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Background: Persons with aphasia (PWA) have shown difficulties in integrating linguistic materials over time and distance in sentence processing. However, few studies have investigated sentence-processing difficulties among PWA as reflected in online processing measures. Furthermore, relatively few studies have examined the online processing of syntactically simple but computationally demanding sentences among PWA. Such sentences are important from the perspective of resource-related theories of aphasic language deficits, which predict that such sentences should be challenging for PWA even if the syntactic structures involved are not. Aims: The purpose of the study was to investigate the sentence-level online reading times of normal adult individuals (NAI) and PWA by word category and as a function of adjective padding. It was assumed that head nouns entail greater processing costs than determiners because they represent the point at which integration of material within a noun phrase must take place. It was also assumed that increasing adjectival padding within a noun phrase requires more integration and creates greater processing costs. Methods & Procedures: A total of 30 NAI and 30 PWA participated in the current study. Sentence stimuli were obtained from the Computerised Revised Token Test (CRTT) (McNeil et al., 2008). Sentences were presented using a non-cumulative (Word Fade = WF) self-paced word-by-word reading method (CRTT-R-WF). Reading times for the determiners and the correct nouns were analysed. Outcomes & Results: Both groups showed significantly longer reading times for the nouns than for determiners and in two-adjective than in one-adjective conditions. Furthermore, the reading times for the two-adjective condition were significantly longer than the one-adjective condition for nouns but not determiners across the groups. The PWA exhibited significantly longer overall reading times, as well as significantly longer reading times on the nouns than the NAI. Conclusions: Increased linguistic integration costs-imposed by greater amounts of material to be integrated, and appearing at the point where integration must take place-differentiated reading-time performance between the NAI and PWA participant groups. The PWA showed differentially longer online processing times for elements that imposed high integration costs. This difference appeared most dramatically when two adjectives intervened between the determiner and the head noun. The current results are consistent with resource-related hypotheses regarding aphasic language deficits, which suggest that PWA with limited control of processing resources should show differentially greater impairments in sentence processing as compared to NAI. [ABSTRACT FROM AUTHOR]

Background: Working memory (WM) has gained recent attention as a cognitive construct that may account for language comprehension deficits in persons with aphasia (PWA) (Caspari, Parkinson, LaPointe, & Katz, 1998; Martin, Kohen, & Kalinyak- Fliszar, 2008; Wright, Downey, Gravier, Love, & Shapiro, 2007). However, few studies have investigated individual differences in performance on sentence comprehension tasks as a function of WM capacity in PWA when WM demands are manipulated. Aims: The purposes of the current study were: (1) to examine the relationships among verbal WM, sentence comprehension, and severity of impairment in PWA and (2) to investigate the differential performance of high versus low verbal WM groups on sentence comprehension tasks in which task demands were manipulated by the length of the sentence stimuli, complexity of syntactic structure, and by presentation method which varied the time over which the linguistic material was available for computation. Methods & Procedures: A total of 20 PWA were divided into high and low WM groups based on a listening version of a WM sentence span task. Each participant completed a listening version (CRTT) and three reading versions (CRTT-R) of the Computerised Revised Token Test as the sentence comprehension tasks. Outcomes & Results: The WM task significantly predicted performance on the CRTT conditions in which information was only temporarily available, thereby imposing greater WM demands on sentence comprehension. The verbal WM task was significantly correlated with aphasia severity and a principal components analysis revealed that the WM task, overall aphasia severity, and overall reading impairment level loaded on a single factor with 76% of shared variance. The low WM group's performance was significantly lower than the high WM group on the CRTT subtests with syntactically more complex structures and on the CRTT conditions with temporally restricted presentation methods. Conclusions: This verbal WM task was significantly and moderately correlated with the overall severity of aphasia as well as with both listening and reading sentence comprehension. The WM group differences emerged only in sentence comprehension tasks with greater WM demands. These results are consistent with the notion that WM effects are most evident when WM capacity is sufficiently taxed by the task demands (e.g., Caplan & Waters, 1999; Just & Carpenter, 1992). [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the Computerized Revised Token Test (CRTT) performance of individuals with normal hearing under several intensity conditions and under several spectral and temporal perturbation conditions. METHOD: Sixty normal-hearing listeners were randomly assigned to 1 of 3 groups. Group 1 provided performance-intensity information about CRTT performance using uncompressed acoustic stimuli. Groups 2 and 3 completed the CRTT using temporally and spectrally compressed and expanded stimuli. CRTT performance functions were plotted for each group. RESULTS: Group 1 required minimal audibility to perform maximally on this task. As expected, Groups 2 and 3 showed significant differences across subtests, regardless of distortion condition. Mean differences in performance between successive conditions for Group 2 increased beyond 40% time compressed. There was 1 significant difference for the time-expanded condition. There were no differences across frequency compressed and expanded conditions. CONCLUSION: Young listeners require limited signal gain on the CRTT to achieve maximum performance. Time and frequency compression and expansion results were consistent with previous findings with varying types of speech stimuli. The results have implications for administration and interpretation of the CRTT administered to persons from other populations and will help in the development of a normative database for the CRTT. [ABSTRACT FROM AUTHOR]

Purpose: Hearing loss simulation (HLS) has been recommended for clinical teaching and counseling of patients and their families, so that they can experience hearing impairment. However, few validated procedures for simulating hearing loss are available to instructors and practicing clinicians. The aim of this study was to assess the accuracy of the Immersive Hearing Loss and Prosthesis Simulator (I-HeLPS) on reducing hearing sensitivity and word recognition to determine its adequacy for educational and clinical use., Method: Thirty-seven young adults with normal hearing completed hearing threshold and word recognition testing under normal and simulated hearing losses. The accuracy of the nominal hearing threshold settings within the I-HeLPS software was assessed with behavioral detection of frequency-modulated pure tones presented in a calibrated sound field, while listeners wore I-HeLPS headphones. The impact of the HLSs on speech perception was measured using the California Consonant Test. Hearing thresholds, word identification accuracy, and sound confusions were compared across listening conditions., Results: Hearing thresholds increased systematically with worse simulated hearing loss. Performance on the California Consonant Test worsened, and the number of phoneme confusions increased with simulated hearing loss severity. Most of the confusions were place confusions with near neighbors and manner confusions increased as a function of increasing severity of simulated hearing loss., Conclusions: The I-HeLPS accurately elevated hearing thresholds with increasing HLS severity and impacted word recognition in a manner consistent with sensorineural hearing loss. The simulations were considered reasonable for educational and clinical purposes., Supplemental Material: https://doi.org/10.23641/asha.24520966.

Perceptual learning reflects experience-driven improvements in the ability to detect changes in stimulus characteristics. The time course for perceptual learning overlaps with that for procedural learning (acquiring general skills and strategies) and task learning (learning the perceptual judgment specific to the task), making it difficult to isolate their individual effects. This study was conducted to examine the role of exposure to stimulus, procedure, and task information on learning for auditory temporal-interval discrimination. Eighty-three listeners completed five online sessions that required temporal-interval discrimination (target task). Before the initial session, listeners were differentially exposed to information about the target task's stimulus, procedure, or task characteristics. Learning occurred across sessions, but an exposure effect was not observed. Given the significant learning across sessions and variability within and across listeners, contributions from stimulus, procedure, and task exposure to overall learning cannot be discounted. These findings clarify the influence of experience on temporal perceptual learning and could inform designs of training paradigms that optimize perceptual improvements.

Introduction: Depression may influence treatment participation and outcomes of people with post-stroke aphasia, yet its prevalence and associated characteristics in aphasia are poorly understood. Using retrospective data from an overarching experimental study, we examined depressive symptoms and their relationship to demographic and language characteristics in people with chronic aphasia. As a secondary objective, we compared prevalence of depressive symptoms among the overarching study's included and excluded participants., Methods: We examined retrospective data from 121 individuals with chronic aphasia including depression scale scores, demographic information (sex, age, time post onset of stroke, education, race/ethnicity, and Veteran status), and scores on assessments of general and modality-specific language impairments., Results: Approximately 50% of participants reported symptoms indicative of depressive disorders: 23% indicative of major depression and 27% indicative of mild depression. Sex (males) and comparatively younger age emerged as statistically significant variables associated with depressive symptoms; naming ability was minimally associated with depressive symptoms. Time post onset of stroke, education level, race/ethnicity, Veteran status, and aphasia severity were not significantly associated with depressive symptoms. Depression-scale scores were significantly higher for individuals excluded from the overarching study compared to those who were included., Conclusions: The rate of depressive disorders in this sample was higher than rates of depression reported in the general stroke literature. Participant sex, age, and naming ability emerged as factors associated with depressive symptoms, though these links appear complex, especially given variable reports from prior research. Importantly, depressive symptoms do not appear to diminish over time for individuals with chronic aphasia. Given these results and the relatively limited documentation of depression in aphasia literature, depression remains a pressing concern for aphasia research and routine clinical care., (Copyright © 2022. Published by Elsevier Inc.)

Objective: Hearing loss (HL) is highly prevalent among older adults and may lead to increased risk of depressive symptoms. In both cross-sectional and longitudinal analysis, we quantified the association between HL and depressive symptoms, incorporating the variable nature of depressive symptoms and characterizing by race and gender., Methods: Data were from the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Study Depression Scale short form (CES-D 10), defined as CES-D 10 score ≥10 or treatment for depression. Hearing was defined via four-frequency pure-tone average (PTA) decibel hearing level (dB HL), categorized as normal hearing (PTA ≤25 dB HL), mild HL (PTA26-40 dB HL), and ≥moderate HL (PTA > 40 dB HL). Associations at baseline were quantified using logistic regression, incident depressive symptoms using Cox proportional hazard models, and change in depressive symptoms over time using growth mixture models and multinomial logistic regression., Results: Among 2,089 older adults (1,082 women, 793 Black; mean age 74.0 SD: 2.8), moderate or greater HL was associated with greater odds of concurrent [Odds Ratio (OR):2.45, 95% CI:1.33, 4.51] and incident depressive symptoms [Hazard Ratio (HR):1.26, 95% CI:1.00, 1.58]. Three depressive symptom trajectory patterns were identified from growth mixture models: low, moderate increasing, and borderline high depressive symptom levels. Those with moderate or greater HL were more likely to be in the borderline high depressive-symptom trajectory class than the low trajectory class [Relative Risk Ratio (RRR):1.16, 95% CI:1.01, 1.32]., Conclusions: HL was associated with greater depressive symptoms. Although findings were not statistically significantly different by gender and race, estimates were generally stronger for women and Black participants. Investigation of psychosocial factors and amelioration by hearing aid use could have significant benefit for older adults' quality of life., Competing Interests: JB reports entitlement to future royalties and equity in miDiagnostics. FL reports being a consultant to Frequency Therapeutics, speaker honoraria from Caption Call, and being the director of a public health research center funded in part by a philanthropic gift from Cochlear Ltd to the Johns Hopkins Bloomberg School of Public Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Powell, Betz, Yaffe, Kritchevsky, Strotmeyer, Simonsick, Rubin, Houston, Pratt, Purchase Helzner, Brewster, Lin, Gross and Deal.)

Here, we work to provide nuance around the assumption that people will work for rewards. We examine whether individuals' inherent tendency to mobilize cognitive effort (need for cognition, NFC) moderates this effect. We re-analyzed our existing data to verify an effect reported by Sandra and Otto (2018) regarding the association between NFC and reward-induced cognitive effort expenditure, using a more ecological cognitive task design and adding a psychophysiological measure of effort. Specifically, distinct from their short time course visual task-switching paradigm, we used a relatively long course auditory comprehension task paradigm. We found that, consistent with the original study, increased cognitive effort in response to incentive reward depends on individual differences in cognitive motivation (need for cognition). We also found that, to observe consistent phenomena, different indices of effort (behavioral and psychophysiological) need to be considered when evaluating the relationship between the effort expenditure and cognitive motivation. Pupil dilation showed an advantage over reaction time in revealing mental effort mobilized over a prolonged cognitive task. Our results suggest that assessing cognitive motivation when planning a behavior-change program involving reward feedback for positive performance could help to optimize individuals' effort investment., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose During videofluoroscopic examination of swallowing, patients commonly are instructed to hold a bolus in their mouth until they hear a verbal instruction to swallow, which usually consists of the word swallow and is commonly referred to as the command swallow condition. The language-induced motor facilitation theory suggests that linguistic processes associated with the verbal command to swallow should facilitate the voluntary component of swallowing. As such, the purpose of the study was to examine the linguistic influences of the verbal command on swallowing. Method Twenty healthy young adult participants held a 5-ml liquid bolus in their mouth and swallowed the bolus after hearing one of five acoustic stimuli presented randomly: congruent action word ( swallow ), incongruent action word ( cough ), congruent pseudoword ( spallow ), incongruent pseudoword ( pough ), and nonverbal stimulus (1000-Hz pure tone). Suprahyoid muscle activity during swallowing was measured via surface electromyography (sEMG). Results The onset and peak sEMG latencies following the congruent action word swallow were shorter than latencies following the pure tone and pseudowords but were not different from the incongruent action word. The lack of difference between swallow and cough did not negate the positive impact of real words on timing. In contrast to expectations, sEMG activity duration and rise time were longer following the word swallow than the pure tone and pseudowords but were not different from cough . No differences were observed for peak suprahyoid muscle activity amplitude and fall times. Conclusions Language facilitation was observed in swallowing. The clinical utility of the information obtained in the study may depend on the purposes for using the command swallow and the type of patient being assessed. However, linguistic processing under the command swallow condition may alter swallow behaviors and suggests that linguistic inducement could be useful as a compensatory technique for patients with difficulty initiating oropharyngeal swallows.

Previous research has shown that genes play a substantial role in determining a person's susceptibility to age-related hearing impairment. The existing studies on this subject have different results, which may be caused by difficulties in determining the phenotype or the limited number of participants involved. Here, we have gathered the largest sample to date (discovery n = 9,675; replication n = 10,963; validation n = 356,141), and examined phenotypes that represented low/mid and high frequency hearing loss on the pure tone audiogram. We identified 7 loci that were either replicated and/or validated, of which 5 loci are novel in hearing. Especially the ILDR1 gene is a high profile candidate, as it contains our top SNP, is a known hearing loss gene, has been linked to age-related hearing impairment before, and in addition is preferentially expressed within hair cells of the inner ear. By verifying all previously published SNPs, we can present a paper that combines all new and existing findings to date, giving a complete overview of the genetic architecture of age-related hearing impairment. This is of importance as age-related hearing impairment is highly prevalent in our ageing society and represents a large socio-economic burden.

Objectives: Listeners who fail to optimize their allocation of effort during auditory comprehension tasks can experience from compromised performance, fatigue and stress, which might result in reduced engagement in social communication activities. Strategically allocating effort based on costs and perceived benefits are commonly observed in the research of effortful physical and visual behaviors. Whether people manage their effort in a similar manner in audition remains unclear. As the listening performance of people with normal hearing often serves as the goal of auditory rehabilitation for people with hearing loss, this study evaluated how strategy-induced effort allocation, challenged by reward and task demand, interactively impacted auditory comprehension in normal hearing adults., Design: A value-based strategic effort allocation paradigm was evaluated in 40 normal-hearing young adults. The paradigm included five levels of reward (motivation) and five levels of task demand (speech rate) that were independently manipulated. Effects of reward and task demand on performance accuracy and pupil dilation (a measure of auditory comprehension effort) were examined., Results: There was a significant interaction effect of reward and task demand on both pupil dilation and comprehension accuracy. At the response stage of speech comprehension processing, pupil dilation significantly decreased as the task demand increased at high reward levels. In contrast, pupil dilation did not vary significantly as a function of task demand at low reward levels. Reward significantly improved performance accuracy at fast and extremely fast rate conditions, but not at the slower rates., Conclusions: Consistent with previous studies on effort regulation, reward and task demand appear to be associated with auditory comprehension effort allocation in an interactive manner when strategic effort control was required to achieve a reward goal. The young normal-hearing listeners in this study prioritized their effort to relatively easy task items over difficult ones at high levels of reward, suggesting a cost-effective value-based strategic effort allocation. Reward significantly improved task performance in terms of accuracy at difficult listening conditions. These findings support the incorporation of affective factors (e.g., reward) and the utility of the value-based strategic effort allocation paradigm in the experimental setting to understand how clinically relevant factors (such as hearing loss and age) might change strategic auditory comprehension behavior., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

The impact of profound hearing loss on infants and adults is variable and greatly influenced by improved audition derived from hearing aids and cochlear implants. However, barriers to healthcare, hearing healthcare in particular, can offset the benefits provided by these sensory devices. Common barriers include cost, location, availability of trained professionals, acceptance of the hearing loss, language and cultural differences, secondary disabilities, and mental health issues. These barriers and their distinct presentations vary somewhat by age, language, and where people live (urban vs. rural), and can interfere with receiving testing and devices in a timely manner. They also can limit auditory, speech and language therapies, and interfere with acceptance of the hearing loss and devices. Rehabilitation should focus on eliminating or reducing the adverse impact of these barriers on patients and their families. Some of which can be done through professional training and multidisciplinary activities, counseling, and community outreach.

Purpose: The purpose of this study was to evaluate the ability of persons with aphasia, with and without hearing loss, to complete a commonly used open-set word recognition test that requires a verbal response. Furthermore, phonotactic probabilities and neighborhood densities of word recognition errors were assessed to explore potential underlying linguistic complexities that might differentially influence performance among groups., Method: Four groups of adult participants were tested: participants with no brain injury with normal hearing, participants with no brain injury with hearing loss, participants with brain injury with aphasia and normal hearing, and participants with brain injury with aphasia and hearing loss. The Northwestern University Auditory Test No. 6 (NU-6; Tillman & Carhart, 1966) was administered. Those participants who were unable to respond orally (repeating words as heard) were assessed with the Picture Identification Task (Wilson & Antablin, 1980), permitting a picture-pointing response instead. Error patterns from the NU-6 were assessed to determine whether phonotactic probability influenced performance., Results: All participants with no brain injury and 72.7% of the participants with aphasia (24 out of 33) completed the NU-6. Furthermore, all participants who were unable to complete the NU-6 were able to complete the Picture Identification Task. There were significant group differences on NU-6 performance. The 2 groups with normal hearing had significantly higher scores than the 2 groups with hearing loss, but the 2 groups with normal hearing and the 2 groups with hearing loss did not differ from one another, implying that their performance was largely determined by hearing loss rather than by brain injury or aphasia. The neighborhood density, but not phonotactic probabilities, of the participants' errors differed across groups with and without aphasia., Conclusions: Because the vast majority of the participants with aphasia examined could be tested readily using an instrument such as the NU-6, clinicians should not be reticent to use this test if patients are able to repeat single words, but routine use of alternative tests is encouraged for populations of people with brain injuries.

Background: Whether apolipoprotein E (APOE) E4 allele status which is associated with an increased risk of cognitive decline is also associated with hearing impairment is unknown., Methods: We studied 1833 men and women enrolled in the Health, Aging and Body Composition study. Regression models adjusted for demographic and cardiovascular risk factors were used to assess the cross-sectional association of APOE-E4 status with individual pure tone hearing thresholds and the 4-frequency pure tone average (0.5-4 kHz) in the better hearing ear., Results: Compared to participants with no APOE-E4 alleles, participants with 1 allele had better thresholds at 4.0 kHz (β = -2.72 dB, P = .013) and 8.0 kHz (β = -3.05 kHz, P = .006), and participants with 2 alleles had better hearing thresholds at 1.0 kHz (β = -8.56 dB, P = .021)., Conclusion: Our results suggest that APOE-E4 allele status may be marginally associated with better hearing thresholds in older adults., (© The Author(s) 2014.)

Background: Although many speech errors can be generated at either a linguistic or motoric level of production, phonetically well-formed sound-level serial-order errors are generally assumed to result from disruption of phonologic encoding (PE) processes. An influential model of PE (Dell, 1986; Dell, Burger & Svec, 1997) predicts that speaking rate should affect the relative proportion of these serial-order sound errors (anticipations, perseverations, exchanges). These predictions have been extended to, and have special relevance for persons with aphasia (PWA) because of the increased frequency with which speech errors occur and because their localization within the functional linguistic architecture may help in diagnosis and treatment. Supporting evidence regarding the effect of speaking rate on phonological encoding has been provided by studies using young normal language (NL) speakers and computer simulations. Limited data exist for older NL users and no group data exist for PWA., Aims: This study tested the phonologic encoding properties of Dell's model of speech production (Dell, 1986; Dell,et al., 1997), which predicts that increasing speaking rate affects the relative proportion of serial-order sound errors (i.e., anticipations, perseverations, and exchanges)., Methods & Procedures: The effects of speech rate on the error ratios of anticipation/exchange (AE), anticipation/perseveration (AP) and vocal reaction time (VRT) were examined in 16 normal healthy controls (NHC) and 16 PWA without concomitant motor speech disorders. The participants were recorded performing a phonologically challenging (tongue twister) speech production task at their typical and two faster speaking rates., Outcomes & Results: A significant effect of increased rate was obtained for the AP but not the AE ratio. Significant effects of group and rate were obtained for VRT., Conclusion: Although the significant effect of rate for the AP ratio provided evidence that changes in speaking rate did affect PE, the results failed to support the model derived predictions regarding the direction of change for error type proportions. The current findings argued for an alternative concept of the role of activation and decay in influencing types of serial-order sound errors. Rather than a slow activation decay rate (Dell, 1986), the results of the current study were more compatible with an alternative explanation of rapid activation decay or slow build-up of residual activation.

Purpose: This study assessed the reliability and validity of intermodality associations and differences in persons with aphasia (PWA) and healthy controls (HC) on a computerized listening and 3 reading versions of the Revised Token Test (RTT; McNeil & Prescott, 1978)., Method: Thirty PWA and 30 HC completed the test versions, including a complete replication. Reading versions varied according to stimulus presentation method: (a) full-sentence presentation, (b) self-paced word-by-word full-sentence construction, and (c) self-paced word-by-word presentation with each word removed with the onset of the next word. Participants also received tests of aphasia and reading severity., Results: The listening version produced higher overall mean scores than each of the reading versions. Differences were small and within 1 standard error of measurement of each version. Overall score test-retest reliability among versions for PWA ranged from r=.89 to r=.97. Correlations between the listening and reading versions ranged from r=.79 to r=.85. All versions correlated highly with aphasia and reading severity. Correlations were generally low for the HC due to restricted variability. Factor analysis yielded a 2-factor solution for PWA and a single-factor for HC., Conclusions: Intermodality differences were small, and all 4 versions were reliable, concurrently valid, and sensitive to similar linguistic processing difficulties in PWA.

Effects of frequency-shifted feedback are typically examined using Eventide Harmonizer Series processors to shift the fundamental frequency (F0) of auditory feedback during vocalizations, eliciting compensatory shifts in speaker F0. Recently, unexpected intensity changes were observed in speakers' ear canals, corresponding with F0 shifts. An investigation revealed that feedback time delays introduced by the processor resulted in phase shifts between feedback and unprocessed voice signals radiating into the ear canal via bone conduction, producing combination waves with gains as high as 6 dB. Shifts of this magnitude potentially alter the interpretation of previously published results and should be controlled in future studies.

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

Purpose: This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students., Method: A total of 555 children (6-12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools., Results: The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice., Conclusions: The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Purpose: The goal of this study was to determine the impact of age, gender, and race on the prevalence and severity of hearing loss in elder adults, aged 72-96 years, after accounting for income, education, smoking, and clinical and subclinical cardiovascular disease. Methods Air-conduction thresholds for standard and extended high-frequency pure-tones were obtained from a cohort of 548 (out of 717) elderly adults (ages 72-96 years) who were recruited during the Year 11 clinical visit (1999-2000) of the Cardiovascular Health Study (CHS) at the Pittsburgh, Pennsylvania site. Participant smoking, income, education, and cardiovascular disease histories were obtained from the CHS database and were included as factors., Results: Hearing loss was more common and more severe for the participants in their 80s than for those in their 70s-the men more than the women and the White participants more than the Black participants. The inclusion of education, income, smoking, and cardiovascular disease (clinical and subclinical) histories as factors did not substantively impact the overall results., Conclusion: Although the data reported in this article were cross-sectional and a cohort phenomenon might have been operational, they suggested that hearing loss is more substantive in the 8th than the 7th decade of life and that race and gender influence this decline in audition. Given the high prevalence in the aging population and the differences across groups, there is a clear need to understand the nature and causes of hearing loss across various groups in order to improve prevention and develop appropriate interventions.

Study Design: Reliability analysis based on expert panel case series review and grading per the Enneking and Weinstein-Boriani-Biagini classification systems., Objective: To assess the reliability of the Enneking and Weinstein-Boriani-Biagini classification systems., Summary of Background Data: The Enneking and Weinstein-Boriani-Biagini (WBB) classifications were developed to stage and facilitate treatment planning in patients with primary spine tumors. To date, their interobserver and intraobserver reliability has not been assessed-a fundamental step in facilitating broader clinical and research use., Methods: Clinical information, imaging studies, and biopsy results were compiled from 15 selected patients with primary spinal tumors. Eighteen spine surgeons independently estimated and scored the cases for Enneking grade, tumor and metastasis categories, Enneking stage, Enneking-recommended surgical margin, WBB zones and layers, and WBB-recommended surgical procedures, with a second assessment performed after random resorting of cases. Interobserver and intraobserver reliability of each category were assessed by percent agreement or proportional overlap. The Fleiss, Cohen, and Mezzich kappa statistics (kappa) were then applied, determined by the type of variable analyzed., Results: The kappa statistics for interobserver reliability were 0.82, 0.22, 0.00, 0.57, 0.47, 0.31, 0.58, and 0.54 for the fields of Enneking grade, tumor and metastasis categories, Enneking stage, Enneking-recommended surgical margin, WBB zones and layers, and WBB-recommended surgical procedures, respectively. The kappa statistics for intraobserver reliability were 0.97, 0.53, 0.47, 0.82, 0.67, 0.63, 0.79, and 0.79 for the same respective fields. According to Landis and Koch, the ranges of kappa values of 0.00 to 0.20, 0.21 to 0.40, 0.41 to 0.60, 0.61 to 0.80, and >0.80 imply slight, fair, moderate, substantial, and near-perfect agreement, respectively., Conclusion: Results indicate moderate interobserver reliability and substantial and near-perfect intraobserver reliability for both the Enneking and WBB classification in terms of staging and guidance for treatment, despite a less than moderate interobserver reliability in interpreting the Enneking local tumor extension and WBB sector. Before incorporating the classifications in the clinical practice and research studies, further work is required to investigate the validity of the classifications.

Purpose: Past research has established parameters for the 2f1-f2 distortion product otoacoustic emissions (DPOAEs) that enhance response levels (e.g., L1 - L2 = 10 dB; f2/f1 = 1.22; L1, L2 = 65, 55 dB SPL). These same parameters do not optimize 2f2-f1 DPOAEs. Therefore, this study was conducted to evaluate more completely those parameters that produce the most robust 2f2-f1 output., Method: Input-output functions of the 2f2-f1 component were obtained from 20 normal-hearing adults (with f2 = 2000 Hz and 4000 Hz). Frequency ratios, level differences, and overall sound levels were manipulated with parameter combinations chosen to expand on information established in previous studies. The DPOAE signal-to-noise ratio (SNR), response presence, and output levels were measured., Results: In general, mean SNRs and 2f2-f1 levels were greater, and DPOAEs were present more often for 2000 than for 4000 Hz across all parameter combinations. No single parameter combination resulted in pronounced maxima for 2f2-f1, which is consistent with past studies but is in sharp contrast to results for the more familiar 2f1-f2., Conclusions: Overall, the results suggest that to maximize the 2f2-f1 level, lower test frequencies, low frequency ratio, essentially equal levels of primary tones, and moderate stimulus levels are best, and such parameters might be important for applying DPOAE measurement to assessment of normal and impaired auditory function.

Bone mineral density (BMD) may be associated with hearing loss in older adults. Demineralization of the cochlear capsule has been associated with hearing loss in those with Paget's disease of the bone and otosclerosis. Osteoporosis may also result in cochlear capsule demineralization. We hypothesized that lower hip BMD and lower heel ultrasound measurements would be associated with hearing loss in a population-based sample of 2,089 older black and white men and women. Bone parameters and hearing function were measured at the fourth clinical follow-up visit. Audiometric threshold testing was used to measure air- and bone-conduction hearing sensitivity. BMD of the hip and its subregions was measured using dual-energy X-ray absorptiometry. Calcaneal bone measurements [broadband ultrasound attenuation (BUA), speed of sound (SOS) and the quantitative ultrasound index (QUI)] were obtained using heel ultrasound. After adjusting for known hearing loss risk factors, no association was found between hearing and any of the bone measurements in whites and black women. In black men, however, lower hip BMD was associated with higher odds of hearing loss; for each standard deviation decrease in total hip BMD, the odds of hearing loss were 1.41 (95% confidence interval 1.08, 1.83), 1.39 (95% CI 1.07, 1.82) for femoral neck BMD and 1.65 (95% CI 1.26, 2.16) for trochanter BMD. Conductive hearing loss was associated with lower heel ultrasound measurements, though only among white men. The results of this study are mixed and inconclusive. Lower BMD of the hip and its subregions was associated with hearing loss among black men, but not among whites or black women. Lower measurements on heel ultrasound were associated with conductive hearing loss, though only among white men. These results suggest that axial and appendicular bone parameters may be modestly associated with hearing loss in older men, but not in women.

Objectives: To determine the prevalence of and risk factors for hearing loss in a sample of 2,052 older adults (aged 73-84; 46.9% male, 37.3% black) enrolled in the Health, Aging and Body Composition (Health ABC) Study., Design: Cross-sectional analysis of a longitudinal cohort study., Setting: Pittsburgh, Pennsylvania, and Memphis, Tennessee, areas., Participants: Random sample of Medicare beneficiary subjects enrolled in the Health ABC program from 1997 to 1998. They included 2,052 individuals: 660 white men (32.2%), 631 white women (30.8%), 310 black men (15.1%), and 451 black women (22.0%). Participants ranged in age from 73 to 84, with a mean age of 77.5., Measurements: Hearing sensitivity was measured using pure-tone threshold testing. Hearing loss was defined based on two averages of hearing thresholds: 500, 1,000, and 2,000 Hz greater than 25-decibel (dB) hearing level (HL) (hearing loss); and 2,000, 4,000, and 8,000 Hz greater than 40-dB HL (high-frequency hearing loss). Potential hearing loss correlates, including demographics, medical history, ototoxic medication use, occupational noise exposure, and lifestyle factors, were collected via questionnaire., Results: The prevalence of hearing loss was 59.9%; the prevalence of high-frequency hearing loss was 76.9%. Hearing loss was most common in white men, followed by white women, black men, and black women. Older age, white race, diabetes mellitus, cerebrovascular disease, smoking, poorer cognitive status, occupational noise exposure, and ear surgery were associated with hearing loss after multivariable adjustment. Race- and sex-specific risk factors included higher blood pressure and occupational noise exposure (white men), poorer cognitive status and smoking (black women), and low total hip bone mineral density (black men). Possible protective factors included salicylate use (overall sample, black men) and moderate alcohol intake (black women)., Conclusion: Hearing loss was extremely common in this population. Because many of the identified hearing loss risk factors are modifiable, some of the burden associated with hearing loss in older people should be preventable.

Objective: The purpose of this research was to compare the signal-to-noise ratio required for equal performance for children (aged 6-14 years) with normal hearing (N=17) versus those with severe-to-profound unilateral hearing impairment (N=20) who can be at a disadvantage, particularly when sounds are presented to the impaired ear. The listening environment is designed to approximate that which is encountered in a typical classroom., Methods: All signals (Hearing in Noise Test-Children and Nonsense Syllable Test) were presented in the sound field from various azimuths with continuous noise presented from all quadrants. The children were required to repeat twenty items, from each test, in each listening condition. The intensity of the presentations was varied based on the accuracy of previous items. Average signal-to-noise ratios are compared between and within groups., Results: (1) In most listening conditions, significantly greater signal-to-noise ratios were needed by those with unilateral hearing impairment than those with normal hearing, on both speech tests. (2) In every listening condition, both groups required significantly greater signal-to-noise ratios to perform equally well on the Nonsense Syllable Test as on the Hearing-In-Noise Test-Children. (3) For the Hearing-In-Noise Test-Children, children with normal hearing required significantly greater signal-to-noise ratios when facing the signal than when the signal was presented to a normally hearing ear (monaural direct). (4) On both tests, the children with unilateral hearing impairment required significantly greater signal-to-noise ratios when facing the signal than in the monaural direct condition. (5) On both tests, the children with unilateral hearing impairment required significantly greater signal-to-noise ratios when the signal was presented to the impaired ear (monaural indirect) than when facing the signal., Conclusions: (1) The children with unilateral hearing impairment require a more advantageous listening condition to perform equally as well as their normally hearing counterparts. (2) All of the children benefited from signals delivered in a monaural direct condition. (3) The children with unilateral hearing impairment performed best in the monaural direct condition or when facing the signal at zero degrees. (4) Significantly greater signal-to-noise ratios were needed for both groups when restricted contextual cues were available versus when sentential cues were available.

The efficacy of the IBM SpeechViewer's Vowel Accuracy Module for the treatment of vowel productions was evaluated in six preschool children with hearing-impairment over a 4-month period. A single-subject design was used, and the vowels /a/, /i/ and /u/ were treated. Untreated sounds also were probed to monitor for carryover and developmental effects. One of the children was dismissed from the study because of noncompliance. Of the remaining five children, four exhibited a treatment effect for /u/, two for /a/, and one for /i/. Four of the children demonstrated some generalization. Developmental effects, as represented by change in /s/-cluster production, were not documented. Although treatment effects were observed, difficulties with the Vowel Accuracy Module were also observed. These included inaccuracies in the feedback on low-intensity, hypernasal, and high-pitched utterances; inability to sustain the attention of preschoolers over multiple sessions; lack of instructional feedback; and nonlinearity in the criterion-adjustment control.

Deterioration followed by recovery of behavioural absolute threshold and frequency selectivity has been observed in guinea pigs following kanamycin administration of 200 mg/kg body weight daily for 16 days. Deterioration in function consistently follows a high-to-low frequency pattern and recovery generally occurs at the lowest of the high (8-32 kHz) frequencies affected. The degree of recovery is related to the magnitude of the threshold elevation; where large (40-45 dB) elevations occur initially, the process appears to be partial since threshold recovers only to within 5-12 dB of pre-administration levels. In instances where smaller threshold elevations (5-20 dB) take place initially, recovery can sometimes be complete. However, when threshold elevations of over 50 dB occur, no recovery is apparent. Recovery is relatively slow, taking place over periods of up to 100 days post-kanamycin administration. Hair cell counts have established that the threshold elevation which remains in instances of partial recovery is not related to a reduction in hair cell numbers at the light microscope level.

The following preliminary study assessed the nonverbal play interactions of two hearing mothers and their profoundly hearing-impaired infants using a nonverbal coding scheme adapted from descriptors used by Fein (1979) and Bruner (1975a,b). The goal also was to describe the nonverbal components of their interactions during play relative to normally hearing mother-child dyads. More specifically, the goal was to determine if the behavioral patterns exhibited by the hearing mothers and their hearing-impaired children were consistent with patterns that have been reported for verbal components of play interactions. The nature of the behavioral patterns were in agreement with much of the previous literature on verbal and social interactions between hearing mothers and hearing-impaired children, but some notable differences were observed.

Four rhesus monkeys were tested for preferences within the wavelength and line-tilt dimensions. In the case of wavelength, the response panel was back-illuminated by light of one of the following wavelengths, presented in a random manner: 470, 525, 580, and 635 nm. Similarly, the line-tilt dimension was studied, by presenting a 5 cm by 0.3 cm black bar tilted at 0, 30, 60, or 90 degrees. No preferences were found within this latter dimension; in contrast, marked wavelength preferences existed, the order of preference being 470 (most preferred), 525, 580, and 635 nm (least preferred). These response preferences were resistant to behavioral manipulation; the number of responses to blue and to red in extinction was about equal when red was used as the training stimulus, but vastly different following training on blue. These results indicate that such response preferences must be taken into account in the design of a wide variety of experiments.

Superior vena cava syndrome is uncommon in infants. With the increased use of central venous catheters, however, there has been an increased incidence of central venous occlusion. We report a case of superior vena cava syndrome occurring on two separate occasions in a premature infant with an indwelling central line. We discuss current concepts of prevention and management.

Otitis media has long been recognized as one of the most common diseases of childhood. Several therapeutic modalities have been advocated for the prevention of recurrent episodes of acute otitis media (AOM). A blinded, prospective, randomized study was designed to determine the efficacy of tympanostomy tubes, antibiotic prophylaxis, and placebo. Children with recurrent AOM were entered in the study and followed for at least 6 months. A total of 65 children completed the protocol. Sixty-three of those were under the age of 4 years. Treatment failure was defined as two or more episodes of AOM or otorrhea in less than 3 months. Five of 22 children in the tympanostomy tube group failed, compared to 12 of 20 in the placebo group (p = .02). There were 8 or 21 treatment failures in the sulfisoxazole group. Children with otitis media with effusion (OME) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes. Tympanostomy tube insertion for prophylaxis of recurrent acute otitis is supported by these findings. Improvement of recurrent AOM was observed in the sulfisoxazole group, but was not statistically significant.

With the advent of Title IX, the proportion of female participants in interscholastic sport has risen sharply while the proportion of female coaches has dropped precipitously. This paper seeks to determine whether there are any differences in coaching philosophy by gender. Questionnaires were sent to the coaches of 600 high school girls' basketball teams selected randomly from the 48 contiguous states. There were 250 usable ones returned for a response rate of 42%. The questionnaires included items designed to assess the attitudes and behaviors of coaches in five areas of coaching philosophy: (1) the coach's role in the overall development of athletes; (2) conditions believed essential to maximize team performance; (3) team rules used; (4) use of sports aphorisms; and (5) expectations of athletes. Summing the findings, we found that in 83 of the 100 comparisons there were no statistical differences in the means of the male and female coaches. In the 17 instances where there were statistically significant differences, 14 times the female coaches were on the more traditional side. Several possible explanations for this interesting finding are discussed.

Frusemide, bumetanide and piretanide were introduced into scala tympani of the guinea pig cochlea by perfusion. The short-term effects of these drugs on the cochlear microphonic, the compound action potential and on the activity of single auditory nerve fibres were studied. the compound action potential was more sensitive to the action of the above compounds than was the cochlear microphonic. Single auditory nerve fibres showed a marked increase in threshold and generally a fall in spontaneous firing rate. A deterioration in in tuning was observed which in some cases, was not invariably accompanied by a rise in threshold. Histological examination revealed oedematous changes in stria vascularis and in supporting cells following cochlea perfusion with the above compounds.

Groups of pigmented guinea pigs (weighing 480 to 650 g at the start of the experiment) were given daily intraperitoneal injections of 16 mg/kg bumetanide or 10, 20 or 40 mg/kg furosemide over a period of 4 weeks. Two weeks following the last diuretic dose the animals were anaesthetized with urethane and the responses of single auditory nerve fibres to pure-tone and click stimuli were recorded. The tuning of individual units, as measured by Q10 dB values of frequency threshold curves, tended to be more affected than threshold at characteristic frequency by both loop diuretics. Light microscope examination of treated cochleas suggested greater effect of the drugs on the organ of Corti than on stria vascularis.