Methodological quality of clinical guidelines for universal newborn hearing screening.

AIM: To review existing guidelines for universal newborn hearing screening (UNHS), identify those that provide comprehensive and clear recommendations on the subject, and provide a brief overview. METHOD: A scoping literature review was performed in PubMed, the Guidelines International Network library, and national guideline databases to identify guidelines on newborn hearing screening developed or updated between 2004 and 2019. The quality of the guidelines was checked with the Checklist for the Quality Assessment of Guidelines (AGREE II). RESULTS: Six guidelines met all the inclusion criteria. All six were based on the 1-3-6 benchmark (screening completed by 1mo, audiological diagnosis by 3mo, enrolment in early intervention by 6mo). However, the guidelines varied in terms of their recommendations for the application of screening methods, role of health professionals in the screening process, and quality. Based on the AGREE II score, flexibility, adaptability, and foundation role for all other guidelines, the 2019 guidelines of the Joint Committee on Infant Hearing position statement were identified as the most appropriate to be recommended for adaptation by countries or programmes. INTERPRETATION: The diversity in the existing guidance can be confusing for countries and institutions that are planning to develop universal hearing screening programmes. As more countries and organizations develop their newborn hearing screening programmes, they will need examples to emulate. This review provides an evaluation of the quality, comprehensiveness, and applicability of existing clinical guidelines that can serve as a facilitator for countries, institutions, or organizations in their planning and implementation of a UNHS programme.

Can auditory brain stem response accurately reflect the cochlear function?

Auditory brain stem response (ABR) and compound action potential (CAP) recordings have been used in animal research to determine hearing sensitivity. Because of the relative ease of testing, the ABR test has been more commonly used in assessing cochlear lesions than the CAP test. The purpose of this experiment is to examine the difference between these two methods in monitoring the dynamic changes in auditory function after cochlear damage and in detecting asymmetric hearing loss due to unilateral cochlear damage. ABR and CAP were measured in two models of cochlear damage: acoustic trauma induced by exposure to a narrowband noise centered at 4 kHz (2,800-5,600 Hz) at 105 dB sound pressure level for 5 h in chinchillas and unilateral cochlear damage induced by surgical destruction of one cochlea in guinea pigs. Cochlear hair cells were quantified after completing the evoked potential testing. In the noise-damaged model, we found different recovery patterns between ABR and CAP. At 1 day after noise exposure, the ABR and CAP assessment revealed a similar level of threshold shifts. However, at 30 days after noise exposure, ABR thresholds displayed an average of 20-dB recovery, whereas CAP thresholds showed no recovery. Notably, the CAP threshold signifies the actual condition of sensory cell pathogenesis in the cochlea because sensory cell death is known to be irreversible in mammals. After unilateral cochlear damage, we found that both CAP and ABR were affected by cross-hearing when testing the damaged ear with the testing stimuli delivered directly into the canal of the damaged ear. When cross-hearing occurred, ABR testing was not able to reveal the presence of cross-hearing because the ABR waveform generated by cross-stimulation was indistinguishable from that generated by the test ear (damaged ear), should the test ear be intact. However, CAP testing can provide a warning sign, since the typical CAP waveform became an ABR-like waveform when cross-hearing occurred. Our study demonstrates two advantages of the CAP test over the ABR test in assessing cochlear lesions: contributing evidence for the occurrence of cross-hearing when subjects have asymmetric hearing loss and providing a better assessment of the progression of cochlear pathogenesis.NEW & NOTEWORTHY Auditory brain stem response (ABR) is more commonly used to evaluate cochlear lesions than cochlear compound action potential (CAP). In a noise-induced cochlear damage model, we found that the reduced CAP and enhanced ABR caused the threshold difference. In a unilateral cochlear destruction model, a shadow curve of the ABR from the contralateral healthy ear masked the hearing loss in the destroyed ear.

Evaluation of newborn hearing screening program.

OBJECTIVE: To evaluate Newborn Hearing Screening Program of Hospital Regional de Sobradinho, from January 2016 to December 2017, according to Multiprofessional Committee on Auditory Health parameters and Joint Committee on Infant Hearing (JCIH) recommendations, as well as to describe the prevalence of risk factors for hearing loss within the study population and their impact on the respective program. METHOD: This is a quantitative, cross-sectional and retrospective study that carefully analyzed registration books of screened newborns. It was established the prevalence of "pass" and "fail" in test and retest, retest percentage of attendance and referral for audiological diagnosis. Risk factors for hearing loss were described, as well as their influence on "pass" and "fail" rates. Inferential statistical analysis was performed using chi-square test and Anderson-Darling test, with 5% reliability index. RESULTS: A total of 3,981 newborns were screened; 2,963 (74.4%) presented no risk factors whereas 1,018 (25.6%) did, prematurity being the most frequent (51.6%). In the test, 166 (4.2%) failed and 118 (71.1%) attended the retest. The referral rate for diagnosis was 0.3%. CONCLUSION: Regarding the percentage of referral for diagnosis, the program reached indexes recommended by the Joint Committee on Infant Hearing and Multiprofessional Committee on Auditory Health. The most prevalent risk factor within the population was prematurity.

Audibility-Based Hearing Aid Fitting Criteria for Children With Mild Bilateral Hearing Loss.

Purpose Because of uncertainty about the level of hearing where hearing aids should be provided to children, the goal of the current study was to develop audibility-based hearing aid candidacy criteria based on the relationship between unaided hearing and language outcomes in a group of children with hearing loss who did not wear hearing aids. Method Unaided hearing and language outcomes were examined for 52 children with mild-to-severe hearing losses. A group of 52 children with typical hearing matched for age, nonverbal intelligence, and socioeconomic status was included as a comparison group representing the range of optimal language outcomes. Two audibility-based criteria were considered: (a) the level of unaided hearing where unaided children with hearing loss fell below the median for children with typical hearing and (b) the level of unaided hearing where the slope of language outcomes changed significantly based on an iterative, piecewise regression modeling approach. Results The level of unaided audibility for children with hearing loss that was associated with differences in language development from children with typical hearing or based on the modeling approach varied across outcomes and criteria but converged at an unaided speech intelligibility index of 80. Conclusions Children with hearing loss who have unaided speech intelligibility index values less than 80 may be at risk for delays in language development without hearing aids. The unaided speech intelligibility index potentially could be used as a clinical criterion for hearing aid fitting candidacy for children with hearing loss.

Population-based age adjustment tables for use in occupational hearing conservation programs.

Objective: In occupational hearing conservation programmes, age adjustments may be used to subtract expected age effects. Adjustments used in the U.S. came from a small dataset and overlooked important demographic factors, ages, and stimulus frequencies. The present study derived a set of population-based age adjustment tables and validated them using a database of exposed workers.Design: Cross-sectional population-based study and retrospective longitudinal cohort study for validation.Study sample: Data from the U.S. National Health and Nutrition Examination Survey (unweighted n = 9937) were used to produce these tables. Male firefighters and emergency medical service workers (76,195 audiograms) were used for validation.Results: Cross-sectional trends implied less change with age than assumed in current U.S. regulations. Different trends were observed among people identifying with non-Hispanic Black race/ethnicity. Four age adjustment tables (age range: 18-85) were developed (women or men; non-Hispanic Black or other race/ethnicity). Validation outcomes showed that the population-based tables matched median longitudinal changes in hearing sensitivity well.Conclusions: These population-based tables provide a suitable replacement for those implemented in current U.S. regulations. These tables address a broader range of worker ages, account for differences in hearing sensitivity across race/ethnicity categories, and have been validated for men using longitudinal data.

Evaluation of newborn hearing screening program / Avaliação de um programa de triagem auditiva neonatal

ABSTRACT OBJECTIVE To evaluate Newborn Hearing Screening Program of Hospital Regional de Sobradinho, from January 2016 to December 2017, according to Multiprofessional Committee on Auditory Health parameters and Joint Committee on Infant Hearing (JCIH) recommendations, as well as to describe the prevalence of risk factors for hearing loss within the study population and their impact on the respective program. METHOD This is a quantitative, cross-sectional and retrospective study that carefully analyzed registration books of screened newborns. It was established the prevalence of "pass" and "fail" in test and retest, retest percentage of attendance and referral for audiological diagnosis. Risk factors for hearing loss were described, as well as their influence on "pass" and "fail" rates. Inferential statistical analysis was performed using chi-square test and Anderson-Darling test, with 5% reliability index. RESULTS A total of 3,981 newborns were screened; 2,963 (74.4%) presented no risk factors whereas 1,018 (25.6%) did, prematurity being the most frequent (51.6%). In the test, 166 (4.2%) failed and 118 (71.1%) attended the retest. The referral rate for diagnosis was 0.3%. CONCLUSION Regarding the percentage of referral for diagnosis, the program reached indexes recommended by the Joint Committee on Infant Hearing and Multiprofessional Committee on Auditory Health. The most prevalent risk factor within the population was prematurity.

RESUMO OBJETIVO Avaliar o Programa de Triagem Auditiva Neonatal do Hospital Regional de Sobradinho, no período de janeiro de 2016 a dezembro de 2017, segundo os parâmetros do Comitê Multiprofissional em Saúde Auditiva e as recomendações do Joint Committee on Infant Hearing (JCIH), bem como descrever a prevalência dos indicadores de risco para deficiência auditiva na população estudada e seu impacto no respectivo programa. MÉTODO Trata-se de um estudo quantitativo, transversal e retrospectivo no qual foram analisados criteriosamente livros de registros dos neonatos triados. Foi estabelecida a prevalência de "passa" e "falha" no teste e reteste, o percentual de comparecimento para reteste e de encaminhamento para diagnóstico audiológico. Foram descritos os indicadores de risco para deficiência auditiva, bem como sua influência nos índices de "passa" e "falha". Foi realizada análise estatística inferencial utilizando o teste do qui-quadrado e o teste de Anderson-Darling, com índice de confiabilidade de 5%. RESULTADOS Foram triados 3.981 neonatos, 2.963 (74,4%) dos quais sem indicadores de risco e 1.018 (25,6%) com, sendo a prematuridade o mais frequente (51,6%). No teste, 166 (4,2%) falharam e 118 (71,1%) compareceram para o reteste. O índice de encaminhamento para diagnóstico foi de 0,3%. CONCLUSÃO O programa atingiu os índices recomendados pelo Joint Committee on Infant Hearing e pelo Comitê Multiprofissional em Saúde Auditiva quanto à porcentagem de encaminhamento para diagnóstico. O indicador de risco mais prevalente na população foi a prematuridade.

Generalizability of clinically measured acoustic reflexes to brief sounds.

Middle ear muscle contractions (MEMC) can be elicited in response to high-level sounds, and have been used clinically as acoustic reflexes (ARs) during evaluations of auditory system integrity. The results of clinical AR evaluations do not necessarily generalize to different signal types or durations. The purpose of this study was to evaluate the likelihood of observing MEMC in response to brief sound stimuli (tones, recorded gunshots, noise) in adult participants (N = 190) exhibiting clinical ARs and excellent hearing sensitivity. Results revealed that the presence of clinical ARs was not a sufficient indication that listeners will also exhibit MEMC for brief sounds. Detection rates varied across stimulus types between approximately 20% and 80%. Probabilities of observing MEMC also differed by clinical AR magnitude and latency, and declined over the period of minutes during the course of the MEMC measurement series. These results provide no support for the inclusion of MEMC as a protective factor in damage-risk criteria for impulsive noises, and the limited predictability of whether a given individual will exhibit MEMC in response to a brief sound indicates a need to measure and control for MEMC in studies evaluating pharmaceutical interventions for hearing loss.

Variable-rate frequency sweeps and their application to the measurement of otoacoustic emissions.

Swept tones allow the efficient measurement of otoacoustic emissions (OAEs) with fine frequency resolution. Although previous studies have explored the influence of different sweep parameters on the measured OAE, none have directly considered their effects on the measurement noise floor. The present study demonstrates that parameters such as sweep type (e.g., linear or logarithmic), sweep rate, and analysis bandwidth affect the measurement noise and can be manipulated to control the noise floor in individual subjects. Although responses to discrete-tone stimuli can be averaged until the uncertainty of the measurement meets a specified criterion at each frequency, linear or logarithmic sweeps offer no such flexibility. However, measurements of the power spectral density of the ambient noise can be used to construct variable-rate sweeps that yield a prescribed (e.g., constant) noise floor across frequency; in effect, they implement a form of frequency-dependent averaging. The use of noise-compensating frequency sweeps is illustrated by the measurement of distortion-product OAEs at low frequencies, where the ear-canal noise is known to vary significantly.

Elaboration of an instrument to evaluate the recognition of Brazilian melodies in children / Criação de um instrumento para avaliar o reconhecimento de melodias brasileiras em crianças

Abstract Introduction: There is evidence pointing to the importance of the evaluation of musical perception through objective and subjective instruments. In Brazil, there is a shortage of instruments that evaluates musical perception. Objective: To develop an instrument to evaluate the recognition of traditional Brazilian melodies and investigate the performance of children with typical hearing. Methods: The study was carried out after approval of the research ethics committee (1.198.607). The instrument was developed in software format with website access, using the languages PHP 5.5.12, Javascript, Cascade style sheets and "HTML5"; database "MYSQL 5.6.17" on the "Apache 2.4.9" server. Fifteen melodies of Brazilian folk songs were recorded in piano synthesized timbre, with 12 seconds per melody reproduction and four second intervals between them. A total of 155 schooled children, aged eight to 11 years, of both sexes, with typical hearing participated in the study. The test was performed in a silent room with sound stimuli amplified by a sound box at 65 dBNA, positioned at 0 azimuth, and at one meter from the participant, the notebook was used for children to play with on the screen on the title and illustration of the melody they recognized they were listening to. The responses were recorded on their own database. Results: The instrument titled "Evaluation of recognition of traditional melodies in children" can be run on various devices (computers, notebooks, tablets, mobile phones) and operating systems (Windows, Macintosh, Android, Linux). Access: http://192.185.216.17/ivan/home/login.php by login and password. The most easily recognized melody was "Cai, cai balão" (89%) and the least recognized was "Capelinha de melão" (25.2%). The average time to perform the test was 3′15″. Conclusion: The development and application of the software proved effective for the studied population. This instrument may contribute to the improvement of protocols for the evaluation of musical perception in children with hearing aid and/or cochlear implants users.

Resumo Introdução: Há evidências que apontam para a importância da avaliação da percepção musical através de instrumentos objetivos e subjetivos. No Brasil, há escassez de instrumentos que avaliem a percepção musical. Objetivo: Desenvolver um instrumento para avaliar o reconhecimento de melodias tradicionais brasileiras e investigar o desempenho de crianças com audição típica. Método: O estudo foi desenvolvido após aprovação do comitê de ética em pesquisa (1.198.607). O instrumento foi desenvolvido em formato de software com acesso ao site, com as linguagens de programação PHP 5.5.12, Javascript, Cascade Style Sheets e HTML5; banco de dados MYSQL 5.6.17 no servidor Apache 2.4.9. Quinze melodias de canções folclóricas brasileiras foram gravadas com timbre sintetizado em piano, com 12 segundos de reprodução da melodia e quatro segundos de intervalo entre elas. Participaram do estudo 155 crianças, alfabetizadas, entre oito e 11 anos, de ambos os sexos, com audição típica. O teste foi feito em sala silenciosa com estímulo sonoro amplificado por uma caixa sonora a 65 dB NA, posicionada a 0 azimute e a um metro do participante e o notebook foi usado para que as crianças brincassem na tela com o título e a ilustração da melodia que eles reconheceram que ouviam. As respostas foram registradas em seu próprio banco de dados. Resultados: O instrumento intitulado "Avaliação do reconhecimento de melodias tradicionais em crianças" pode ser executado em vários dispositivos (computadores, notebooks, tablets, telefones celulares) e sistemas operacionais (Windows, Macintosh, Android, Linux). Acesse: http://192.185.216.17/ivan/home/login.php através de login e senha. A melodia mais facilmente reconhecida foi "Cai cai balão" (89%) e a menos reconhecida foi "Capelinha de melão" (25,2%). O tempo médio para fazer o teste foi de 3′15″. Conclusão: O desenvolvimento e a aplicação do software se mostraram eficazes para a população estudada. Esse instrumento pode contribuir para o aprimoramento de protocolos de avaliação da percepção musical em crianças usuárias de próteses auditivas e/ou usuárias de implante coclear.

FreeHear: A New Sound-Field Speech-in-Babble Hearing Assessment Tool.

Pure-tone threshold audiometry is currently the standard test of hearing. However, in everyday life, we are more concerned with listening to speech of moderate loudness and, specifically, listening to a particular talker against a background of other talkers. FreeHear delivers strings of three spoken digits (0-9, not 7) against a background babble via three loudspeakers placed in front and to either side of a listener. FreeHear is designed as a rapid, quantitative initial assessment of hearing using an adaptive algorithm. It is designed especially for children and for testing listeners who are using hearing devices. In this first report on FreeHear, we present developmental considerations and protocols and results of testing 100 children (4-13 years old) and 23 adults (18-30 years old). Two of the six 4 year olds and 91% of all older children completed full testing. Speech reception threshold (SRT) for digits and noise colocated at 0° or separated by 90° both improved linearly across 4 to 12 years old by 6 to 7 dB, with a further 2 dB improvement for the adults. These data suggested full maturation at approximately 15 years old SRTs at 90° digits/noise separation were better by approximately 6 dB than SRTs colocated at 0°. This spatial release from masking did not change significantly across age. Test-retest reliability was similar for children and adults (standard deviation of 2.05-2.91 dB SRT), with a mean practice improvement of 0.04-0.98 dB. FreeHear shows promise as a clinical test for both children and adults. Further trials in people with hearing impairment are ongoing.

Reference ranges and stability of auditory and vestibular measures in a comprehensive assessment battery for traumatic brain injury.

BACKGROUND: Audiology clinics have many tools available to evaluate auditory and vestibular complaints. However, many tools lack established normative ranges across the life span. We conducted this study to establish reference ranges across the life span for audiology/vestibular measures commonly used to evaluate patients with traumatic brain injury. MATERIALS AND METHODS: In this repeated measures study, 75 adults, ages 18-65 years, without a history of traumatic brain injury, underwent robust auditory/vestibular evaluations three times over six months, including rotational chair, videonystagmography, computerized dynamic posturography, vestibular evoked myogenic potentials, and retinal fundoscopy. RESULTS: Age effect was notable for transient evoked otoacoustic emissions, pure-tone audiometry, auditory brainstem response, auditory middle latency response, and auditory-steady state response at 4000 hertz (Hz). Older participants (50-65 years) were more likely to have delayed latency horizontal saccades, positional nystagmus, slowed lower-extremity motor control responses, and delayed latency ocular vestibular evoked myogenic potentials. Low to mid-frequency horizontal (0.003-4 Hz) and mid-frequency vertical (1-3 Hz) vestibulo-ocular reflex, otolith-mediated reflexes, dynamic visual acuity and balance measures were generally not influenced by age. Females had larger static subjective visual testing offset angles, longer cervical vestibular evoked myogenic potential P1 latency, faster velocity horizontal saccades, and quicker motor control latency for large backward translations than age-matched males. CONCLUSION: These reference ranges can be used to discern impairment within the auditory and vestibular pathway following traumatic brain injury in young to middle-aged adults. ID: TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01925963.

Development of hearing standards for Ontario's Constable Selection System.

Objective: Develop valid and defensible hearing standards for Ontario constables to ensure safe and efficient operations. Design: Research involved three steps: (1) identification of hearing critical (HC) tasks, (2) characterisation of real-world noise environments where these tasks are performed (3) and establishment of screening criteria and protocols for determining fitness for duty. Study sample: Three panels of subject matter experts (SMEs) from different Ontario police services participated in Steps 1 and 3. Result: Fifty-one HC tasks conducted in 25 different environments were identified. Acceptable levels of speech communication in noise were based on environments with the highest frequency, importance and difficulty ratings. The ability to understand soft speech was also deemed critical. These translated into a 2 dB maximum elevation in the Noise Composite speech recognition threshold (SRT) with the Hearing-In-Noise-Test and a threshold in quiet of 35 dBA or better. Conclusions: Speech communication modelling methodology greatly facilitates the task of developing fitness for duty hearing standards, but participation of SMEs is crucial for face validity.

Clinical Protocol to Promote Standardization of Basic Tinnitus Services by Audiologists.

Purpose Clinical services for tinnitus are needed by millions of people annually. These services have not been standardized, and patients are vulnerable to receiving services that may appear legitimate but are not based on research evidence. The purpose of this clinical focus article is to promote standardization of tinnitus services by proposing an efficient clinical protocol for audiologists. Method The suggested clinical protocol is based primarily on research conducted at the National Center for Rehabilitative Auditory Research for the past 2 decades, with the focus on 2 randomized controlled trials completed recently that showed efficacy of an audiologic protocol involving hearing aids and brief tinnitus counseling. The protocol is mostly consistent with clinical practice guidelines that have been published. Results The two National Center for Rehabilitative Auditory Research randomized controlled trials revealed significant reduction of tinnitus functional effects for both hearing aids and "combination instruments" (hearing aids with a built-in sound generator), although there were no significant differences between devices. Existing clinical practice guidelines for tinnitus are summarized with respect to their common recommendations for assessment and intervention. Conclusions A defined clinical protocol is suggested for audiologists, which includes a case history, appropriate referral, audiologic assessment, use of the Tinnitus and Hearing Survey ( Henry, Griest, et al., 2015 ), brief tinnitus counseling, hearing aids or combination instruments as warranted, follow-up assessment, and criteria for determining if further tinnitus-specific services are needed. Use of this protocol can help to promote standardization of tinnitus practice by audiologists.

Confidence of School-Based Speech-Language Pathologists and School Psychologists in Assessing Students With Hearing Loss and Other Co-Occurring Disabilities.

Purpose This study assessed the confidence of speech-language pathologists (SLPs) and school psychologists (SPs) in working with children with hearing loss (HL) and other co-occurring disabilities. Professionals' opinions on barriers to and importance of interdisciplinary collaboration were also of interest. Method A 59-item online survey was distributed to SLPs and SPs in the United States through state professional organizations and social media posts. A total of 320 respondents completed the survey and met criteria. Perceptions of confidence across 5 different skill set types were assessed, along with experiences and attitudes concerning professional training and interdisciplinary collaboration. Results A 2-way analysis of variance revealed significant main effects of profession and skill set type on professionals' confidence in assessing a student with HL and other co-occurring disabilities, as well as their confidence in determining the etiology of a student's difficulties. Results from a multiple linear regression revealed the number of students worked with who have HL and the amount of training in graduate school as significant predictors of confidence in both aforementioned skill set types. Results indicate that respondents value interdisciplinary collaboration but that time and access to other professionals are barriers to collaboration. Conclusions Results of the current study indicate that many school-based SLPs and SPs have insufficient training or experience in working with students who have HL and other co-occurring disabilities. Limited training and experience with this unique population among practitioners have the potential to affect the quality of services provided to these students and thus need to be addressed within the school system and the fields of school psychology and speech-language pathology. Supplemental Material https://doi.org/10.23641/asha.7772867.

Effects of Forward- and Emitted-Pressure Calibrations on the Variability of Otoacoustic Emission Measurements Across Repeated Probe Fits.

OBJECTIVE: The stimuli used to evoke otoacoustic emissions (OAEs) are typically calibrated based on the total SPL measured at the probe microphone. However, due to the acoustics of the ear-canal space (i.e., standing-wave interference), this method can underestimate the stimulus pressure reaching the tympanic membrane at certain frequencies. To mitigate this effect, stimulus calibrations based on forward pressure level (FPL) can be applied. Furthermore, the influence of ear-canal acoustics on measured OAE levels can be compensated by expressing them in emitted pressure level (EPL). To date, studies have used artificial shallow versus deep probe fits to assess the effects of calibration method on changes in probe insertion. In an attempt to better simulate a clinical setting, the combined effects of FPL calibration of stimulus level and EPL compensation of OAE level on response variability during routine (noncontrived) probe fittings were examined. DESIGN: The distortion component of the distortion-product OAE (DPOAE) and the stimulus-frequency OAE (SFOAE) were recorded at low and moderate stimulus levels in 20 normal-hearing young-adult subjects across a five-octave range. In each subject, three different calibration approaches were compared: (1) the conventional SPL-based stimulus calibration with OAE levels expressed in SPL; (2) FPL stimulus calibration with OAEs expressed in SPL; and (3) FPL stimulus calibration with OAEs expressed in EPL. Test and retest measurements were obtained during the same session and, in a subset of subjects, several months after the initial test. The effects of these different procedures on the inter- and intra-subject variability of OAE levels were assessed across frequency and level. RESULTS: There were no significant differences in the inter-subject variability of OAE levels across the three calibration approaches. However, there was a significant effect on OAE intra-subject variability. The FPL/EPL approach resulted in the overall lowest test-rest differences in DPOAE level for frequencies above 4 kHz, where standing-wave interference is strongest. The benefit was modest, ranging on average from 0.5 to 2 dB and was strongest at the lower stimulus level. SFOAE level variability did not show significant differences among the three procedures, perhaps due to insufficient signal-to-noise ratio and nonoptimized stimulus levels. Correlations were found between the short-term replicability of DPOAEs and the benefit derived from the FPL/EPL procedure: the more variable the DPOAE, the stronger the benefit conferred by the advanced calibration methods. CONCLUSIONS: Stimulus and response calibration procedures designed to mitigate the effects of standing-wave interference on both the stimulus and the OAE enhance the repeatability of OAE measurements and reduce their dependence on probe position, even when probe shifts are small. Modest but significant improvements in short-term test-retest repeatability were observed in the mid- to high-frequency region when using combined FPL/EPL procedures. The authors posit that the benefit will be greater in a more heterogeneous group of subjects and when different testers participate in the fitting and refitting of subjects, which is a common practice in the audiology clinic. The impact of calibration approach on OAE inter-subject variability was not significant, possibly due to a homogeneous subject population and because factors other than probe position are at play.

How Do We Know That Our Patients Have Benefitted From Our ENT/Audiological Interventions? Presented at the Annual Meeting of ADANO 2016 in Berlin.

: This short review article gives an introduction to some of the fundamental concepts and challenges facing measurement in hearing healthcare practice and research. The impact of hearing loss almost always extends beyond the sensory impairment itself, even when the measured degree of audiometric loss is mild. Yet, going beyond audibility, into the realm of measuring impact, takes us into a much more complex and less well-defined space. How does one therefore best measure the therapeutic benefit for evaluating efficacy or for clinical practice audit? Three case studies illustrate approaches to overcome such challenges. Each example highlights the importance of thinking critically about what it is one is seeking trying to measure, rather than selecting a questionnaire instrument based simply on its popularity or accessibility. We conclude by highlighting the important role that clinicians can play in collecting clinical data about their preferred instruments so that we have some evidence to inform decisions about good practice (content validity etc.). We would also strongly support open data sharing as we think that this is one of the best ways to make the most rapid progress the field.

Elaboration of an instrument to evaluate the recognition of Brazilian melodies in children.

INTRODUCTION: There is evidence pointing to the importance of the evaluation of musical perception through objective and subjective instruments. In Brazil, there is a shortage of instruments that evaluates musical perception. OBJECTIVE: To develop an instrument to evaluate the recognition of traditional Brazilian melodies and investigate the performance of children with typical hearing. METHODS: The study was carried out after approval of the research ethics committee (1.198.607). The instrument was developed in software format with website access, using the languages PHP 5.5.12, Javascript, Cascade style sheets and "HTML5"; database "MYSQL 5.6.17" on the "Apache 2.4.9" server. Fifteen melodies of Brazilian folk songs were recorded in piano synthesized timbre, with 12 seconds per melody reproduction and four second intervals between them. A total of 155 schooled children, aged eight to 11 years, of both sexes, with typical hearing participated in the study. The test was performed in a silent room with sound stimuli amplified by a sound box at 65dBNA, positioned at 0 azimuth, and at one meter from the participant, the notebook was used for children to play with on the screen on the title and illustration of the melody they recognized they were listening to. The responses were recorded on their own database. RESULTS: The instrument titled "Evaluation of recognition of traditional melodies in children" can be run on various devices (computers, notebooks, tablets, mobile phones) and operating systems (Windows, Macintosh, Android, Linux). Access: http://192.185.216.17/ivan/home/login.php by login and password. The most easily recognized melody was "Cai, cai balão" (89%) and the least recognized was "Capelinha de melão" (25.2%). The average time to perform the test was 3'15″. CONCLUSION: The development and application of the software proved effective for the studied population. This instrument may contribute to the improvement of protocols for the evaluation of musical perception in children with hearing aid and/or cochlear implants users.

Hearing impairment detection and intervention in children from centre-based early intervention programmes.

The study aimed to describe ages at identification and initiation of early intervention (EI) services for children enrolled in centre-based EI programmes in Gauteng, as well as to describe the nature of EI services that the children received. The researchers conducted retrospective record reviews of the EI programme files. In addition, caregivers of eight children identified with hearing impairments and enrolled in centre-based EI programmes in Gauteng completed a newly constructed questionnaire. The caregiver questionnaire produced data pertaining to the child's family demographics, background information and schooling history. Descriptive statistics were used to analyse the data, using frequency distribution and measures of central tendency. None of the children received newborn hearing screening services, thus they were identified late following maternal suspicion of hearing impairment. Late identification of the hearing impairment resulted in suboptimal initiation of EI services. All the children received aural habilitation and/or speech-language therapy services. These findings indicate that there is a great need for the establishment of widespread early hearing detection and intervention programmes that will lead to earlier identification of infant and childhood hearing impairment and timely initiation of EI services.

Feasibility of interleaved Bayesian adaptive procedures in estimating the equal-loudness contour.

A Bayesian adaptive procedure, the interleaved-equal-loudness contour (IELC) procedure, was developed to improve the efficiency in estimating the equal-loudness contour. Experiment 1 evaluated the test-retest reliability of the IELC procedure using six naive normal-hearing listeners. Two IELC runs of 200 trials were conducted and excellent test-retest reliability was found at both the group and individual levels. Using the same group of listeners, Experiment 2 compared the IELC procedure to two other procedures that required frequency-by-frequency testing. One of these procedures was the commonly adopted interleaved staircase (ISC) procedure from Jesteadt [(1980). Atten. Percept. Psychophys. 28, 85-88]. The other procedure, the interleaved maximum-likelihood (IML) procedure, was a modification of the updated maximum-likelihood procedure [Shen and Richards (2012). J. Acoust. Soc. Am. 132, 957-967]. For each of the ISC and IML procedures, two runs of approximately 500 trials were conducted, followed by one additional IELC run. The test-retest reliability of the IELC procedure was comparable to that of the ISC and IML procedure. The accuracies of all three procedures measured in Experiment 2 were similar, which was superior to the accuracies of the IELC runs from Experiment 1, indicating a potential training effect.