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Purpose: Equitable representation of children with hearing loss who are members of marginalized or minority groups in behavioral intervention studies enhances inclusivity in the scientific process and generalizability of results. The goal of this systematic review was to ascertain the percentage of studies conducted in the United States in the past 2 decades that reported relevant demographic variables. Method: Studies were searched across eight databases and clinical trial registries in October 2022. Variations of the following search strings were used to retrieve peer-reviewed published studies and unpublished clinical trials: children, hearing loss, and intervention. Results: Thirty-nine intervention studies met the inclusion criteria. The selected studies were reviewed and coded for the following demographic variables: area and type of intervention, participant age, hearing technology data, sample size, gender, race/skin color and ethnicity, primary/home language(s), additional disabilities, parental education, family income, and parental occupation. Results revealed that many demographic variables were remarkably underreported, with parental education, family income, and parental occupation variables being the least reported data. Conclusions: Demographic data can be an important tool for changing disparities related to intervention outcomes. This systematic review suggests that inclusive research practices should be extended to low-literacy or low-economic resources, non-White, and non--English-speaking groups. Inclusion practices coupled with sufficient sample sizes will ultimately aid in identifying hearing health disparities. [ABSTRACT FROM AUTHOR]

Purpose: This study explored user perspectives on the relationship between hearing aid cost and uptake, as well as cost-related recommendations for others with hearing difficulties, in a sample of prescription and over-the-counter (OTC) hearing aid users. Method: A secondary analysis was conducted on a cross-sectional survey using qualitative content analysis to analyze responses related to the cost of hearing aids. The study included a total of 241 adult participants, comprising 179 prescription hearing aid users from the Hearing Tracker website and 62 OTC hearing aid users from the Lexie Hearing U.S. database. Results: Prescription users had a mean age of 66.7 years (SD = 13.2), including 62.0% males, 37.4% females, and 0.6% nonbinary individuals. OTC users had a mean age of 63.0 years (SD = 13.4), with 48.4% males and 51.6% females. Three overarching domains were identified: perceived enablers to hearing aid uptake related to the cost, perceived barriers to hearing aid uptake related to the cost, and recommendations to others with hearing difficulties related to the cost, with 14 categories recognized for prescription users and 12 for OTC users. Both groups identified the high cost of hearing aids and lack of insurance coverage as significant barriers to uptake. Many prescription users reported external support (e.g., financial support and health insurance coverage) as an enabler, while OTC users frequently mentioned the affordability of OTC devices. The most common recommendation among prescription users was to seek professional support, whereas OTC users recommended researching hearing aids before making a purchase. Conclusions: Cost and insurance coverage consistently emerge as primary barriers to hearing aid adoption for both prescription and OTC users. To foster greater accessibility, initiatives should target these financial obstacles. Additional research is warranted on the relationship between hearing aid cost and uptake, especially among OTC users and those seeking financial assistance. Supplemental Material: https://doi.org/10.23641/asha.26496922 [ABSTRACT FROM AUTHOR]

Purpose: Population-based evidence in the interrelationships among hearing, brain structure, and cognition is limited. This study aims to investigate the cross-sectional associations of peripheral hearing, brain imaging measures, and cognitive function with speech-in-noise performance among older adults. Method: We studied 602 participants in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) brain magnetic resonance imaging (MRI) ancillary study, including 427 ACHIEVE baseline (2018--2020) participants with hearing loss and 175 Atherosclerosis Risk in Communities Neurocognitive Study Visit 6/7 (2016--2017/2018--2019) participants with normal hearing. Speech-in-noise performance, as outcome of interest, was assessed by the Quick Speech-in-Noise (QuickSIN) test (range: 0--30; higher = better). Predictors of interest included (a) peripheral hearing assessed by pure-tone audiometry; (b) brain imaging measures: structural MRI measures, white matter hyperintensities, and diffusion tensor imaging measures; and (c) cognitive performance assessed by a battery of 10 cognitive tests. All predictors were standardized to z scores. We estimated the differences in QuickSIN associated with every standard deviation (SD) worse in each predictor (peripheral hearing, brain imaging, and cognition) using multivariable-adjusted linear regression, adjusting for demographic variables, lifestyle, and disease factors (Model 1), and, additionally, for other predictors to assess independent associations (Model 2). Results: Participants were aged 70-84 years, 56% female, and 17% Black. Every SD worse in better-ear 4-frequency pure-tone average was associated with worse QuickSIN (-4.89, 95% confidence interval, CI [-5.57, -4.21]) when participants had peripheral hearing loss, independent of other predictors. Smaller temporal lobe volume was associated with worse QuickSIN, but the association was not independent of other predictors (-0.30, 95% CI [-0.86, 0.26]). Every SD worse in global cognitive performance was independently associated with worse QuickSIN (-0.90, 95% CI [-1.30, -0.50]). Conclusions: Peripheral hearing and cognitive performance are independently associated with speech-in-noise performance among dementia-free older adults. The ongoing ACHIEVE trial will elucidate the effect of a hearing intervention that includes amplification and auditory rehabilitation on speech-in-noise understanding in older adults. [ABSTRACT FROM AUTHOR]

Objective: This systematic review examined the audiological and non-audiological factors that influence hearing aid use, benefit and satisfaction in adults based on studies published during the last decade (2010 and 2023). Design: Studies were identified by using PRISMA guidelines for systematic searches on five platforms (Web of Science, Scopus, PubMed, EBSCOhost including CINAHL and Academic Search Complete). The National Institute of Health Quality assessment tool and the Oxford Centre for Evidence Based Medicine tool were used for quality assessment and grading of level of evidence. Results: Forty-six articles were included in the review. A total of 101 significant factors influencing hearing aid use (n = 47), benefit (n = 17) and satisfaction (n = 37) were identified. Clear determinants of hearing aid use, benefit and satisfaction included hearing sensitivity, self-reported hearing difficulty, speech perception, attitude and beliefs. 34 cross-sectional studies in this review were graded level 4, 9 cohort studies rated level 3, and 3 randomised control trials rated level 2. Conclusion: Factors associated with hearing aid outcomes identified in the past decade support previous evidence. New factors like social networks and service-delivery models, have also been identified. These factors require further investigations through high quality studies to further strengthen existing evidence. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to comprehensively review animal and human studies that explore the role of omega-3 PUFAs in maintaining the health of the auditory organ across all life stages. Methods: This narrative review involved searching Scopus, PubMed, Google Scholar, and Cochrane Library databases for relevant articles from December 1980 to July 2023. Results: some animal and human studies suggest that both deficiency and excessive intake of long-chain omega-3 PUFAs, particularly docosahexaenoic acid (DHA), can lead to auditory neural conduction impairment and reduced hearing acuity from fetal development to old age (presbycusis). These effects are likely to be dependent on the dosage. Some research indicates that an excessive intake of omega-3, rather than a deficiency, can result in nutritional toxicity and hearing impairments. Animal studies highlight the positive impact of omega-3 supplements with high DHA content in addressing hearing damage, but human research on this subject is limited. Furthermore, certain studies propose that omega-3 PUFAs may prevent or delay age-related hearing loss, with high plasma omega-3 concentration, particularly long-chain omega-3 PUFA, linked to reduced hearing loss. Additionally, consuming fish more than twice a week may be associated with a lower risk of hearing loss in adulthood, with these effects potentially influenced by age and gender. However, the majority of studies have been conducted on animals, and clinical trials are scarce. Research on the influence of omega-3 PUFAs on the peripheral and central vestibular systems remains limited. Conclusion: This article delves into the impact of omega-3 on the auditory-vestibular system, exploring its influence on neurodevelopment, protection, and treatment. It not only highlights specific research gaps but also offers valuable insights for potential future studies. [ABSTRACT FROM AUTHOR]

While targeted rehabilitation can enhance hearing aid self-efficacy (HASE), little research has been done to determine the factors contributing to its predictive value. By investigating the experiences of individuals who successfully use HAs and have high levels of HASE, we hoped to illuminate specific strategies and/or sources of support these individuals share that might explain why high HASE is often linked to successful outcomes. This qualitative study explored the experiences of five older adults who were successful HA users and reported having high HASE. Semi-structured interview guides were developed using the transtheoretical model of behavioral change as a framework. Interviews were analyzed thematically and holistically. Participants attributed their HA success to: intrinsic motivation to improve their hearing, confident self-reliance when making health decisions, willingness to act on advice from trusted others, pro-social personal attributes, positive expectations about HA outcomes, and actively pursuing an optimal HA outcome. For these participants, internal factors related to emotional state and source of motivation, and, to a lesser extent, verbal persuasion played a crucial role in their long-term success. This suggests that external influencers might be less impactful in facilitating success for those with high HASE. [ABSTRACT FROM AUTHOR]

Background: Effective management of hearing loss in adults is fundamental for communication, relationships, employment, and learning. This study examined the rates and management of self-reported hearing loss in urban Aboriginal and Torres Strait Islander adults. Methods: A retrospective, observational study of Aboriginal and Torres Strait Islander people aged ≥15 years who had annual health checks at an urban Aboriginal and Torres Strait Islander primary healthcare clinic in Inala, Queensland, was conducted to determine self-reported hearing loss rates by age and ethnic groups stratified by sex. A medical record audit of patients who self-reported hearing loss from January to June 2021 was performed to identify current management approaches, and the proportion of patients that were appropriately managed. Results: Of the 1735 patients (average age 40.7 years, range 15.0–88.5 years, 900 [52.0%] women) who completed 3090 health checks between July 2018 and September 2021, 18.8% self-reported hearing loss. Rates did not differ between men and women. However, significant effects were noted for age, with rates increasing from 10.7% for patients aged 15–24 years to 38.7% for those aged ≥65 years. An audit of 73 patient medical records revealed that 39.7% of patients with self-reported hearing loss were referred to Ear, Nose and Throat/audiology or received other management. A total of 17.8% of patients owned hearing aids. Conclusions: Only 40% of Aboriginal and Torres Strait Islander adults who self-reported hearing loss were referred for management. Significant changes to clinical management and government-funded referral options for hearing services are required to improve the management of self-reported hearing loss in this population. Limited evidence on hearing loss in Aboriginal and Torres Strait Islander adults exists. In this primary care adult population, the rate of self-reported hearing loss was 18.8%. Only two in five adults received further action to manage their hearing loss with successful hearing outcomes evident. Hearing loss in Aboriginal and Torres Strait Islander adults is underreported, undermanaged, and requires urgent attention from health professionals and government policymakers to enhance its clinical management leading to improved quality of life. [ABSTRACT FROM AUTHOR]

Purpose: The study examines the effect of hearing loss and hearing aid (HA) amplification on the conversational dynamics between hearing-impaired (HI) and normal-hearing (NH) interlocutors. Combining data from the current and a prior study, we explore how the speech levels of both interlocutors correlate and relate to HI interlocutors' degree of hearing loss. Method: Sixteen pairs of younger NH and elderly HI interlocutors conversed in quiet, with the HI interlocutor either unaided or wearing HAs. We analyzed the effect of hearing status and HA amplification on the conversational dynamics, including turn-taking times (floor-transfer offsets), utterance lengths, and speech levels. Furthermore, we conducted an in-depth analysis of the speech levels using combined data sets from the current and previously published data by Petersen, MacDonald, and Sørensen (2022). Results: Unaided HI interlocutors were slower and more variable at timing their turns, but wearing HAs reduced the differences between the HI and NH interlocutors. Conversations were less interactive, and pairs were slower at solving the conversational tasks when the HI interlocutor was unaided. Both interlocutors spoke louder when the HI interlocutor was unaided. The speech level of the NH interlocutors was related to that of the HI interlocutors, with the HI speech levels also correlating with their own degree of hearing loss. Conclusions: Despite typically being unchallenging for HI individuals, one-onone conversations in quiet were impacted by the HI interlocutor not wearing HAs. Additionally, combining data sets revealed that NH interlocutors adjusted their speech level to match that of HI interlocutors. [ABSTRACT FROM AUTHOR]

Background: Although remarkable progress has been made in conventional hearing aids, patients with hearing loss are still reluctant to use them due to cosmetic or functional reasons, such as the feedback phenomenon or the occlusion effect. In the late 20th century, implantable hearing aids were developed and used as an alternative. Current Concepts: Several devices have been developed, with three currently available on the international market (Vibrant Soundbridge [Med-El Corporation], MAXUM [SOUNDTEC Inc.], and Esteem [Envoy Medical Corporation]). Electromagnetic and piezoelectric transduction systems enable the devices to transmit external sounds to the internal auditory system, enabling sounds to be heard without amplifying the sound source. Although not an implantable hearing aid, Earlens (Earlens Corporation), which attaches to the eardrum and transmits sound, has also been developed and is commercially available. This manuscript briefly describes these devices, evaluates their benefits and limitations, and considers future research directions in the field of implantable hearing aids. Discussion and Conclusion: Implantable or attachable hearing aids are innovative technologies that compensate for the shortcomings of conventional hearing aids while providing comparable or better results. The demand for them is expected to continue to increase in the future owing to the continued increase in the population with hearing loss and the trend toward quality of life and external beauty. [ABSTRACT FROM AUTHOR]

To investigate the effect of hearing aid (HA) intervention on long-term health-related quality of life (HRQoL) changes in first-time and experienced HA users using the 15D questionnaire. Secondly, the study explored the relationship between clinical parameters and changes in 15D scores. A prospective observational study. The study population included 1562 patients (1113 first-time and 449 experienced HA users) referred for HA rehabilitation. All patients responded to the 15D at baseline, two months after HA fitting, and at long-term follow-up (698 ± 298 d). Among both first-time and experienced HA users, significant improvements in hearing-dimension (15D-3) score were observed at two-month follow-up which sustained at long-term follow-up. 15D total scores significantly decreased at long-term follow-up. Self-reported hearing abilities, word recognition scores, and HA use time were significantly and positively correlated to increased 15D. Both groups of HA users reported improved hearing-related QoL after HA treatment which sustained at long-term follow-up but the improvement in total 15D total score did not sustain for either group. The results suggest that HA intervention positively affects hearing-related QoL among older adults with hearing loss, and the findings support the use of 15D as a tool for the evaluation of HA treatment effects. [ABSTRACT FROM AUTHOR]

To analyse the effects of auditory environments on receptive and expressive language outcomes in children with a CI. A single-institution retrospective review was performed. The auditory environments included Speech-Noise, Speech-Quiet, Quiet, Music, and Noise. Hearing Hour Percentage (HHP) and percent total hours were calculated for each environment. Generalised Linear Mixed Models (GLMM) analyses were used to study the effects of auditory environments on PLS Receptive and Expressive scores. Thirty-nine children with CI On GLMM, an increase in Quiet HHP and Quiet percent total hours were positively associated with PLS Receptive scores. Speech-Quiet, Quiet, and Music HHP were positively associated with PLS Expressive scores, with only Quiet being significant for percent total hours. In contrast, percent total hours of Speech-Noise and Noise had a significant negative association with PLS Expressive scores. This study suggests that more time spent in a quiet auditory environment positively influences PLS Receptive and Expressive scores and that more time listening to speech in quiet and music positively influences PLS Expressive scores. Time spent in environments recognised as Speech-Noise and Noise might negatively impact a child's expressive language outcomes with a CI. Future research is needed to better understand this association. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the perspectives of Australiabased hearing health care consumers regarding the (a) provision and utilization of teleaudiology services, (b) experiences with teleaudiology, and (c) barriers and enablers to future teleaudiology use. Method: A national prospective self-report online survey was completed between April and October 2020, amid COVID-19. Data were analyzed using descriptive statistics (closed-answer items) and content analysis (open-text responses). A total of 381 participants (Mage = 72.07 years ± 10.08, 142 females) were recruited from different states and territories of Australia. Results: Despite positive outcomes reported by those who undertook teleaudiology appointments during COVID-19, results indicate low-consumer teleaudiology uptake. It can be inferred that consumers were not aware of teleaudiology as an appointment option, clinicians/clinic staff had not informed and/or supported teleaudiology as an option, and biases existed that prevented teleaudiology being more widely adopted. It is unclear whether consumers who were eligible for government subsidies understood that teleaudiology appointments were reimbursed through government funding. Barriers to future teleaudiology uptake were largely related to concerns regarding confidentiality and privacy. Conclusion: Lowconsumer uptake of teleaudiology appointments appears to be driven by consumer preference for in-person services, which appears to be driven by lack of knowledge regarding the availability and effectiveness of teleaudiology. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the potential contribution of limited English proficiency on daily hearing aid wear time for children with hearing loss. Method: A retrospective chart review was completed to evaluate hearing aid wear time based on data logging information available at the time of a follow-up visit following an initial hearing aid fitting. Children were included in the study if they had permanent bilateral hearing loss and were less than 60 months of age at the time of their first follow-up visit. Wear time was compared between children who attended an interpreter-mediated appointment and those who did not have an interpreter present. The presence of an interpreter at the appointment was the study indicator that the family had limited English proficiency. Results: Children from families with limited English proficiency exhibited significantly shorter daily wear time (M = 1.3 hr) than their peers whose families were English-proficient speakers, thus, having a shared language with their audiologists (M = 5.2 hr). Conclusions: Results of this study suggest that family--clinician language discordance might put children at greater risk of shorter hearing aid wear time than children whose caregivers share a common language with their child's audiologist. There can be many linguistic, cultural, and educational factors that contribute to hearing aid wear time in children whose families have limited English proficiency as well as different approaches to improving that wear time. Efforts should ensure that hearing and hearing aid--related information is accessible to all families, especially those with clinician--family language discordance. Such efforts can include, among others, training that improves clinicians' cultural and linguistic responsiveness to the diverse families they serve. [ABSTRACT FROM AUTHOR]

Purpose: Verbal working memory is poorer for children with hearing loss than for peers with normal hearing (NH), even with cochlear implantation and early intervention. Poor verbal working memory can affect academic performance, especially in higher grades, making this deficit a significant problem. This study examined the stability of verbal working memory across middle childhood, tested working memory in adolescents with NH or cochlear implants (CIs), explored whether signal enhancement can improve verbal working memory, and tested two hypotheses proposed to explain the poor verbal working memory of children with hearing loss: (a) Diminished auditory experience directly affects executive functions, including working memory; (b) degraded auditory inputs inhibit children’s abilities to recover the phonological structure needed for encoding verbal material into storage. Design: Fourteen-year-olds served as subjects: 55 with NH; 52 with CIs. Immediate serial recall tasks were used to assess working memory. Stimuli consisted of nonverbal, spatial stimuli and four kinds of verbal, acoustic stimuli: nonrhyming and rhyming words, and nonrhyming words with two kinds of signal enhancement: audiovisual and indexical. Analyses examined (a) stability of verbal working memory across middle childhood, (b) differences in verbal and nonverbal working memory, (c) effects of signal enhancement on recall, (d) phonological processing abilities, and (e) source of the diminished verbal working memory in adolescents with cochlear implants. Results: Verbal working memory remained stable across middle childhood. Adolescents across groups performed similarly for nonverbal stimuli, but those with CIs displayed poorer recall accuracy for verbal stimuli; signal enhancement did not improve recall. Poor phonological sensitivity largely accounted for the group effect. Conclusions: The central executive for working memory is not affected by hearing loss or cochlear implantation. Instead, the phonological deficit faced by adolescents with CIs denigrates the representation in storage and augmenting the signal does not help. [ABSTRACT FROM AUTHOR]

Introduction: Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment‐related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. Methods: A qualitative design was used with semi‐structured interviews (online or in‐person) with participants recruited through audiology services and nonclinical services, such as lip‐reading classes. Forty‐six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. Results: The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). Conclusions: The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld‐led care, family‐centred care and peer support to build support for those with hearing loss. Patient or Public Contribution: We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co‐authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript. [ABSTRACT FROM AUTHOR]

Objective: The outcome of cartilage interposition ossiculoplasty was assessed in cases of incus necrosis after posterior malleus repositioning in the plane of the stapes, in terms of hearing gain after ossicular reconstruction. Methods: A retrospective observational study was conducted of 30 patients admitted to an Ain Shams University hospital from March 2021 to September 2021. All patients with ossicular disruption due to chronic suppurative otitis media and hearing loss of more than 40 dB were included in the study. Pure tone audiometry was conducted for each patient after three months, six months and one year post operation. Results: The audiogram showed a post-operative air–bone gap of 20 dB or less in 83.33 per cent of patients (n = 25) at three months post-operatively and in 80 per cent of patients after six months; after one year, the results remained the same. Conclusion: The use of cartilage interposition after malleus posterior mobilisation represents an excellent partial ossicular replacement technique. [ABSTRACT FROM AUTHOR]

Purpose: The decision to proceed with bone-conduction hearing devices is not an easy one despite being the audiological management of choice for the majority of children with unilateral hearing loss secondary to microtia--atresia, and the outcome is not always as hoped for. This study aimed to explore parent and child views on decision making and outcomes. Method: Qualitative methods (focus groups and individual interviews) were used to explore parent and child opinions on factors influencing the decision to try a bone-conduction device and their subsequent use or nonuse. Quantitative methods (questionnaires) investigated the impact of hearing loss on listening effort and fatigue, quality of life, and learning, including executive functions such as working memory, information processing, and attention. Twelve parent--child dyads participated in the study, with children aged 9-14 years. Results: A thematic analysis of qualitative data highlighted the importance to parents of timely, consistent, and accessible device information as well as concerns regarding bullying, psychosocial well-being, and educational impacts. Children's concerns included feeling different from their peers, bullying, device appearance, and sound quality, as well as the support they wanted and received. Questionnaire results provided useful confirmatory information on the impacts of unilateral hearing loss on learning for a substantial proportion of the children in this sample. Conclusion: The findings provide insights into the wide range of issues that have implications for the provision of audiological services as well as educational and psychological support for children with unilateral microtia--atresia. [ABSTRACT FROM AUTHOR]

Purpose: To examine the knowledge, stress levels, and attitudes of clinical nurses regarding care for individuals considered the oldest-old (i.e., aged ≥80 years) and to identify related factors. Method: In this descriptive cross-sectional study, data were collected via an online structured questionnaire survey administered to 128 clinical nurses. Results: Participants had low levels of knowledge about the oldest-old with hearing impairments or mental health problems (e.g., depression, anxiety, delirium), and high levels of stress. Factors influencing attitudes toward the oldest-old were graduate or higher educational level (p = 0.002), ≥10 years of work experience (p = 0.049), and lower stress (p = 0.033). The explanatory power of the regression model was 18.1%. Conclusion: Further research and development programs should aim to promote positive attitudes toward care for older adults among nurses and develop methods to reduce and better manage stress when caring for these individuals. [Journal of Gerontological Nursing, 50(6), 35–43.] [ABSTRACT FROM AUTHOR]

The auditory brainstem response (ABR) is a valuable clinical tool for objective hearing assessment, which is conventionally detected by averaging neural responses to thousands of short stimuli. Progressing beyond these unnatural stimuli, brainstem responses to continuous speech presented via earphones have been recently detected using linear temporal response functions (TRFs). Here, we extend earlier studies by measuring subcortical responses to continuous speech presented in the sound-field, and assess the amount of data needed to estimate brainstem TRFs. Electroencephalography (EEG) was recorded from 24 normal hearing participants while they listened to clicks and stories presented via earphones and loudspeakers. Subcortical TRFs were computed after accounting for non-linear processing in the auditory periphery by either stimulus rectification or an auditory nerve model. Our results demonstrated that subcortical responses to continuous speech could be reliably measured in the sound-field. TRFs estimated using auditory nerve models outperformed simple rectification, and 16 minutes of data was sufficient for the TRFs of all participants to show clear wave V peaks for both earphones and sound-field stimuli. Subcortical TRFs to continuous speech were highly consistent in both earphone and sound-field conditions, and with click ABRs. However, sound-field TRFs required slightly more data (16 minutes) to achieve clear wave V peaks compared to earphone TRFs (12 minutes), possibly due to effects of room acoustics. By investigating subcortical responses to sound-field speech stimuli, this study lays the groundwork for bringing objective hearing assessment closer to real-life conditions, which may lead to improved hearing evaluations and smart hearing technologies. [ABSTRACT FROM AUTHOR]

To ascertain the prevalence, causes, and risk factors of hearing healthcare delays in older people with self-reported hearing loss in the United States. This cross-sectional study used data from the National Health and Ageing Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries. A supplemental COVID-19 survey was mailed to the participants from June to October 2020. By January 2021, 3257 participants had returned completed COVID-19 questionnaires, with the majority having been self-administered between July and August 2020. The participants in the study represented 32.7 million older adults in the US, with 29.1% reporting hearing loss. Among over 12.4 million older adults who put off needed or planned medical care, 19.6% of those with self-reported hearing loss and 24.5% of hearing aid or device users stated they delayed hearing appointments. Approximately 629,911 older adults with hearing devices were impacted by the COVID-19 outbreak for audiological services. The top three reasons were deciding to wait, service cancellation, and fear of going. Education and race/ethnicity were associated with delaying hearing healthcare. The COVID-19 pandemic impacted hearing healthcare utilisation among older adults with self-reported hearing loss in 2020, with both patient- and provider- initiated delays. [ABSTRACT FROM AUTHOR]

The Caribbean region has a diverse population of about 40 million people, spread over 13 sovereign states. This review aims to describe the existing studies on hereditary hearing loss (HL) in the Caribbean population. We systematically reviewed scientific articles on HL prevalence, genetic causes, technology use, and environmental effects in Caribbean nations and the Caribbean diaspora in the United States. Key findings show that HL rates, with diverse genetic variables, vary across Puerto Rico, Cuba, and the Dominican Republic. Local resources and technology have been used to diagnose HL, particularly in rural areas. Environmental factors tend to affect HL prevalence in various regions. This literature review of Caribbean-focused studies helps guide future research and healthcare strategies, particularly concerning genetic drift caused by migration to the United States. Understanding these factors can help diagnose and treat HL in America's diverse population. [ABSTRACT FROM AUTHOR]

This article provides a summary of the study by de Gruy et al (2023). Applying a simple data-driven analysis, 15 dB HL is established as a reasonable fence for pure-tone audiometry for identifying perceived hearing difficulty. The findings also show limitations in the diagnostic accuracy of pure-tone audiometry in identifying perceived hearing difficulty and support the need for considerations beyond pure-tone audiometry. [ABSTRACT FROM AUTHOR]

Hearing loss is common in childhood. The most common causes of hearing loss varies by age. In childhood this is most frequently due to Otitis Media with Effusion (OME, also known as 'glue ear') or Chronic Suppurative Otitis Media (CSOM)). In adolescence hearing loss can result from exposure to loud noise from environmental causes or personal listening devices. Hearing loss has a significant impact upon the ability to learn, socialize and work. Effective early interventions exist and make a difference to speech, access to education, socialization and employment opportunities. The World Health Organization is prioritizing hearing health globally via the World Hearing Forum (WHF) and child health organizations are invited to join. This short review, aimed at healthcare professionals working with children and young people highlights the scale of the problem, provides a global perspective and outlines some of the possible solutions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare three intervention conditions in virtual rapid word learning instruction for young children who are deaf and hard of hearing (DHH): traditional, general physical activity, and semantic richness physical activity. We focused on an initial step in learning a new word: mapping a word form to a referent. Fourteen children who were DHH and 14 children with typical hearing (TH) participated in a pseudoword-learning virtual session in each condition, and receptive and expressive knowledge of targeted pseudowords was assessed. Of interest was the impact of different types of physical activity on rapid learning of word-like forms. There was an interaction of group and condition for expressive production of pseudowords. Children who were DHH learned to produce more pseudowords in the general physical activity condition, whereas children with TH learned to produce more pseudowords in the semantic richness physical activity condition. There were no effects of group or condition on receptive learning of pseudowords. Children who are DHH can rapidly map word-like forms to referents via teleintervention, and physical activity may interact with word learning differently for children who are DHH and children with TH. [ABSTRACT FROM AUTHOR]

The study's objective was to identify consonant and vowel confusions in cochlear implant (CI) users, using a nonsense syllable repetition test. In this cross-sectional study, participants repeated recorded mono- and bisyllabic nonsense words and real-word monosyllables in an open-set design. Twenty-eight Norwegian-speaking, well-performing adult CI users (13 unilateral and 15 bilateral), using implants from Cochlear, Med-El and Advanced Bionics, and a reference group of 20 listeners with normal hearing participated. For the CI users, consonants were confused more often than vowels (58% versus 71% correct). Voiced consonants were confused more often than unvoiced (54% versus 64% correct). Voiced stops were often repeated as unvoiced, whereas unvoiced stops were never repeated as voiced. The nasals were repeated correctly in one third of the cases and confused with other nasals in one third of the cases. The real-word monosyllable score was significantly higher than the nonsense syllable score (76% versus 63% correct). The study revealed a general devoicing bias for the stops and a high confusion rate of nasals with other nasals, which suggests that the low-frequency coding in CIs is insufficient. Furthermore, the nonsense syllable test exposed more perception errors than the real word test. [ABSTRACT FROM AUTHOR]

Background and Aim: Mucopolysaccharidosis (MPS II) is a group of rare lysosomal storage disorders, with seven sub-types. MPS II also known as Hunter's syndrome is the only subtype that is affected by X-linked inheritance, while the others are of autosomal inheritance. The Case: The study aimed to discuss the impact of Hunter syndrome, its pathophysiology, assessment diagnosis, audiological profiling, rehabilitation, and prognostic factors in a child diagnosed with MPS II at the age of 4 years. The auditory symptoms begin around at the age of 2-4 years, as the harmful molecule builds up in the middle ear bone sizes resulting in joint stiffness, and conductive hearing loss gradually progressing into mixed hearing loss with varying degree. Each audiological test finding was linked to the pathophysiology of MPS II, with the discussion emphasising suitable rehabilitative options and importance of multidisciplinary management of hunter syndrome. Conclusion: The atypical manifestations of MPS II with fluctuating hearing loss is suggestive of the need for early identification, adequate profiling, appropriate rehabilitative measures and role of allied professionals in management of the disorder. [ABSTRACT FROM AUTHOR]

Hearing impairment in children is a significant issue worldwide, including Poland, as it hinders their proper development. Early hearing prosthetics ensure language and social development comparable to their healthy peers. Proper diagnosis is essential to achieve this goal. In Poland, the Universal Newborn Hearing Screening Program allows for the rapid detection of children with hearing impairment and early therapeutic intervention. Bilateral sensorineural hearing loss is the primary indication for cochlear implantation. Patient assessment, surgery, and rehabilitation are carried out in highly specialized centers. Hearing impairment is also a concern for an older age group of children, where the causes are primarily inflammatory. In this case, parents, pediatricians, family doctors, speech therapists, and teachers play a significant role in suspecting hearing impairment in children. It is crucial to effectively and promptly include all children with hearing impairment in the program, especially those with risk factors, where delayed onset hearing loss may occur. [ABSTRACT FROM AUTHOR]

Purpose: Adverse childhood experiences affect early brain development and future health outcomes. The principles of trauma-informed care (TIC) incorporate safety, screening, understanding context, avoiding retraumatization, and discharge planning to provide optimal care for patients and families. Secondary traumatic stress is the trauma providers' experience when serving patients and families who have experienced trauma. The purpose of this article is to examine the impact of trauma, investigate the principles of TIC, and identify the ways to implement it in hearing health care. Conclusions: Providers working with children and families who have experienced trauma should be trained to provide a trauma-informed approach and learn the signs, symptoms, and risks of secondary traumatic stress. To improve the quality of care for children with hearing loss who have experienced trauma, their adverse experiences must be considered with trauma-informed techniques incorporated into the hearing health care model of care. [ABSTRACT FROM AUTHOR]

Purpose: The Joint Committee on Infant Hearing recommends hearing screening before 1 month of age, audiologic diagnosis before 3 months of age, and enrollment in early intervention before 6 months of age (1-3-6 benchmarks of Early Hearing Detection and Intervention [EHDI] programs). Nearly 98% of newborns have their hearing screened, but many, who do not pass or do not complete their newborn hearing screening, fail to complete the EHDI process. Historically, lower socioeconomic level, more complex infant health status, and farther geographical location reduce rates of EHDI follow-up, but levels vary widely across states. This study examined barriers to the EHDI process by comparing census-based variables at the state and regional levels to national and Texas EHDI outcomes, respectively. Method: We used correlational analysis to assess relationships between U.S. Census data (state- and region-specific population and geographic characteristics, sociodemographic and geographic factors, and health and health insurance) and EHDI data (newborn screening, audiologic diagnosis, and early intervention) at the national level and in Texas. Results: Nationally, higher labor force participation, lower unemployment rates, and presence of health insurance significantly correlated with higher rates of completing EHDI benchmarks. Larger population size and density and higher socioeconomic factors coincided with higher rates of completing the EHDI process and lower rates of loss to follow-up (LTF) or loss to documentation in Texas. Conclusions: Population, socioeconomic, and demographic factors significantly correlate with following through with the EHDI process, with weak correlations at the national level and strong correlations at the state level. These findings underscore the need to increase our attention to underserved, economically challenged, and/or geographically distanced families who have children with a higher risk of becoming LTF in the EHDI process. [ABSTRACT FROM AUTHOR]

Purpose: There is a clear need for speech-language pathologists, audiologists, and related health care professionals to understand the barriers to hearing health care, so that we may propose possible solutions. Through interview, collaboration, and analysis, the objective was to identify opportunities to enhance support provided for these children. Method: The authors conducted a review of available literature related to hearing health care disparities. Dr. Matthew Bush, an expert in hearing health care disparities and advocacy, was interviewed on October 12, 2022. Data were extracted and compiled from available literature and the interview including demographics, themes, and available interventions. Results: The section "Entry Barriers" describes findings in the main categories of Steps, Proximity, Health Care Literacy, and Systemic Inequalities. The "Opportunities for Change" section describes topics from the interview for ongoing discussion in the field. Conclusions: Ultimately, having this conversation led exactly in a direction that it should--toward further professional development, awareness, and a call to action. To facilitate meaningful change, we are tasked with active discussion, questioning, probing, and improvement. Only through evolution of existing systemic bias and harmful structures can we make meaningful change. [ABSTRACT FROM AUTHOR]

Purpose: A number of barriers exist that limit access to hearing aids and services, including high cost, limited number of providers, and patients' perceived lack of need. The traditional model of hearing aid service delivery requires patients to undergo a hearing test, receive a medical evaluation or waiver, and receive a hearing aid fitting from qualified providers, such as a licensed audiologist. In an effort to improve access and affordability, the U.S. Food and Drug Administration recently established a new category of over-the-counter (OTC) hearing aids for adults with perceived mild--moderate hearing loss that can be purchased without the involvement of a professional. The purpose of this Viewpoint article is to reflect on the progress that has been accomplished in the inaugural year of OTC hearing aids. Conclusions: In the last year, hearing aids have become more readily available to consumers online and in stores. A number of companies have entered the OTC hearing aid market, leading to innovative designs and a variety of options for consumers. The regulations governing OTC hearing aids have also spurred increased attention on hearing care and created new opportunities for interprofessional collaboration. In addition, research has illustrated the real-world effectiveness of OTC hearing aids. Still, in some respects, the first year of OTC hearing aids has not met expectations. Evidence points to low adoption as well as misconceptions, including regarding the distinction between OTC and prescription hearing aids. Audiologists can play an important role in addressing misconceptions by increasing their own knowledge of the devices and talking about them with patients and in outreach activities. There are a number of outstanding needs, including to investigate U.S. consumers' satisfaction when using these devices long term and to evaluate the impact of OTC hearing aids in countries outside of the United States. [ABSTRACT FROM AUTHOR]

This longitudinal multiple-case study research focused on the scaffolding strategies that two Israeli deaf mothers use to boost their young hearing children's engagement in reading interactions. Despite being significant to language learning, few studies have examined the dialogic reading practices of deaf-signing mothers. The study shows that until the age of 22 months, the mothers shared picture books with their children. Between the ages of 12 to 24 months, the mothers used mostly low-demand cognitive prompts and responsive utterances. Between the ages of 24 to 36 months, they used more high-demand prompts (including open-ended questions) and expanded their responses. In line with previous studies, this research demonstrated that the Israeli deaf mothers used the books as a foundation for storytelling and reading conversations. The shared reading provided the mothers with opportunities to model the construction of ISL narratives and language functional behaviors, such as asking questions, describing things or expanding on the text. [ABSTRACT FROM AUTHOR]

Follow-up of cochlear implant effectiveness is mainly focused on 3 years postoperatively, and studies with more than 5 years of observation are rare, especially for local Chinese brands. Nurotron (Chinese domestic cochlear implant brand) CI recipients who participated in the clinical trial in 2009 were followed-up for 10 years prospectively, providing data to guide doctors and patients. From December 2009 to April 2010, 57 subjects underwent Nurotron Venus CI surgery at multiple-centers, and were continued to be followed up and assessed at 1, 2, 3, 4, 5, and 10 years after switch on. All recipients were successfully implanted with CIs with no difficulty in subsequent use with one reported case of re-implantation at 9 years after implantation. The aided hearing thresholds were significantly improved at one month after switch on (p < 0.0001) and remained stable afterwards for 10 years. Speech recognition scores were significantly higher than pre-operative results (p < 0.05) and continued to improve till 3 years after switch on. At 10 years post-operation, most subjects had improved QOL scores in most sub-items. Nurotron Venus CI System provides long-term, stable results in hearing speech assistance capabilities and can improve the quality of life of CI recipients. [ABSTRACT FROM AUTHOR]

Purpose: Persons with cystic fibrosis (PwCF) are at high risk for ototoxicity due to the routine use of intravenous aminoglycoside (IV-AG) antibiotics in respiratory infection management. Additionally, factors that contribute to ototoxicity-related symptom development and severity in PwCF are unknown. Given the increased risk of ototoxicity in people with diabetes, we explored the association between cystic fibrosis--related diabetes (CFRD) and self-reported ototoxicity symptoms (tinnitus and vestibular problems) in PwCF treated with aminoglycosides. Method: PwCF (N = 39; 25 females, 14 males; Mage = 30.1 years, SD = 10.3) were recruited from the Cystic Fibrosis Care Center at Oregon Health & Science University. Patients completed the validated questionnaires to ascertain their experiences with ototoxicity-related symptoms of tinnitus and balance function. The diagnosis of CFRD, including oral glucose tolerance testing (OGTT), insulin treatment, hemoglobin A1c, and cumulative IV-AG treatment history, was obtained through a medical chart review. Participants were classified into three groups based on their medical diagnoses via OGTT: normal glucose tolerance (NGT; control; n = 16), abnormal glucose tolerance (AGT; n = 9), and CFRD (n = 14). Participants in each group were further classified based on survey outcomes for ototoxicity-related symptoms. Results: There was a trend toward a higher proportion of patients with CFRD reporting tinnitus compared to the AGT and NGT groups, but did not meet statistical significance (§² = 2.24, p = .13). Approximately, 43% of patients with CFRD reported experiencing clinically significant tinnitus lasting > 3 min compared to 11% in the AGT group and 13% in the NGT group (§² = 3.751, p = .05). Cumulative IV-AG exposure tended to be higher in CFRD compared to other groups. High balance function was generally reported in all groups. Conclusions: Patients with CFRD have greater ototoxicity-related symptoms. Further investigation of the relationship between CF-related comorbidities and the risk of developing ototoxicity-related symptoms is warranted to improve the detection and management of ototoxicity in PwCF. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to (a) compare the Revised Hearing Handicap Inventory (RHHI) and pure-tone average (PTA) in their abilities to predict hearing aid use and (b) report the optimal cut-point values on the RHHI and PTA that predict hearing aid use. Method: Participants were from a community-based cohort study. We evaluated the ability of the RHHI and PTA as (a) continuous variables and (b) binary variables characterized by the optimal cut point determined by the Youden Index to predict hearing aid use. RHHI scores range from 0 to 72, and PTA was defined as averaged thresholds at frequencies 0.5, 1.0, 2.0, and 4.0 kHz in the worse ear. We used logistic regression models and receiver operating characteristic curves with corresponding concordance statistics (c-statistics) and 95% confidence intervals (CIs) to determine the predictive ability of models and chisquare tests to determine whether c-statistics were significantly different. Results: This study included 581 participants (Mage = 72.9 [SD = 9.9] years; 59.9% female; 14.3% Minority race). The c-statistics for the RHHI (0.79, 95% CI [0.75, 0.83]) and PTA (0.81, 95% CI [0.78, 0.85]), as continuous variables, were not significantly different (p = .25). The optimal cut points for the RHHI and PTA to predict hearing aid use were 6 points and 32.5 dB HL, respectively. The c-statistics for the RHHI (0.72, 95% CI [0.68, 0.76]) and PTA (0.75, 95% CI [0.71, 0.79]), as binary variables, were not significantly different (p = .27). Conclusion: The RHHI and PTA are similar in their ability to predict hearing aid use. [ABSTRACT FROM AUTHOR]

Purpose: The U.S. Food and Drug Administration finalized regulations for overthe- counter hearing aids (OTC-HAs) on August 17, 2022. Little is known about the comparative performance of OTC-HAs and prescription HAs. This study compared amplification accuracy of prescription HAs and direct-to-consumer devices (DTCDs, including personal sound amplification products [PSAPs] and OTC-HAs). Method: Eleven devices were programmed to meet prescriptive targets in an acoustic manikin for three degrees of hearing loss. Devices consisted of highand low-end HAs, PSAPS, and OTC-HAs. Each was tested, and deviations from target measured with an HA analyzer at every combination of 10 frequencies and low-, average-, and high-level inputs. Accuracy was compared using a multilevel Poisson model with device-specific intercepts controlling for input level, frequency, and device type. Results: For mild--moderate hearing loss, deviations from targets were not statistically different between high- and low-end HAs, but PSAPs (5.50 dB, SE = 0.92 dB) and OTC-HAs (8.83 dB, SE = 1.10 dB) had larger differentials. For flat moderate hearing loss, compared to high-end HAs, average differentials were larger for all device types at all input levels and frequencies (Low HA: 3.82 dB, SE = 1.10 dB; PSAP: 9.24 dB, SE = 1.22 dB; OTC-HA: 8.61 dB, SE = 1.19 dB). For mild sloping to severe hearing loss, compared to high-end HAs, OTC-HAs (9.72 dB, SE = 1.20 dB) and PSAPs (7.34 dB, SE = 1.07 dB) had larger differentials and significant variability at the highest and lowest frequencies. Half (three) of the PSAPs and OTC-HAs met most targets within ±5 dB. Conclusions: DTCDs were unable to meet prescriptive targets for severe types of hearing loss but could meet them for mild hearing loss. This study provides an examination of current hearing devices. More research is needed to determine whether meeting prescriptive targets provides any benefit in the outcomes and performance with DTCD devices. [ABSTRACT FROM AUTHOR]

Objective: Consistent symptom reporting for conditions like tinnitus that do not have an associated sign is critical for evaluating severity and intervention effectiveness, and for interpreting research findings. There is little research examining reporting of tinnitus and hearing difficulty over time. We address this here by comparing reported hearing difficulty and tinnitus at two time-points. Design: A cross-sectional study comparing symptom reporting in March 2019 and August/September 2021 using data from two online surveys of the same cohort. Although each survey was designed to address a different question, both asked about symptoms of tinnitus and hearing difficulties and enabled this exploratory analysis. Study sample: 6881 members of the UK general public aged 18+ years. Results: Inconsistent reporting was evident - many participants who reported experiencing tinnitus and/or hearing difficulties in 2019, said in 2021 that they had never had such symptoms before. Additionally, reports of new tinnitus/hearing difficulties in 2021 were unexpectedly high, equating to 18-month incidence rates of 13.6% and 11.7%, respectively. Conclusions: Psychosocial factors, expectations and context impact symptom reporting. This should be considered when treating patients and interpreting research findings. Using real-time data collection methods could thus provide a better understanding of experiences of tinnitus and hearing. [ABSTRACT FROM AUTHOR]

Cochlear implantation successfully improves hearing in most adult recipients. However, in rare cases, post-implant rehabilitation is required to maximize benefit. The primary aim of this investigation was to test if self-reports by cochlear implant users indicate the need for post-implant rehabilitation. Listening performance was assessed with the Speech, Spatial and Qualities short-form SSQ12, which was self-administered via a web-based survey. Subjects included over 2000 adult bilateral or unilateral cochlear implant users with at least one year of experience. A novel application of regression tree analysis identified core SSQ12 items that serve as first steps in establishing a plan for further rehabilitation: items 1, 8, and 11 dealing with single-talker situations, loudness perception, and clarity, respectively. Further regression and classification tree analyses revealed that SSQ12 item scores were weakly related to age, degree of tinnitus, and use of bilateral versus unilateral implants. Conversely, SSQ12 scores were strongly associated with self-rated satisfaction and confidence in using their cochlear implant. The SSQ12 total scores did not vary significantly over 1–9 or more years' experience. These findings suggest that the SSQ12 may be a useful tool to guide rehabilitation at any time after cochlear implantation. Identification of poor performance may have implications for timely management to improve the outcomes, through various techniques such as device fitting adjustments, counseling, active sound exposure, and training spatial hearing. [ABSTRACT FROM AUTHOR]

Recent studies suggest that sound amplification via hearing aids can improve postural control in adults with hearing impairments. Unfortunately, only a few studies used well-defined posturography measures to assess balance in adults with hearing loss with and without their hearing aids. Of these, only two examined postural control specifically in the elderly with hearing loss. The present study examined the impact of hearing aid use on postural control during various sensory perturbations in older adults with age-related hearing loss. Thirty individuals with age-related hearing impairments and using hearing aids bilaterally were tested. Participants were asked to perform a modified clinical sensory integration in balance test on a force platform with and without hearing aids. The experiment was conducted in the presence of a broadband noise ranging from 0.1 to 4 kHz presented through a loudspeaker. As expected, hearing aid use had a beneficial impact on postural control, but only when visual and somatosensory inputs were both reduced. Data also suggest that hearing aid use decreases the dependence on somatosensory input for maintaining postural control. This finding can be of particular importance in older adults considering the reduction of tactile and proprioceptive sensitivity and acuity often associated with aging. These results provide an additional argument for encouraging early hearing aid fitting for people with hearing loss. [ABSTRACT FROM AUTHOR]

This study aimed to synthesise information concerning the potential benefits and risks related to cochlear implants (CIs) versus hearing aids (HAs) in children with residual hearing. A systematic review of articles published from January 2003 to January 2019 was conducted. Our review included studies that compared the benefits and risks of CIs versus HAs in children (≤18 years old) with residual hearing. A total of 3265 citations were identified; 8 studies met inclusion criteria. Children with CIs showed significantly better speech perception scores post-CI than pre-CI. There was limited evidence related to improvement in everyday auditory performance, and the results showed non-significant improvement in speech intelligibility. One study on social-emotional functioning suggested benefits from CIs. In four studies, 37.2% (16/43) of children showed loss of residual hearing and 14.0% (8/57) had discontinued or limited use of their device. Children with CIs showed improvement in speech perception outcomes compared to those with HAs. However, due to the limited number of studies and information to guide decision-making related to other areas of development, it will be important to conduct further research of both benefits and risks of CIs in this specific population to facilitate decision-making. [ABSTRACT FROM AUTHOR]

Purpose: Regulatory changes in the United States introduced over-the-counter (OTC) hearing aids with the goal of increasing the accessibility and affordability of hearing health care. It is critical to understand the values inherent to hearing health care systems to evaluate their effectiveness in serving people with hearing difficulty. In this study, we evaluated the relative importance of values across service delivery models and the extent to which the introduction of OTC hearing aids represents a values shift relative to traditional audiology. Method: We performed a qualitative content analysis of two document categories: critique documents that motivated the creation of OTC hearing aids and regulatory documents that defined OTC hearing aids. Team members coded portions of text for the values they expressed. In total, 29,235 words were coded across 72 pages in four documents. Rank-order analyses were performed to determine the prioritization of values within each category of documents and subsequently compare values between OTC and traditional audiology documents analyzed in a previous study. Results: Critique and regulatory documents both prioritized values related to reducing barriers to hearing aid access and use, but the lack of a significant correlation in the rank order of values in these documents was evidence of inconsistency between the motivation and implementation of OTC hearing aids. Differences in the rank order of values in the OTC documents compared to traditional audiology were consistent with a values shift. Conclusions: The introduction of OTC as a solution to low hearing aid use represents a values shift, challenging the values of traditional audiology. This research demonstrates a need to establish the values of hearing health care service delivery through a consensus of stakeholders, including individuals from diverse backgrounds underserved by the traditional model. [ABSTRACT FROM AUTHOR]

This article is the seventh in a series of eight articles that comprise a special issue on family-centered early intervention for children who are deaf or hard of hearing and their families, or FCEI-DHH. This article, Structure Principles , is the third of three articles (preceded by Foundation Principles and Support Principles) that describe the 10 FCEI-DHH Principles. The Structure Principles include 4 Principles (Principle 7 , Principle 8 , Principle 9 , and Principle 10) that highlight (a) the importance of trained and effective Early Intervention (EI) Providers, (b) the need for FCEI-DHH teams to work collaboratively to support families, (c) the considerations for tracking children's progress through developmental assessment, and (d) the essential role of progress monitoring to continuously improve systems. [ABSTRACT FROM AUTHOR]

Demands for effective assessments of speech perception specific to the aging brain are increasing, as the impacts of hearing loss on an individual's functional health, socialization, and cognition have become more widely recognized. Understanding the mechanisms behind the optimal function of the aging brain in relation to speech and language is challenging, especially in the bilingual population where the language learning and language interference processes could be mistaken for perceptual difficulty. Age-related presbycusis is unavoidable, and the contributions of this sensorineural hearing loss (SNHL) process on impaired speech recognition are not completely understood. This lack of understanding of the effects of aging and bilingual language competency on speech perception can act as a barrier to successful auditory rehabilitation. The present study investigated the effects of aging on vowel sound discrimination in adult listeners (age 50+) with the following characteristics: American English (AE) monolinguals with normal hearing, simultaneous or early sequential Spanish- English (SE) bilinguals with normal hearing, and AE monolinguals with SNHL (AESNHL). The goal was to identify the differences in vowel sound discrimination performance between the monolingual and bilingual aging populations to guide future language assessments and intervention processes. English vowel discrimination was assessed using an AXB discrimination task in quiet and using the Quick Speech in Noise (QuickSIN) test. SE bilinguals were outperformed by AE and AE-SNHL monolinguals, suggesting SE bilinguals primarily use their L1 acoustic properties to discriminate speech segments. No significant difference was found in QuickSIN performance between the bilingual and the monolingual groups, but there was a significant difference between AE and AE-SNHL. In conclusion, vowel discrimination was affected by interference with the native language, while performance in the noise condition was affected by hearing loss. The results of this study contribute to our understanding of the age-related speech processing deficits from three different aging groups regarding the cognitive control system. [ABSTRACT FROM AUTHOR]

Conducting research in clinical settings is challenging. The aim of this study was to increase our understanding of hearing care professionals' perceptions of barriers to participating in such research. A modified group concept mapping approach was used to gain anonymous responses from 124 hearing care professionals to the statement: "One reason why it is hard to conduct intervention research studies in my centre/practice is....". Participants were asked for reasons other than 'time' as this is universally reported as a barrier to clinical research. A total of 107 distinct reasons were provided by participants and these were sorted into 5 clusters: "Competing demands/pressures" (18 statements), "Not a priority for management/organisation" (14 statements), "Lack of opportunity/support" (19 statements), "Clinician's knowledge, confidence, and beliefs" (24 statements), and "Recruitment/adherence to protocols is challenging" (32 statements). Identified barriers were generally similar to those reported in other healthcare settings, with unique barriers being those associated with a fear of scrutiny and lack of trust in the "academic elite". Findings highlight the importance of researchers, clinicians, and clinic managers working together at all stages of the research process in order for clinical research to be successful. [ABSTRACT FROM AUTHOR]