this effect is moderated by HA use. This pattern of results supports the notion that poor hearing leads to reduced volume in brain regions recruited during speech understanding under challenging conditions. These findings should be tested in future longitudinal, experimental studies. Supplemental Material https://doi.org/10.23641/asha.7949357

Objective: To establish the effect of self-rated and measured functional hearing on depression, taking age and gender into account. Additionally, the study investigates if hearing-aid usage mitigates the effect, and if other physical health problems and social engagement confound it. Design: Cross-sectional data from the UK Biobank resource, including subjective and behavioural measures of functional hearing and multifactorial measures of depressive episodes and symptoms, were accessed and analysed using multi-regression analyses. Study sample: Over 100 000 community-dwelling, 39-70 year-old volunteers. Results: Irrespective of measurement method, poor functional hearing was significantly (p l 0.001) associated with higher levels of depressive episodes ( 0.16 factor scores) and depressive symptoms ( 0.30 factor scores) when controlling for age and gender. Associations were stronger for subjective reports, for depressive symptoms, and the younger participants. Females generally reported higher levels of depression. Hearing-aid usage did not show a mitigating effect on the associations. Other physical health problems particularly partially confounded the effects. Conclusion: Data support an association between functional hearing and depression that is stronger in the younger participants (40-49 years old) and for milder depression. The association was not alleviated by hearing-aid usage, but was partially confounded by other physical health problems.

OBJECTIVES: Universal newborn hearing screening has been implemented to detect permanent childhood hearing loss (PCHL) early, with the ultimate goal of improving outcomes through early treatment. However, there is disagreement between studies on the size of this benefit and in some cases whether it is significantly different from 0. There have been no studies of sufficient size in which researchers have determined reliably whether the effect varies with degree of PCHL. We aimed to explore how intervention timing influences 5-year language in children with PCHL. METHODS: Via a prospective study of 350 children, we used standard multiple regression analyses to investigate the effect of age at intervention or hearing screening on language outcomes after allowing for the effects of nonverbal IQ, degree of PCHL, sex, birth weight, maternal education, additional disabilities, and communication mode. RESULTS: The benefit of early intervention for language development increased as hearing loss increased. Children whose amplification started at age 24 months had poorer language than those whose amplification started at 3 months. The difference was larger for 70-dB HL (−11.8 score points; 95% confidence interval [95% CI]: −18.7 to −4.8) than for 50-dB HL (−6.8; 95% CI: −10.8 to −2.8). Children who received cochlear implants at 24 months had poorer language than those implanted at 6 months (−21.4; 95% CI: −33.8 to −9.0). There was no significant effect of screening on outcomes. CONCLUSIONS: Early intervention improves language outcomes, thereby lending support to streamlining clinical pathways to ensure early amplification and cochlear implantation after diagnosis.

This paper compares language development and speech perception of children with bimodal fitting (a cochlear implant in one ear and a hearing aid in the opposite ear) or bilateral cochlear implantation.Participants were children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment study. Language development was assessed at 3 years of age using standardized tests. Speech perception was evaluated at 5 years of age. Speech was presented from a frontal loudspeaker, and babble noise was presented either from the front or from both sides.On average, there was no significant difference in language outcomes between 44 children with bimodal fitting and 49 children with bilateral cochlear implants; after controlling for a range of demographic variables. Earlier age at cochlear implant activation was associated with better outcomes. Speech perception in noise was not significantly different between children with bimodal fitting and those with bilateral cochlear implants. Compared to normal-hearing children, children with cochlear implants required a better signal-to-noise ratio to perform at the same level, but demonstrated spatial release from masking of a similar magnitude.This population-based study found that language scores for children with bilateral implants were higher than those with bimodal fitting or those with unilateral implants, but neither reached significance level.

To investigate the predicted threshold shift associated with the use of nonlinear hearing aids fitted to the NAL-NL2 or the DSL m[i/o] prescription for children with the same audiograms. For medium and high input levels, we asked: (1) How does predicted asymptotic threshold shifts (ATS) differ according to the choice of prescription? (2) How does predicted ATS vary with hearing level for gains prescribed by the two prescriptions?A mathematical model consisting of the modified power law combined with equations for predicting temporary threshold shift (Macrae, 1994b) was used to predict ATS.Predicted threshold shift were determined for 57 audiograms at medium and high input levels.For the 57 audiograms, DSL m[i/o] gains for high input levels were associated with increased risk relative to NAL-NL2. The variation of ATS with hearing level suggests that NAL-NL2 gains became unsafe when hearing loss90 dB HL. The gains prescribed by DSL m[i/o] became unsafe when hearing loss80 dB HL at a medium input level, and70 dB HL at a high input level.There is a risk of damage to hearing for children using nonlinear amplification. Vigilant checking for threshold shift is recommended.

This research investigated the speech, language, and functional auditory outcomes of 119 3-year-old children with hearing loss and additional disabilities. Outcomes were evaluated using direct assessment and caregiver report. Multiple regressions revealed that type of additional disability and level of maternal education were significant predictors of language outcomes. Poorer outcomes were achieved in a combined group of children with autism, cerebral palsy, and/or developmental delay (DD) (Group A), compared with children with vision or speech output impairments, syndromes not entailing DD, or medical disorders (Group B). Better outcomes were associated with higher levels of maternal education. The association between better language outcomes and earlier cochlear implant switch-on approached significance. Further regression analyses were conducted separately for children with different types of additional disabilities. Level of maternal education was the only significant predictor of outcomes for Group A children, whereas degree of hearing loss was the strongest predictor for children in Group B. The findings highlight the variable impact that different types of additional disabilities can have on language development in children with hearing loss.

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

To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment.All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes.Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age.Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.

Objectives Difficulty in understanding speech in background noise is frequently reported by hearing-impaired people despite well-fitted amplification. Understanding speech in the presence of background noise involves segregating the various auditory stimuli into distinct streams using cues such as pitch characteristics, spatial location of speakers, and contextual information. One possible cause of listening difficulties in noise is reduced spatial-processing ability. Previous attempts to investigate spatial processing in hearing-impaired people have often been confounded by inadequate stimulus audibility. The present research aimed to investigate the effects of hearing impairment and aging on spatial-processing ability. The effect of cognitive ability on spatial processing was also explored. In addition, the relationship between spatial-processing ability and self-report measures of listening difficulty was examined to investigate how much effect spatial-processing ability has in real-world situations. Design Eighty participants aged between 7 and 89 years took part in the study. Participants' hearing thresholds ranged from within normal limits to a moderately severe sensorineural hearing loss. All participants had English as their first language and no reported learning disabilities. The study sample included both hearing aid users and non-hearing aid users. Spatial-processing ability was assessed with a modified version of the Listening in Spatialized Noise-Sentences test (LiSN-S). The LiSN-S was modified to incorporate a prescribed gain amplifier that amplified the target and distracting stimulus according to the National Acoustic Laboratories-Revised Profound (NAL-RP) prescription. In addition, participants aged 18 years and above completed the Neurobehavioral Cognitive Status examination and the Speech, Spatial and Qualities questionnaire. Participants aged under 18 years completed the Listening Inventory for Education questionnaire. Results Spatial-processing ability, as measured by the spatial advantage measure of the LiSN-S, was negatively affected by hearing impairment. Aging was not significantly correlated with spatial-processing ability. No significant relationship was found between cognitive ability and spatial processing. Self-reported listening difficulty in children, as measured with the Listening Inventory for Education, and spatial-processing ability were not correlated. Self-reported listening difficulty in adults, as measured by the Speech, Spatial and Qualities questionnaire, was significantly correlated with spatial-processing ability. Conclusions All hearing-impaired people will have a spatial processing deficit of some degree. This should be given due consideration when counseling patients in regard to realistic expectations of how they will perform in background noise. Further research is required into potential remediation for spatial-processing deficits and the cause of these deficits.

The physical properties of circum-aural hearing protectors, such as mass, clamping force and cup volume, have an influence on the attenuation performance of the device. This paper closely examines the physical and acoustic properties 39 of hearing protectors readily available to all users. The results indicate that attenuation increases with clamping force up to a limiting value of around 11 Newtons above which expected increases in attenuation are very small for large increases in clamping force. Likewise increasing the (newly introduced term) bulk of a hearing protector (volume, mass and cup elements) increases the attenuation but, as with clamping force a limit is reached where increased bulk increases discomfort and wearing difficulty

Objectives: Verbal reasoning performance is an indicator of the ability to think constructively in everyday life and relies on both crystallized and fluid intelligence. This study aimed to determine the effect of functional hearing on verbal reasoning when controlling for age, gender, and education. In addition, the study investigated whether hearing aid usage mitigated the effect and examined different routes from hearing to verbal reasoning. Design: Cross-sectional data on 40- to 70-year-old community-dwelling participants from the UK Biobank resource were accessed. Data consisted of behavioral and subjective measures of functional hearing, assessments of numerical and linguistic verbal reasoning, measures of executive function, and demographic and lifestyle information. Data on 119,093 participants who had completed hearing and verbal reasoning tests were submitted to multiple regression analyses, and data on 61,688 of these participants, who had completed additional cognitive tests and provided relevant lifestyle information, were submitted to structural equation modeling. Results: Poorer performance on the behavioral measure of functional hearing was significantly associated with poorer verbal reasoning in both the numerical and linguistic domains (p l 0.001). There was no association between the subjective measure of functional hearing and verbal reasoning. Functional hearing significantly interacted with education (p l 0.002), showing a trend for functional hearing to have a greater impact on verbal reasoning among those with a higher level of formal education. Among those with poor hearing, hearing aid usage had a significant positive, but not necessarily causal, effect on both numerical and linguistic verbal reasoning (p l 0.005). The estimated effect of hearing aid usage was less than the effect of poor functional hearing. Structural equation modeling analyses confirmed that controlling for education reduced the effect of functional hearing on verbal reasoning and showed that controlling for executive function eliminated the effect. However, when computer usage was controlled for, the eliminating effect of executive function was weakened. Conclusions: Poor functional hearing was associated with poor verbal reasoning in a 40- to 70-year-old community-dwelling population after controlling for age, gender, and education. The effect of functional hearing on verbal reasoning was significantly reduced among hearing aid users and completely overcome by good executive function skills, which may be enhanced by playing computer games.

Background: Hearing threshold estimation based on cortical auditory evoked potentials (CAEPs) has been applied for some decades. However, available research is scarce evaluating the accuracy of this technique with an automated paradigm for the objective detection of CAEPs. Purpose: To determine the difference between behavioral and CAEP thresholds detected using an objective paradigm based on the Hotelling’s T 2 statistic. To propose a decision tree to choose the next stimulus level in a sample of hearing-impaired adults. This knowledge potentially could increase the efficiency of clinical hearing threshold testing. Research Design: Correlational cohort study. Thresholds obtained behaviorally were compared with thresholds obtained through cortical testing. Study Sample: Thirty-four adults with hearing loss participated in this study. Data Collection and Analysis: For each audiometric frequency and each ear, behavioral thresholds were collected with both pure-tone and 40-msec tone-burst stimuli. Then, corresponding cortical hearing thresholds were determined. An objective cortical-response detection algorithm based on the Hotelling’s T 2 statistic was applied to determine response presence. A decision tree was used to select the next stimulus level. In total, 241 behavioral-cortical threshold pairs were available for analysis. The differences between CAEP and behavioral thresholds (and their standard deviations [SDs]) were determined for each audiometric frequency. Cortical amplitudes and electroencephalogram noise levels were extracted. The practical applicability of the decision tree was evaluated and compared to a Hughson-Westlake paradigm. Results: It was shown that, when collapsed over all audiometric frequencies, behavioral pure-tone thresholds were on average 10 dB lower than 40-msec cortical tone-burst thresholds, with an SD of 10 dB. Four percent of CAEP thresholds, all obtained from just three individual participants, were more than 30 dB higher than their behavioral counterparts. The use of a decision tree instead of a Hughson-Westlake procedure to obtain a CAEP threshold did not seem to reduce test time, but there was significantly less variation in the number of CAEP trials needed to determine a threshold. Conclusions: Behavioral hearing thresholds in hearing-impaired adults can be determined with an acceptable degree of accuracy (mean threshold correction and SD of both 10 dB) using an objective statistical cortical-response detection algorithm in combination with a decision tree to determine the test levels.

Background: A reliable and valid method for the automatic in situ measurement of hearing thresholds is a prerequisite for the feasibility of a self-fitting hearing aid, whether such a device becomes an automated component of an audiological management program or is fitted by the user independently of a clinician. Issues that must be addressed before implementation of the procedure into a self-fitting hearing aid include the role of real-ear-to-dial difference correction factors in ensuring accurate results and the ability of potential users to successfully self-direct the procedure. Purpose: The purpose of this study was to evaluate the reliability and validity of an automatic audiometry algorithm that is fully implemented in a wearable hearing aid, to determine to what extent reliability and validity are affected when the procedure is self-directed by the user, and to investigate contributors to a successful outcome. Research Design: Design was a two-phase correlational study. Study Sample: A total of 60 adults with mild to moderately severe hearing loss participated in both studies: 20 in Study 1 and 40 in Study 2. Twenty-seven participants in Study 2 attended with a partner. Participants in both phases were selected for inclusion if their thresholds were within the output limitations of the test device. Data Collection and Analysis: In both phases, participants performed automatic audiometry through a receiver-in-canal, behind-the-ear hearing aid coupled to an open dome. In Study 1, the experimenter directed the task. In Study 2, participants followed a set of written, illustrated instructions to perform automatic audiometry independently of the experimenter, with optional assistance from a lay partner. Standardized measures of hearing aid self-efficacy, locus of control, cognitive function, health literacy, and manual dexterity were administered. Statistical analysis examined the repeatability of automatic audiometry; the match between automatically and manually measured thresholds; and contributors to successful, independent completion of the automatic audiometry procedure. Results: When the procedure was directed by an audiologist, automatic audiometry yielded reliable and valid thresholds. Reliability and validity were negatively affected when the procedure was self-directed by the user, but the results were still clinically acceptable: test-retest correspondence was 10 dB or lower in 97% of cases, and 91% of automatic thresholds were within 10 dB of their manual counterparts. However, only 58% of participants were able to achieve a complete audiogram in both ears. Cognitive function significantly influenced accurate and independent performance of the automatic audiometry procedure; accuracy was further affected by locus of control and level of education. Several characteristics of the automatic audiometry algorithm played an additional role in the outcome. Conclusions: Average transducer- and coupling-specific correction factors are sufficient for a self-directed in situ audiometry procedure to yield clinically reliable and valid hearing thresholds. Before implementation in a self-fitting hearing aid, however, the algorithm and test instructions should be refined in an effort to increase the proportion of users who are able to achieve complete audiometric results. Further evaluation of the procedure, particularly among populations likely to form the primary audience of a self-fitting hearing aid, should be undertaken.

Objective: This paper presents a summary of otoacoustic emission (OAE) data collected as part of an Australian hearing health survey (Carter, 2011; Williams et al, 2014) designed to: (1) examine the relationship between audiological indicators and participant characteristics, and (2) extract audiological data suitable for reference use. Design: Cross-sectional cohort study. Distortion product (DP) OAE and transient evoked (TE) OAE measures. Study sample: Age range 11–35 years; N = 1386 participants (2672 test ears). Results: Descriptive statistics for amplitude and signal-to-noise ratio (SNR) were calculated for 327 participants (589 test ears; age 13 to 32 years). DPOAE amplitudes down to the 25th percentile were > 0 dB SPL for test frequencies up to 6 kHz. TEOAE SNRs down to the 25th percentile were > 6 dB SPL up to 4 kHz. Summary: This dataset can be used as a clinical reference for similar populations, providing that the same test parameters are used. Conclusions: The clinical significance of OAE testing would be greater if agreed criteria were available. These data could be pooled with other datasets to build a substantial OAE database, similar to the existing international standards for pure-tone hearing threshold levels (HTLs) (ISO, 2000).

Detailed information on the hearing threshold levels (HTLs) of young Australians was gathered as part of a large-scale study of the relationship between HTL and leisure-noise exposure in young Australians.HTL data for the study population (18-35 year olds) was carefully collected, as well as otoscopy, tympanometry, contra-lateral acoustic reflexes, and otoacoustic emissions (transient and distortion product), together with a comprehensive hearing health history - both past and present.The sample cohort consisted of 1407 individuals, females and males.Prior to analysis, HTL data were filtered according to both a 'Low' and 'High' set of exclusion criteria. The results obtained for both high-screen and low-screen datasets were around +5 dB above the traditionally accepted values of audiometric zero. This is consistent with previous published reports.Comparison with 'ISO 7029 Acoustics: Statistical distribution of hearing thresholds as a function of age' indicated that threshold values for this dataset have a similar distribution to those of the Standard. This data provides a suitable reference HTL ('normative') database for young Australians.

This research investigated the concurrent association between early reading skills and phonological awareness (PA), print knowledge, language, cognitive, and demographic variables in 101 5-year-old children with prelingual hearing losses ranging from mild to profound who communicated primarily using spoken language. All participants were fitted with hearing aids (n = 71) or cochlear implants (n = 30). They completed standardized assessments of PA, receptive vocabulary, letter knowledge, word and non-word reading, passage comprehension, math reasoning, and nonverbal cognitive ability. Multiple regressions revealed that PA (assessed using judgments of similarity based on words' initial or final sounds) made a significant, independent contribution to children's early reading ability (for both letters and words/non-words) after controlling for variation in receptive vocabulary, nonverbal cognitive ability, and a range of demographic variables (including gender, degree of hearing loss, communication mode, type of sensory device, age at fitting of sensory devices, and level of maternal education). Importantly, the relationship between PA and reading was specific to reading and did not generalize to another academic ability, math reasoning. Additional multiple regressions showed that letter knowledge (names or sounds) was superior in children whose mothers had undertaken post-secondary education, and that better receptive vocabulary was associated with less severe hearing loss, use of a cochlear implant, and earlier age at implant switch-on. Earlier fitting of hearing aids or cochlear implants was not, however, significantly associated with better PA or reading outcomes in this cohort of children, most of whom were fitted with sensory devices before 3 years of age.

To determine the effect of nonlinear frequency compression (NLFC) on children's development of speech and language at three years of age.A randomized controlled trial was conducted as part of the population-based longitudinal study on outcomes of children with hearing impairment (LOCHI). Participants were randomly assigned to fitting with NLFC (Phonak Naida V SP or UP) or with conventional processing in hearing aids, prescribed by using either the NAL or the DSL formula. Standardized tests of speech production, receptive and expressive language were administered, and parent ratings were collected. All assessments were double-blinded.Participants were 44 of the 450 children in the LOCHI cohort.Compared to children using conventional processing, receptive and expressive language was higher but receptive vocabulary and consonant articulation scores were lower for children who use NLFC. There was increased substitution of affricates by fricatives for children using NLFC, compared to children using conventional amplification. After allowing for the effect of multiple demographic variables, the difference in global language scores between groups was not significant (effect: 0.8 [95% confidence interval: - 6.7, 8.3]).There is insufficient evidence to indicate a difference in language ability between children using NLFC and those using conventional amplification.

Objectives: The primary objective of this study was to determine whether a combination of automatically administered pure-tone audiometry and a tone-in-noise detection task, both delivered via an air conduction (AC) pathway, could reliably and validly predict the presence of a conductive component to the hearing loss. The authors hypothesized that performance on the battery of tests would vary according to hearing loss type. A secondary objective was to evaluate the reliability and validity of a novel automatic audiometry algorithm to assess its suitability for inclusion in the test battery. Design: Participants underwent a series of hearing assessments that were conducted in a randomized order: manual pure-tone air conduction audiometry and bone conduction audiometry; automatic pure-tone air conduction audiometry; and an automatic tone-in-noise detection task. The automatic tests were each administered twice. The ability of the automatic test battery to: (a) predict the presence of an air-bone gap (ABG); and (b) accurately measure AC hearing thresholds was assessed against the results of manual audiometry. Test-retest conditions were compared to determine the reliability of each component of the automatic test battery. Data were collected on 120 ears from normal-hearing and conductive, sensorineural, and mixed hearing-loss subgroups. Results: Performance differences between different types of hearing loss were observed. Ears with a conductive component (conductive and mixed ears) tended to have normal signal to noise ratios (SNR) despite impaired thresholds in quiet, while ears without a conductive component (normal and sensorineural ears) demonstrated, on average, an increasing relationship between their thresholds in quiet and their achieved SNR. Using the relationship between these two measures among ears with no conductive component as a benchmark, the likelihood that an ear has a conductive component can be estimated based on the deviation from this benchmark. The sensitivity and specificity of the test battery vary depending on the size of this deviation, but increase with increasing ABG size, with decreasing test frequency, and when results from multiple test frequencies are taken into account. The individual automatic tests comprising the battery were found to be reliable and valid, with strong, significant correlations between the test and retest results (r = 0.81 to 0.99; p < 0.0001) and between automatic and manual audiometry procedures (r = 0.98 to 0.99; p < 0.0001). Conclusions: The presence of an ABG can be predicted with a reasonably high degree of accuracy using AC tests alone. Applications of such a test battery include any clinical context in which bone conduction audiometry or specialized diagnostic equipment is unavailable or impractical. Examples of these include self-fitting hearing aids, whose efficacy relies on the ability of the device to automatically administer an in situ hearing test; self-administered adult hearing screenings in both clinical and home environments; large-scale industrial hearing conservation programs; and test environments in which ambient noise levels exceed the maximum permissible levels for unoccluded ears.