Tissue Classification After Bone-Anchored Hearing Implant Surgery: A Machine Learning Approach to Monitoring Skin Response.

HYPOTHESIS: Here, we aim to 1) expand the available evidence for the use of machine learning techniques for soft tissue classification after BCD surgery and 2) discuss the implications of such approaches toward the development of classification applications to aid in tissue monitoring. BACKGROUND: The application of machine learning techniques in the soft tissue literature has become a large field of study. One of the most commonly reported outcomes after percutaneous bone-conduction device (BCD) surgery is soft tissue health. Unfortunately, the classification of tissue around the abutment as healthy versus not healthy is a subjective process, even though such decisions can have implications for treatment (i.e., topical steroid versus surgical revision) and resources (e.g., clinician time). METHODS: We built and tested a convolutional neural network (CNN) model for the classification of tissues that were rated as "green" (i.e., healthy), "yellow" (i.e., unhealthy minor), and "red" (i.e., unhealthy severe). METHODS: Representative image samples were gathered from a regional bone-conduction amplification site (N = 398; 181 samples of green; 144 samples of yellow; 73 samples of red). The image samples were cropped, zoomed, and normalized. Feature extraction was then implemented and used as the input to train an advanced CNN model. RESULTS: Accuracy of image classification for the healthy ("green") versus not healthy ("yellow" and "red") model was approximately 87%. Accuracy of image classification for the unhealthy ("yellow") versus unhealthy ("red") model was approximately 94%. CONCLUSIONS: Monitoring tissue health is an ongoing challenge for BCD users and their clinicians not trained in soft tissue management (e.g., audiologists). If machine learning can aid in the classification of tissue health, this would have significant implications for stakeholders. Here we discuss how machine learning can be applied to tissue classification as a potential technological aid in the coming years.

An investigation of white matter properties as they relate to spelling behaviour in skilled and impaired readers.

RESULTS: While the inferior longitudinal fasciculus was more strongly related to spelling behaviour in skilled adults, the uncinate fasciculus was more strongly related to spelling behaviour in impaired adults. We found strong left lateralization of the arcuate fasciculus and inferior longitudinal fasciculus in both groups. However, lateralization of the inferior frontal occipital fasciculus was more strongly related to spelling response time behaviour in skilled adults, whereas lateralization of the uncinate fasciculus was more strongly related to spelling accuracy behaviour in the impaired adults. CONCLUSION: This study provides some useful information for understanding the underlying white matter pathways that support spelling in skilled and impaired adults and underscore the advantage of adopting multiple spelling tasks and outcomes (i.e., response time and accuracy) to better characterize brain-behaviour relationships in skilled and impaired adults.

Which threshold do we trust? A comparison of threshold measurements in adult bone-conduction device users and normal hearing adults.

OBJECTIVES: Advancements in prescriptive formulae for bone-conduction hearing devices (BCDs) have highlighted the importance of measuring in-situ bone-conduction hearing thresholds. In-situ measurements are performed within the BCD manufacturer's software, using the patient's BCD as a transducer. While in-situ testing is a different approach than standard diagnostic bone-conduction testing, both approaches are in fact measuring the same inner ear hearing. Despite this, each approach may result in different thresholds for the same individual. This study aimed to answer the following question: In adults with normal hearing and adults who currently wear a bone-conduction device, are there differences and, if so, how large are these differences when thresholds are measured using different approaches? DESIGN: Bone-conduction hearing thresholds were measured for a group 32 normal hearing participants and a group 15 percutaneous BCD users. The normal hearing participants were tested in two conditions: (1) in-situ, with a BCD worn on a soft-band and (2) with the B71 bone-conduction diagnostic transducer. The BCD users were tested in these two conditions and (3) in-situ with a BCD attached to their abutment. In-situ hearing thresholds were measured with BCDs from two manufacturers. The mean intra-subject differences between these conditions were calculated. RESULTS: For the normal hearing participants, BCD softband thresholds were poorer than the thresholds obtained with the diagnostic transducer across all tested frequencies. The average differences between the BCD softband thresholds and the diagnostic transducer were particularly large in the high frequencies (13 to 35 dB from 3 to 6 kHz). Similar differences were observed for the BCD user participants when comparing their BCD softband thresholds to the diagnostic transducer thresholds. The in-situ percutaneous thresholds were on average better than the diagnostic bone-conduction thresholds, although the differences were not statistically significant. Skin attenuation, calibration differences, and BCD characteristics were contributing factors to these differences. CONCLUSIONS: The intra-subject differences measured in this study confirmed that using different bone-conduction transducers results in the measurement (i.e., recording) of different hearing threshold levels. These results support the necessity for a measurement tool able to measure audibility at threshold independent of the various coupling configurations used in bone-conduction amplification. An effective measurement tool would be required to take into account, or bypass, the factors contributing to the differences measured in this study. Until such a tool is commercially available, clinicians will continue to face uncertainty when fitting and attempting to assess the audibility of passive transcutaneous BCDs.

From lollipops to lidocaine: The need for a universal print-to-speech framework.

OBJECTIVE: There is a strong relationship between reading and articulation (Lervåg & Hulme, 2009; Pan et al., 2011). Given the tight coupling of these processes, innovative approaches are needed to understand the intricacies associated with print-speech connections. Here we ran a series of tightly controlled experiments to examine the impact of mouth perturbations on silent reading. METHOD: We altered the mouth, via somatosensory feedback, in several ways: (a) a large lollipop in the mouth (E1), (b) a candy stick (bite bar) held horizontally between the teeth (E2), and (c) lidocaine that served to numb the mouth (E3). Three tasks were completed: (a) picture categorization, (b) "spell" lexical decision (Spell-LDT; "does the letter string spell a real word, yes or no?"), and (c) "sound" lexical decision (Sound-LDT; "does the letter string sound like a real word, yes or no?"). Participants (N = 97; E1 = 27; E2 = 32; E3 = 38) completed each of the tasks two times: once with a somatosensory perturbation (lollipop, bite bar, or lidocaine) and once without. RESULTS: For each experiment, a linear mixed effects analysis was run. Overall, we found that the lollipop (E1) and lidocaine (E3) had some specific effects on word recognition (e.g., for "no" responses), particularly in the Spell-LDT, whereas the bite bar (E2) had no effect on word recognition. The picture categorization task was not impacted by any perturbations. CONCLUSION: These findings provide evidence that sensorimotor information is connected to reading. We discuss how these findings advance our understanding of a print-to-speech framework. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A survey of public awareness of dysphagia.

OBJECTIVES: Purpose: Dysphagia affects a wide cross-section of society. Reports of stigma and missed diagnoses suggest limited public awareness of this prevalent condition, exacerbating the hidden disability stemming from this impairment. This study explored the public awareness of dysphagia among people both with and without occupational ties to healthcare to assess the level of awareness and identify topics where public knowledge may be deficient. METHODS: Method: An online purpose-built survey was administered to determine self-assessed awareness of dysphagia, and researcher-assessed understanding of the causes, symptoms, assessment and treatment of swallowing disorders. Survey answers (n = 374) were grouped by healthcare (n = 105) and non-healthcare (n = 269) respondents. Responses were analysed using both qualitative and quantitative methods. RESULTS: Result: Self-assessed respondent awareness was low among 71% of non-healthcare and 29% of healthcare respondents, corroborating the limited demonstrated knowledge of the causes, symptoms, assessment and treatment of dysphagia. Self-assessed and researcher-assessed awareness was more limited among non-healthcare respondents. CONCLUSIONS: Conclusion: Survey results confirm limited public knowledge of dysphagia and demonstrate the need for greater public awareness of this largely invisible disorder.

Psychosocial outcome measures for conductive and mixed hearing loss treatment: An overview of the relevant literature.

OBJECTIVE: To identify the psychosocial assessments utilized with individuals with conductive and/or mixed hearing loss as part of a broader effort by the Auditory Rehabilitation Outcomes Network (AURONET) group to develop a core set of patient-centred outcome measures. DESIGN: A review of articles published between 2006 and 2016 was completed. Included studies had more than three adult participants, were available in English, and reported a psychosocial outcome from any treatment of mixed and/or conductive hearing loss. STUDY SAMPLE: Sixty-six articles from seven databases. RESULTS: Sixty-six articles met our inclusion/exclusion criteria. Within this set, 15 unique psychosocial or patient-reported outcome measures (PROs) were identified, with the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Glasgow Benefit Inventory (GBI) being the most frequently dispensed. Five of the fifteen were only administered in one study. In-house questionnaires (IHQs) were reported in 19 articles. CONCLUSIONS: Only 66 (22%) of the 300 articles with outcomes contained a PRO. Some of the mostly frequently employed PROs (e.g., APHAB) were judged to include only social items and no psychological items. Lack of PRO standardization and the use of IHQs make psychosocial comparisons across treatments in this population difficult for patients, clinicians and stakeholders.

Hearing outcome measures for conductive and mixed hearing loss treatment in adults: a scoping review.

OBJECTIVE: Rehabilitation options for conductive and mixed hearing loss are continually expanding, but without standard outcome measures comparison between different treatments is difficult. To meaningfully inform clinicians and patients core outcome sets (COS), determined via a recognised methodology, are needed. Following our previous work that identified hearing, physical, economic and psychosocial as core areas of a future COS, the AURONET group reviewed hearing outcome measures used in existing literature and assigned them into different domains within the hearing core area. DESIGN: Scoping review. STUDY SAMPLE: Literature including hearing outcome measurements for the treatment of conductive and/or mixed hearing loss. RESULTS: The literature search identified 1434 studies, with 278 subsequently selected for inclusion. A total of 837 hearing outcome measures were reported and grouped into nine domains. The largest domain constituted pure-tone threshold measurements accounting for 65% of the total outcome measures extracted, followed by the domains of speech testing (20%) and questionnaires (9%). Studies of hearing implants more commonly included speech tests or hearing questionnaires compared with studies of middle ear surgery. CONCLUSIONS: A wide range of outcome measures are currently used, highlighting the importance of developing a COS to inform individual practice and reporting in trials/research.

Listen before you drive: the effect of voice familiarity on listening comprehension and driving performance.

OBJECTIVE: Voice familiarity has been reported to reduce cognitive load in complex listening environments. The extent to which the reduction in listening effort allows for mental resources to be reallocated to other complex tasks needs further investigation. We sought to answer whether a familiar audiobook narrator provides benefits to (1) listening comprehension and/or (2) driving performance. DESIGN: A double-blind between-groups design was implemented. Participants were randomly assigned to the Familiar group or the Unfamiliar group. STUDY SAMPLE: Participants (n = 30) were normal-hearing adults, 18 to 28-years-old (M = 23, SD = 2.6) (n = 18 female). Participants first listened to an audiobook read by either Voice 1 (Familiar condition) or Voice 2 (Unfamiliar condition). Then they completed a virtual reality driving task while listening to a second audiobook, always read by Voice 1. Audiobook comprehension (30-question multiple-choice test) and driving performance (number of driving errors made) were recorded. RESULTS: Participants in the Familiar group made fewer driving errors than participants in the Unfamiliar group. There were no differences in listening comprehension. CONCLUSIONS: Increased voice familiarity positively impacts behaviour (i.e. reduced driving errors) in normal-hearing adults. We discuss our findings in the context of effortful listening frameworks.

Comparison Of Health Insurance Coverage For Hearing Aids And Other Services In Alberta.

OBJECTIVES: Of the several barriers associated with uptake and adherence to hearing services, cost is the most commonly identified barrier in Canada. This study evaluated health insurance plans for hearing care coverage within Alberta, Canada, and subsequent out-of-pocket expenses that would result if an individual chose to pursue treatment. METHODS: An investigation of eight companies that provide supplementary health coverage in Alberta was conducted. Categories of health service coverage included hearing, vision, speech-language pathology (S-LP), physical therapy related (PT-R; including massage therapy and chiropractic therapy) and alternative medicine related (AM-R; including osteopathy, acupuncture and naturopathy). All coverage amounts were corrected to a four-year term for comparison purposes. RESULTS: For a four-year term, the coverage amounts for hearing services were CAD 300-750; for vision services were CAD 0-900; for S-LP services were CAD 0-2,400; for PT-R services were CAD 1,400-10,200; and for AM-R services were CAD 0-10,200 per four-year term. The expected out-of-pocket expense for vision ranged from CAD 0 to CAD 2,766, whereas for hearing, it ranged from CAD 250 to CAD 11,700. CONCLUSION: A considerable range and discrepancy were reported between hearing care and most paramedical services. In addition, the coverage amounts for hearing care were inconsistent with treatment costs, resulting in considerable out-of-pocket expenses for most consumers. The potential implications of such cost-related barriers on public health are an important consideration as our understanding of the impact of untreated hearing impairment continues to increase.

Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology.

OBJECTIVES: In this article, we explore two manipulations of "meaning response," intended to either "impart" meaning to participants through the manipulation of a few words in the test instructions or to "invite" meaning by making the participant feel involved in the setting of their preferred sound. DESIGN: In experiment 1, 59 adults with normal hearing were randomly assigned to one of the two groups. Group 1 was told "this hearing in noise test (HINT) you are about to do is really hard," while the second group was told "this HINT test is really easy." In experiment 2, 59 normal-hearing adults were randomly assigned to one of two groups. Every participant was played a highly distorted sound file and given 5 mystery sliders on a computer to move as often and as much as they wished until the sound was "best" to them. They were then told we applied their settings to a new file and they needed to rate their sound settings on this new file against either (1) another participant in the study, or (2) an expert audiologist. In fact, we played them the same sound file twice. RESULTS: In experiment 1, those who were told the test was hard performed significantly better than the easy group. In experiment 2, a significant preference was found in the group when comparing "my setting" to "another participant." No significant difference was found in the group comparing "my setting" to the "expert." CONCLUSIONS: Imparting or inviting meaning into the context of audiological outcome measurement can alter outcomes even in the absence of any additional technology or treatment. These findings lend support to a growing body of research about the many nonauditory factors including motivation, effort, and task demands that can impact performance in our clinics and laboratories.

"To Name or Not to Name: That is the Question": The Role of Response Inhibition in Reading.

Reading is a complex process that includes the integration of information about letters (graphemes) and sounds (phonemes). In many circumstances, such as noisy environments, response inhibition is an additional factor that plays a marked role in successful oral reading. Response inhibition can take the form of task relevant inhibition (i.e., foils in a go/no-go task) and task irrelevant inhibition (i.e., distractor information). Here we investigated task relevant inhibition by having participants (N = 30) take part in two tasks: go/no-go naming with nonwords foils (GNG-NW) and go/no-go naming with pseudohomophones foils (GNG-PH). Also, we investigated the addition of task irrelevant inhibition by having participants (N = 28) take part in two tasks: GNG-NW + information masking and GNG-PH + information masking. We provide evidence that during a task relevant inhibition task, sub-word sound level information can be successfully inhibited, as evidenced by comparable response times for regular words and exception words, provided the foils do not contain familiar sound-based information (GNG-NW). In contrast, regular words were read aloud faster than exception words in a GNG-PH task, indicating that sub-word level interference occurs when the foils contain familiar sound-based information. The addition of task irrelevant inhibition (i.e., information masking at the phoneme level), served to increase response time overall, but did not impact the pattern of response times between regular words and exception words. Together these findings provide useful information regarding the role of response inhibition in word recognition and may be useful in computational models of word recognition and future work may benefit from accounting for the effects outlined in this paper.

Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification.

Purpose: The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test performance of LTC residents with early- to middle-stage dementia and mild-to-moderate hearing loss? and (b) What is the relationship between measured hearing ability and hearing ability recorded by staff using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS; Hirdes et al., 1999)? Method: Thirty-one residents from 5 long-term care facilities participated in this quasiexperimental crossover study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants' hearing were compared to audiological assessment results. Results: Participants' speech intelligibility index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive-communication test scores with amplification. A significant correlation was found between participants' average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. Conclusions: Measuring short-term improvement of performance-based cognitive communication may not be the most effective means of assessing amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.

Are Open-Fit Hearing Aids a Possible Alternative to Bone-Anchored Hearing Devices in Patients with Mild to Severe Hearing Loss? A Preliminary Trial.

Open-fit hearing aids (OFHAs) may be of benefit for some individuals with chronic outer and middle ear conditions for which boneanchored hearing devices (BAHDs) are normally recommended. The purpose of this study was to compare performance between OFHAs and BAHDs. A Starkey Destiny 800 OFHA was fit on eight adult BAHD users and speech perception measures in quiet and in background noise were compared under two different test conditions: i) BAHD only and ii) OFHA only. Equivalent outcome measure performance between these two conditions suggests that the OFHA was able to provide sufficient amplification for mild to moderate degrees of hearing loss (pure-tone averages (PTAs) less than 47 dB HL). The improved speech perception performances and increased loudness ratings observed for several of the participants with moderately-severe to severe degrees of hearing loss (PTAs of 47 dB HL or greater) in the BAHD only condition suggest that the OFHA did not provide sufficient amplification for these individuals. Therefore, OFHAs may be a successful alternative to the BAHD for individuals with no more than a moderate conductive hearing loss who are unable or unwilling to undergo implant surgery or unable to wear conventional hearing aids due to allergies, irritation, or chronic infection associated with the ear being blocked with a shell or earmold.

Can Uhear me now? Validation of an iPod-based hearing loss screening test.

OBJECTIVE: To evaluate the uHear iPod-based application as a test for hearing loss. METHODS: We recruited 100 adult participants through a single otology practice. Patients with otorrhea and cognitive impairment were excluded. All patients completed the uHear test in the clinic and in the sound booth and underwent a standard audiogram by the same audiologist. We compared the results of the uHear test to the standard audiogram. RESULTS: The uHear was able to correctly diagnose the presence of hearing loss (pure-tone average [PTA] > 40 dB) with a sensitivity of 98% (95% CI = 89-100), a specificity of 82% (95% CI = 75-88), and a positive likelihood ratio of 9 (95% CI = 6.0-16). Compared to the audiogram, the uHear overestimated the PTA among all ears by 14 dB in the clinic and by 8 dB in the sound booth (p < .0001). Compared to the audiogram, the uHear overestimated the PTA among ears with hearing loss by 6 dB in the clinic and by 4 dB in the sound booth. CONCLUSIONS: The uHear application is a reasonable screening test to rule out moderate hearing loss (PTA > 40 dB) and and is valid at quantifying the degree of hearing loss in patients known to have abnormal hearing.

Listening levels of teenage iPod users: does measurement approach matter?

The main objective of this study was to determine the influence of background noise levels and measurement approach on user-selected listening levels (USLLs) chosen by teenaged MP3 player users. It was hypothesized that the presence of background noise would (i) increase the USLL across all measurement approaches, (ii) result in no significant USLL differences between survey reports, objective lab measures or calibrated self-report field measures, and (iii) cause no interaction effect between level of background noise and measurement approach. There were two independent variables in this study: the level of background noise and measurement approach. The first independent variable, level of background noise, had two levels: quiet and transportation noise. The second independent variable, measurement approach, had three levels: survey, objective in-ear lab measurement and calibrated self-report field measurement. The dependent variable was ear canal A-weighted sound pressure level (dBA SPL). A 2 × 3 repeated-measures ANOVA was used to determine the significance of the main and interaction effects. USLLs increased in the presence of background noise, regardless of the measurement approach used. However, the listening levels estimated by the participants using the survey and self-report field measure were significantly lower than those recorded using in-ear laboratory measurements by 9.6 and 3.3 dBA respectively. In-ear laboratory measures yielded the highest listening levels. Higher listening levels were observed in the presence of background noise for all measurement approaches. It appears that subjects' survey responses underestimate true listening levels in comparison to self-report calibrated field measures, and that both underestimate listening levels measured in the laboratory setting. More research in this area is warranted to determine whether measurement techniques can be refined and adjusted to accurately reflect real-world listening preferences.

Automated hearing tests: applying the otogram to patients who are difficult to test.

OBJECTIVE: The Otogram is an automated audiometer capable of determining air and bone conduction thresholds with masking when appropriate. The manufacturer claims that testing can be done in a quiet physician's consultation room without a sound-treated booth. We aimed to test the validity of the Otogram on "difficult-to-test" patients, all of whom require masking. METHODS: Twenty-eight difficult-to-test patients underwent three audiograms: two by an audiologist and one by the Otogram. First, audiograms performed by the audiologists were compared, establishing test-retest reliability. Second, audiograms performed by the Otogram were compared to those of the audiologists. We calculated the percentage of pure-tone thresholds that were in agreement by 10 dB. Weighted kappa statistical analyses demonstrated levels of agreement. RESULTS: Comparisons between audiologists demonstrated a very high degree of agreement. More than 90% of air and bone conduction thresholds fell within 10 dB of each other. Comparisons between audiologists and the Otogram also demonstrated a high degree of agreement. CONCLUSIONS: The Otogram has the capability to accurately ascertain air and bone conduction thresholds. It appropriately used masking when indicated. The Otogram has great potential as a diagnostic tool to improve access to health care, especially where hearing test facilities are limited or unavailable.