International trial of online auditory training programme for distinguishing innocent and pathological murmurs.

AIM: Recognition of normal and abnormal heart sounds and murmurs is an important but declining clinical skill among practitioners. Current teaching methods are often ineffective. This may result from inadequate repetition and normal-abnormal comparisons needed for auditory recognition. This paper describes a rapid new method of teaching murmur recognition using principles of auditory training. METHODS: Participants were 120 Australian and 42 Canadian medical students. The medical students were randomised to intervention and control (no intervention) groups. The 1-h online programme structured like a computer game used auditory training methodology to teach students to distinguish between innocent and pathological murmurs. Participants underwent pre- and post-testing on 20 paediatric murmurs. Post-testing occurred immediately following training and after 2 months. Twenty-two Canadian medical students were retested 1 year later with a brief mastery-style reinforcement programme. RESULTS: Median pre- and post-test scores improved in about 1 h from 75-95% (P < 0.001) for Australian students and 85-95% (P = 0.004) for Canadian students. Two-month post-test scores declined for Australian students to 85% (P = 0.001), and for Canadian students to 85% (P = 0.02). Australian controls had no significant change during the study period, whereas Canadian controls improved slightly. The group receiving reinforcement after 1 year had a median final score of 90%. CONCLUSIONS: This auditory training programme rapidly teaches students to distinguish innocent and pathological murmurs with at least 90% accuracy. The skill declines within 2 months but can be restored with brief mastery reinforcement 1 year later.

Clear speech for adults with a hearing loss: does intervention with communication partners make a difference?

Spouses of persons with hearing loss served as talkers to examine the benefits of clear speech intervention. One talker received intervention on clear speech. A second talker was simply instructed to speak clearly. Each talker was recorded reading sentences in three conditions: conversational speech, clear speech one week postintervention, and clear speech one month postintervention. Speech acoustic measures were obtained. Then the sentences were presented to subjects with normal hearing and subjects with hearing loss to measure speech recognition. Results showed that simply asking a talker to speak clearly was effective in eliciting clear speech; however, providing intervention yielded changes in more speech parameters, more stable changes, and better speech recognition. When listening to the talker who received intervention, subjects with hearing loss achieved the same performance as subjects with normal hearing. However, they performed worse than subjects with normal hearing when listening to the talker who received clear speech instructions only. Individuals with hearing loss would receive speech recognition benefits if their partners were provided with clear speech intervention.

A Comparison Between Wireless CROS and Bone-anchored Hearing Devices for Single-sided Deafness: A Pilot Study.

INTRODUCTION: This study compared wireless Contralateral Routing of Signals (CROS) hearing aid and bone-anchored hearing device (BAHD) in patients with single-sided deafness. METHODS: Eight adults with single-sided deafness previously implanted with a BAHD were given a 2-week trial with a CROS hearing aid and tested in unaided and aided conditions. Both devices were compared on head shadow effect reduction, speech perception measures in quiet and in noise, self-assessment questionnaires, and daily diaries. RESULTS: Both the CROS and BAHD significantly reduced the head shadow effect. QuickSIN scores were significantly better with noise presented to the poorer ear, as compared to the better ear, for the unaided condition, the BAHD, and the CROS. Scores showed no significant differences between the CROS and BAHD with noise presented to the better ear, but scores with the CROS were significantly poorer than in the unaided condition with noise presented to the poorer ear. There were no significant differences between BAHD and CROS for the ratings on the Bern Benefit in Single-Sided Deafness and Speech Spatial Qualities questionnaires. Both devices were worn an average of 10 hours per day. Four participants preferred the CROS for sound quality; three preferred the BAHD for comfort. CONCLUSION: Comparisons of CROS and BAHD need to be re-evaluated as both technologies have evolved. In our pilot study, both devices seem comparable, with the CROS avoiding the risks of surgery, and we recommend a trial of CROS in our center for first line treatment of single-sided deafness.

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.