Clinicians' views of using cortical auditory evoked potentials (CAEP) in the permanent childhood hearing impairment patient pathway.

Objective: To obtain clinicians' views on the use of cortical auditory evoked potentials (CAEP) in the clinical pathway.Design: A questionnaire aimed at clinicians who use the HEARLab system with the Aided Cortical Assessment (ACA) Module. Results compared for Australians (where HEARLab produced) to other countries.Sample: The questionnaire was completed by 49 clinicians; 33 from Australia and 13 clinicians outside of Australia and 3 clinicians, destination unknown.Results: The findings of this research demonstrated that clinicians using CAEPs found them valuable for clinical practice. CAEPs were used to verify or modify hearing aid fittings and were used for counselling parents to reinforce the need for hearing aids. With the use of speech token as the stimulus clinicians had more relevant information to increase confidence in decision-making on paediatric hearing management.Conclusions: The main benefit from the use of CAEPs (using speech token stimuli) was for infant hearing aid fitting programmes, to facilitate earlier decisions relating to hearing aid fitting, for fine-tuning the aids and as an additional measure for cochlear implant referrals.

Development of a hearing help-seeking questionnaire based on the theory of planned behavior.

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

A qualitative review of parents' perspectives on the value of CAEP recording in influencing their acceptance of hearing devices for their child.

Objective: To obtain a parental perspective on how audiological tests, including recording cortical auditory-evoked potentials (CAEP) to speech sounds, influenced their uptake of hearing devices for their infant. Design: A focus group was established by parents of hearing-impaired children. A facilitator explored how audiology tests influenced their understanding and management of hearing loss in their child and their acceptance of hearing aids or cochlear implant referral. The views were transcribed and thematic analysis was used to understand key topics. Study samples: Eight sets of parents participated. Their children had been enrolled in an audiology pathway that included CAEP testing. The sample included six children who were aided, one child who was going through the implant assessment and one child who was implanted. Results: Parents reported that it was important for them to understand the test results because this influenced acceptance of hearing aids and cochlear implant assessments. Seven sets of parents had not understood ABR results, while six reported that CAEPs had helped them to understand their child's hearing and need for intervention. Conclusion: Compliance with early hearing aid use and referral for cochlear implant depends upon parents' understanding of their infant's hearing loss by including CAEPs in the audiology pathway.

[Newborn Hearing Screening - Results of a Parental Survey in Saxony-Anhalt]. / Neugeborenen-Hörscreening ­ Ergebnisse einer Elternbefragung in Sachsen-Anhalt.

Background: In recent years quality assurance has become an essential part of today's health-care system in the wake of the modern patient-oriented quality management. With the statutory introduction of newborn hearing screening (NHS) in 2009, a quality assurance of these early detection methods has become necessary. The aim of the study was to determine patient satisfaction in relation to the NHS in Saxony-Anhalt. Patients/Methods: During the period from November 2013 to April 2014, 394 parents were retrospectively interviewed about their experiences and expectations in relation to the NHS, using a standardised questionnaire. In total, 21 child care centres and 6 paediatric primary care centres from all over Saxony-Anhalt were involved. Results: It turns out that the majority of parents are satisfied with the NHS and 97.7% are in favour of the offer of an NHS. Of the surveyed parents, 69.3% felt the information as sufficient. However, only 66.2% of parents took a closer look at the leaflet issued by the G-BA. In addition, 17.7% of respondents are dissatisfied with the professional competence of the examining staff. Conclusion: The study shows that the general attitude among parents towards newborn hearing screening was very positive. They felt reassured by it although there are some aspects still open to criticism.

Knowledge and attitude of parents/caregivers towards hearing loss and screening in newborns - a systematic review.

OBJECTIVE: The parents/caregivers of a newborn play a pivotal role in the process of hearing screening and intervention. The decisions taken by them depend on their knowledge and attitude. The purpose of this study was to review the literature systematically on knowledge and attitude of parents/caregivers towards infant hearing loss and newborn hearing screening. DESIGN: A systematic search was conducted using electronic databases for the periods from 1990 to March 2016. Two authors scrutinized the studies and extracted the data based on predetermined criteria. STUDY SAMPLE: Ten studies. RESULTS: Ear discharge was correctly identified as a risk factor for hearing loss along with measles, drugs/medication, family history, congenital causes and noise exposure. The studies revealed mixed results for knowledge about newborn hearing screening. Overall, the parents/caregivers showed positive attitudes towards hearing screening and intervention options. However, due to heterogeneity in the studies, it's hard to derive a conclusion. CONCLUSIONS: The present review sheds light on the common areas of misconception among parents/caregivers about risk factors of infant hearing loss and newborn hearing screening. The review also draws attention to the need to have more studies exploring this knowledge and attitude of parents/caregivers among diverse populations.

[Hearing function and hearing loss in the elderly]. / Hörfähigkeit und Schwerhörigkeit alter Menschen.

Statistically, hearing function decreases with advancing age, but not all people are affected to the same extent. Environmental influences, such as noise exposure in particular, also play an important role in the development of hearing loss. Since the functional capacity of parts of the central auditory processing system can also diminish with age, these should also be evaluated in diagnostic procedures. Rehabilitative treatment of older people with hearing aids in particular, has to be improved. Audiotherapy can enhance the acceptance of hearing aids and optimize central auditory processing.

Auditory neuropathy spectrum disorder in the wider health context: experiences of parents whose infants have been identified through newborn hearing screening programme.

OBJECTIVE: This paper presents an insight into the parental experiences of how parents made sense of having their child identified with auditory neuropathy spectrum disorder (ANSD), given the broader context of their child's other health issues. DESIGN: Qualitative narrative study. STUDY SAMPLE: Twenty-one families participated whose children had been identified with ANSD through the newborn hearing screening programme. RESULTS: The majority of parents in the sample were overwhelmed with perinatal health issues and initially gave the diagnosis of ANSD very low priority. CONCLUSIONS: An understanding of parents' perspective is particularly relevant to everyone involved in early support and management of infants with ANSD.

Impaired perception of harmonic complexity in congenital amusia: a case study.

This study investigates whether congenital amusia (an inability to perceive music from birth) also impairs the perception of musical qualities that do not rely on fine-grained pitch discrimination. We established that G.G. (64-year-old male, age-typical hearing) met the criteria of congenital amusia and demonstrated music-specific deficits (e.g., language processing, intonation, prosody, fine-grained pitch processing, pitch discrimination, identification of discrepant tones and direction of pitch for tones in a series, pitch discrimination within scale segments, predictability of tone sequences, recognition versus knowing memory for melodies, and short-term memory for melodies). Next, we conducted tests of tonal fusion, harmonic complexity, and affect perception: recognizing timbre, assessing consonance and dissonance, and recognizing musical affect from harmony. G.G. displayed relatively unimpaired perception and production of environmental sounds, prosody, and emotion conveyed by speech compared with impaired fine-grained pitch perception, tonal sequence discrimination, and melody recognition. Importantly, G.G. could not perform tests of tonal fusion that do not rely on pitch discrimination: He could not distinguish concurrent notes, timbre, consonance/dissonance, simultaneous notes, and musical affect. Results indicate at least three distinct problems-one with pitch discrimination, one with harmonic simultaneity, and one with musical affect-and each has distinct consequences for music perception.

Predictors of Purchasing a Hearing Aid After an Evaluation Period: A Prospective Study in Dutch Older Hearing Aid Candidates.

Purpose The current study aimed to identify factors that distinguish between older (50+ years) hearing aid (HA) candidates who do and do not purchase HAs after having gone through an HA evaluation period (HAEP). Method Secondary data analysis of the SUpport PRogram trial was performed (n = 267 older, 1st-time HA candidates). All SUpport PRogram participants started an HAEP shortly after study enrollment. Decision to purchase an HA by the end of the HAEP was the outcome of interest of the current study. Participants' baseline covariates (22 in total) were included as candidate predictors. Multivariable logistic regression modeling (backward selection and reclassification tables) was used. Results Of all candidate predictors, only pure-tone average (average of 1, 2, and 4 kHz) hearing loss emerged as a significant predictor (odds ratio = 1.03, 95% confidence interval [1.03, 1.17]). Model performance was weak (Nagelkerke R 2 = .04, area under the curve = 0.61). Conclusions These data suggest that, once HA candidates have decided to enter an HAEP, factors measured early in the help-seeking journey do not predict well who will and will not purchase an HA. Instead, factors that act during the HAEP may hold this predictive value. This should be examined.

Parental experiences of the newborn hearing screening programme in Wales: a postal questionnaire survey.

OBJECTIVES: To evaluate parental experiences and satisfaction with Newborn Hearing Screening Wales, which was set up over 18 months in 2003-04 to provide an all-Wales neonatal hearing screening programme. METHODS: A postal questionnaire was developed and piloted, then distributed to mothers of babies who had recently been screened. RESULTS: General satisfaction levels were high. Women were less satisfied with the information provided than with staff or the test itself. Women whose babies had had no clear responses on initial screening were significantly more likely to feel that the test upset their baby (P<0.05) and that there were things they were unhappy with about the screening programme (P<0.01). These women also reported significantly more anxiety after screening than women whose babies had clear initial responses (P<0.01). CONCLUSIONS: The survey results provide a baseline against which future user satisfaction surveys of neonatal hearing screening programmes can be evaluated. They highlight significant differences in user satisfaction between those whose babies had clear responses on initial screening and those who did not, and point to areas where improvement may be possible.

Auditory skills of figure-ground and closure in air traffic controllers. / Habilidades auditivas de figura-fundo e fechamento em controladores de tráfego aéreo.

PURPOSE: To investigate the auditory skills of closure and figure-ground and factors associated with health, communication, and attention in air traffic controllers, and compare these variables with those of other civil and military servants. METHODS: Study participants were sixty adults with normal audiometric thresholds divided into two groups matched for age and gender: study group (SG), comprising 30 air traffic controllers and control group (CG), composed of 30 other military and civil servants. All participants were asked a number of questions regarding their health, communication, and attention, and underwent the Speech-in-Noise Test (SIN) to assess their closure skills and the Synthetic Sentence Identification Test - Ipsilateral Competitive Message (SSI-ICM) in monotic listening to evaluate their figure-ground abilities. Data were compared using nonparametric statistical tests and logistic regression analysis. RESULTS: More individuals in the SG reported fatigue and/or burnout and work-related stress and showed better performance than that of individuals in the CG for the figure-ground ability. Both groups performed similarly and satisfactorily in the other hearing tests. The odds ratio for participants belonging in the SG was 5.59 and 1.24 times regarding work-related stress and SSI-ICM (right ear), respectively. CONCLUSION: Results for the variables auditory closure, self-reported health, attention, and communication were similar in both groups. The SG presented significantly better performance in auditory figure-ground compared with that of the CG. Self-reported stress and right-ear SSI-ICM were significant predictors of individuals belonging to the SG.

OBJETIVO: Investigar o perfil das habilidades auditivas de fechamento e figura-fundo e fatores relacionados à atenção, comunicação e saúde de controladores de tráfego aéreo (CTA) de aproximação de aeronaves e comparar com os de outros profissionais civis e militares. MÉTODO: Participaram 60 adultos com limiares audiométricos normais reunidos em dois grupos, pareados por idade e gênero: o grupo estudo formado por 30 profissionais do Controle de Aproximação de aeronaves e o controle, por 30 outros servidores civis e militares. Todos foram submetidos a perguntas relacionadas à atenção, comunicação e saúde e ao Teste de Fala com Ruído e de Identificação de Sentenças Sintéticas em escuta monótica (SSI) para avaliar fechamento e figura-fundo, respectivamente. Foram usados testes estatísticos não paramétricos e análise de regressão logística. RESULTADOS: O CTA autorreferiu maior cansaço/esgotamento e estresse e obteve melhor desempenho do que o grupo controle em figura-fundo e semelhante em fechamento. Foi observado que ocorreu uma probabilidade de ser CTA para o estresse em 5,59 vezes e para identificação de sentenças em escuta monótica à orelha direita de 1,24. CONCLUSÃO: Fechamento e autorrelato de dificuldades de saúde, comunicação e atenção na maioria das questões foram similares em ambos os grupos. Figura-fundo foi significativamente melhor em CTA. Autorreferência de estresse e desempenho à orelha direita no SSI foram preditores significantes do indivíduo ser do CTA.

Person-centred cochlear implant care: Assessing the need for clinic intervention in adults with cochlear implants using a dual approach of an online speech recognition test and a questionnaire.

OBJECTIVES: To evaluate the feasibility of adults with cochlear implants using an online speech recognition test and questionnaire at home to assess whether they need to come to the clinic or not. METHODS: A prospective single-centre feasibility study evaluating • An online speech recognition test (digit triplet test (DTT)). • A long-term follow-up questionnaire to assess aspects that a clinician would ask in a face-to-face appointment. • A satisfaction questionnaire to assess patient perception of remote speech recognition testing. • Seventeen people using cochlear implants aged from 34 to 84 years took part. RESULTS: • The majority of adults were able and willing to use tools at home to assess if they need to come to the centre. • The DTT speech reception threshold was repeatable on three occasions within 3 weeks. • The majority of adults felt positive about testing their own hearing using the DTT at home. However, only a minority (two out of 17) felt they preferred remote testing to clinic testing (the majority was undecided). CONCLUSION: The concept of a dual approach of online speech recognition test and questionnaire both done at home has potential to identify which adults with cochlear implants require clinic intervention, although sensitivity and specificity measures are unknown. A clinic visit remains the gold standard of care, but remote care may supplement traditional care pathways.

Maternal anxiety following newborn hearing screening: the moderating role of knowledge.

OBJECTIVES: To describe the impact upon maternal anxiety of newborn hearing screening and examine the Possible moderating role of knowledge. METHODS: Questionnaires assessing maternal state anxiety, worry and certainty about the baby's hearing, and knowledge about screening, were sent to four groups of mothers three weeks after screening: Group 1 consisted of mothers whose babies had clear responses on a first or second screening test (n=103); Group 2 consisted of mothers whose babies had clear responses on the third screening test (n=81); Group 3 consisted of mothers whose babies did not have clear responses in one ear at the third screening test and were referred for audiological assessment (n=105); and Group 4 consisted of mothers whose babies did not have clear responses in either ear at the third hearing test and were referred for audiological assessment (n=55). RESULTS: Although mean anxiety levels were in the normal range, there was a significant trend for anxiety to rise as testing increased (F(1,327)=4.280, P<0.05). Worry increased significantly (F(1,337)=70.432, P<0.001) and certainty decreased significantly (F(1,339)=27.474, P=0.001) as the number of tests increased. Although total knowledge did not significantly moderate anxiety (R(2)=0.016, P=0.096), there was a significant interaction between mothers' group and one knowledge item, understanding that receipt of no clear responses was unlikely to mean that the baby had a hearing loss: mothers in Group 4 who understood this had lower anxiety (F(3,323)=4.791, P<0.01) and lower worry (F(3,332)=3.565, P<0.01) compared with mothers who did not. CONCLUSIONS: Understanding the meaning of being recalled following screening may avoid some of the anxiety associated with this.

The management of children with Down syndrome and profound hearing loss.

INTRODUCTION: Although, the association between Down syndrome (DS) and conductive hearing loss is well recognized, the fact that a small proportion of these children may have a severe to profound sensorineural hearing loss that could benefit from cochlear implantation (CI) is less well understood. The management of significant co-morbidities in children with DS can delay initial diagnosis of hearing impairment and assessment of suitability for CI can likewise be challenging, due to difficulties conditioning to behavioural hearing tests. METHODS: We performed a retrospective case note review of three children with DS referred to the Manchester Cochlear Implant Programme. RESULTS: Three illustrative cases are described including CI in a 4 years old. Using conventional outcome measurement instruments, the outcome could be considered to be suboptimal with a Categories of Auditory Performance score of 4 at 6 months post-op and at last follow up. In part, this is likely to reflect the delay in implantation, but the role of cognitive impairment must be considered. The cases described emphasize the importance of comprehensive radiological and audiological assessment in children with DS being considered for CI. CONCLUSION: The influence of cognitive impairment upon outcome of CI must be taken into account, but should not be considered a contra-indication to implantation in children with DS. Benefit that might be considered limited when quantified using existing general outcome measurement instruments, may have a significant impact upon psychosocial development and quality of life in children with significant cognitive impairment, or other additional needs.

Maternal anxiety and satisfaction following infant hearing screening: a comparison of the health visitor distraction test and newborn hearing screening.

BACKGROUND: Newborn hearing screening is currently replacing the health visitor distraction test (HVDT) conducted at eight months. Our previous research indicates that recall for further tests following newborn hearing screening can have a negative impact on the emotional well being of mothers, but it is not known if this is greater than that caused by recall following the distraction test. OBJECTIVE: To compare the impact on maternal anxiety and satisfaction of recall following newborn hearing screening and the HVDT. METHODS: Four groups participated: 27 mothers of babies receiving a satisfactory result and 21 mothers of babies recalled after the HVDT 26 mothers of babies receiving a satisfactory result and 16 mothers of babies recalled after newborn hearing screening. Questionnaires assessing maternal anxiety, worry and certainty about the babies' hearing, satisfaction with and attitudes towards the screening test were sent to mothers three weeks and six months following screening. RESULTS: Comparison of the effects of receipt of different results showed no significant differences in maternal anxiety, worry and certainty between the two tests. Those mothers whose babies had a newborn hearing screening test were significantly more satisfied, regardless of the result received. Those who received a satisfactory result on the newborn hearing screening programme also had more positive attitudes towards that screening test than those receiving a satisfactory result following the HVDT. CONCLUSION: These results suggest that newborn hearing screening does not have a more negative emotional impact than the HVDT.

When instructions fail. The effects of stimulus control training on brain injury survivors' attending and reporting during hearing screenings.

Bedside hearing screenings are routinely conducted by speech and language pathologists for brain injury survivors during rehabilitation. Cognitive deficits resulting from brain injury, however, may interfere with obtaining estimates of auditory thresholds. Poor comprehension or attention deficits often compromise patient abilities to follow procedural instructions. This article describes the effects of jointly applying behavioral methods and psychophysical methods to improve two severely brain-injured survivors' attending and reporting on auditory test stimuli presentation. Treatment consisted of stimulus control training that involved differentially reinforcing responding in the presence and absence of an auditory test tone. Subsequent hearing screenings were conducted with novel auditory test tones and a common titration procedure. Results showed that prior stimulus control training improved attending and reporting such that hearing screenings were conducted and estimates of auditory thresholds were obtained.

Failure of hearing screening in high-risk neonates does not increase parental anxiety.

OBJECTIVE: The aim of this study was to determine whether a failure of neonatal hearing screening affected the anxiety level of parents of high-risk infants. METHODS: Two hundred and eighty-eight parents of infants included in the neonatal hearing screening protocol of our Institution were tested with the Spielberger State-Trait Anxiety Inventory and with an open-question questionnaire investigating parents' attitude to hearing problems in their child, done at the time of audiological follow-up. 105 were parents of high-risk infants who had been discharged from neonatal intensive care unit (NICU) and 183 of low-risk infants discharged from well-baby nursery. RESULTS: No differences in anxiety levels were seen between parents of high-risk infants passing and failing neonatal hearing screening using homogeneous case-control pairs. Additionally, no differences in the level of anxiety were found between parents of high- and low-risk infants failing neonatal auditory screening. CONCLUSIONS: Failure of neonatal auditory screening does not affect the anxiety levels of parents of high-risk infants at post discharge from NICU. This finding is a key factor to be considered when evaluating the costs and benefits of tests for universal neonatal hearing screening.

Habilidades auditivas de figura-fundo e fechamento em controladores de tráfego aéreo / Auditory skills of figure-ground and closure in air traffic controllers

RESUMO Objetivo Investigar o perfil das habilidades auditivas de fechamento e figura-fundo e fatores relacionados à atenção, comunicação e saúde de controladores de tráfego aéreo (CTA) de aproximação de aeronaves e comparar com os de outros profissionais civis e militares. Método Participaram 60 adultos com limiares audiométricos normais reunidos em dois grupos, pareados por idade e gênero: o grupo estudo formado por 30 profissionais do Controle de Aproximação de aeronaves e o controle, por 30 outros servidores civis e militares. Todos foram submetidos a perguntas relacionadas à atenção, comunicação e saúde e ao Teste de Fala com Ruído e de Identificação de Sentenças Sintéticas em escuta monótica (SSI) para avaliar fechamento e figura-fundo, respectivamente. Foram usados testes estatísticos não paramétricos e análise de regressão logística. Resultados O CTA autorreferiu maior cansaço/esgotamento e estresse e obteve melhor desempenho do que o grupo controle em figura-fundo e semelhante em fechamento. Foi observado que ocorreu uma probabilidade de ser CTA para o estresse em 5,59 vezes e para identificação de sentenças em escuta monótica à orelha direita de 1,24. Conclusão Fechamento e autorrelato de dificuldades de saúde, comunicação e atenção na maioria das questões foram similares em ambos os grupos. Figura-fundo foi significativamente melhor em CTA. Autorreferência de estresse e desempenho à orelha direita no SSI foram preditores significantes do indivíduo ser do CTA.

ABSTRACT Purpose To investigate the auditory skills of closure and figure-ground and factors associated with health, communication, and attention in air traffic controllers, and compare these variables with those of other civil and military servants. Methods Study participants were sixty adults with normal audiometric thresholds divided into two groups matched for age and gender: study group (SG), comprising 30 air traffic controllers and control group (CG), composed of 30 other military and civil servants. All participants were asked a number of questions regarding their health, communication, and attention, and underwent the Speech-in-Noise Test (SIN) to assess their closure skills and the Synthetic Sentence Identification Test - Ipsilateral Competitive Message (SSI-ICM) in monotic listening to evaluate their figure-ground abilities. Data were compared using nonparametric statistical tests and logistic regression analysis. Results More individuals in the SG reported fatigue and/or burnout and work-related stress and showed better performance than that of individuals in the CG for the figure-ground ability. Both groups performed similarly and satisfactorily in the other hearing tests. The odds ratio for participants belonging in the SG was 5.59 and 1.24 times regarding work-related stress and SSI-ICM (right ear), respectively. Conclusion Results for the variables auditory closure, self-reported health, attention, and communication were similar in both groups. The SG presented significantly better performance in auditory figure-ground compared with that of the CG. Self-reported stress and right-ear SSI-ICM were significant predictors of individuals belonging to the SG.

Early hearing detection and intervention: parent experiences with the diagnostic hearing assessment.

PURPOSE: The aim of this study was to investigate parent experiences with the infant diagnostic hearing evaluation process. METHOD: This study used a cross-sectional survey design. Surveys were distributed via parent support organizations in December 2009 to parents of children with hearing loss. A total of 416 completed surveys were received from 43 states. RESULTS: The median age of diagnosis of hearing loss has decreased over time from 11 months of age to 2 months. For babies born between 2006 and 2009, the most frequently reported challenge to obtaining a diagnostic hearing evaluation by 3 months of age was a delay in appointment availability (36%). Just >¼ (27%) of parents reported that they did not feel comfortable in knowing what they needed to do next after talking with the audiologist at the time their child was diagnosed with hearing loss. CONCLUSION: Significant progress has been made over the past 2 decades in reducing the age of hearing loss identification. However, many parents in this study experienced challenges that resulted in delays that exceeded Joint Committee on Infant Hearing (2007) recommendations of diagnosis by 3 months of age. The parent-reported experiences provide valuable information about areas that need further investigation to improve the early hearing detection and intervention process for children with hearing loss.