The effect of age on the hearing-related quality of life in normal-hearing adults.

INTRODUCTION: Recently, a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life was developed, named the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). The purpose of the current study was to evaluate if the hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life. METHODS: One-hundred thirteen normal-hearing participants (mean age: 42.13; range: 19 to 69 years) filled in the entire hAVICOP questionnaire online through the Research Electronic Data Capture surface. The hAVICOP consists of 27 statements, across three major subdomains (auditory-visual, cognitive, and psychosocial functioning), which have to be rated on a visual analogue scale ranging from 0 (rarely to never) to 100 (almost always). Mean scores were calculated for each subdomain separately as well as combined within a total score; the worse one's hearing-related quality of life, the lower the score. Linear regression models were run to predict the hAVICOP total as well as the three subdomain scores from age and sex. RESULTS: A significant main effect of age was observed for the total hAVICOP and all three subdomain scores, indicating a decrease in hearing-related quality of life with increasing age. For none of the analyses, a significant sex effect was found. CONCLUSION: The hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life within a large group of normal-hearing adults, emphasizing its clinical utility. This age effect on the hearing-related quality of life might be related to the interplay of age-related changes in the bottom-up and top-down processes involved during speech processing.

Binaural sound therapy for tinnitus treatment: A psychometric and neurophysiological evaluation.

INTRODUCTION: Tinnitus is an annoying buzz that manifests itself in many ways. In addition, it can provoke anxiety, stress, depression, and fatigue. The acoustic therapies have become the most commonly applied treatment for tinnitus, either self-administered or clinically prescribed. Binaural Sound Therapy (BST) and Music Therapy (MT) aim to reverse the neuroplasticity phenomenon related to tinnitus by adequately stimulating the auditory path-way. The goal of this research is to evaluate the feasibility of applying BST for tinnitus treatment by comparing its effect with MT effect. MATERIALS AND METHODS: 34 patients with tinnitus from 29 to 60 years were informed about the experimental procedure and consented their participation. Patients were divided into two groups: 1) MT and 2) BST. They applied their sound-based treatment for one hour every day along eight weeks. Each treatment was adjusted to Hearing Loss (HL) and tinnitus characteristics of each participant. To record EEG data, a bio-signal amplifier with sixteen EEG channels was used. The system recorded data at a sampling frequency of 256 Hz within a bandwidth between 0.1 and 100 Hz. RESULTS: The questionnaire-monitoring reported that MT increased tinnitus perception in 30% of the patients, and increased anxiety and stress in 8% of them. Regarding EEG-monitoring, major neural synchronicity over the frontal lobe was found after the treatment. In the case of BST reduced stress in 23% of patients. Additionally, BST reduced tinnitus perception similar to MT (15% of patients). With respect to EEG-monitoring, slightly major neural synchronicity over the right frontal lobe was found after the treatment. CONCLUSIONS: MT should be applied with caution since it could be worsening the tinnitus sufferer condition. On the other hand, BST is recommended for tinnitus sufferers who have side effects concerning stress but no anxiety.

The effect of a coding strategy that removes temporally masked pulses on speech perception by cochlear implant users.

Speech recognition in noisy environments remains a challenge for cochlear implant (CI) recipients. Unwanted charge interactions between current pulses, both within and between electrode channels, are likely to impair performance. Here we investigate the effect of reducing the number of current pulses on speech perception. This was achieved by implementing a psychoacoustic temporal-masking model where current pulses in each channel were passed through a temporal integrator to identify and remove pulses that were less likely to be perceived by the recipient. The decision criterion of the temporal integrator was varied to control the percentage of pulses removed in each condition. In experiment 1, speech in quiet was processed with a standard Continuous Interleaved Sampling (CIS) strategy and with 25, 50 and 75% of pulses removed. In experiment 2, performance was measured for speech in noise with the CIS reference and with 50 and 75% of pulses removed. Speech intelligibility in quiet revealed no significant difference between reference and test conditions. For speech in noise, results showed a significant improvement of 2.4 dB when removing 50% of pulses and performance was not significantly different between the reference and when 75% of pulses were removed. Further, by reducing the overall amount of current pulses by 25, 50, and 75% but accounting for the increase in charge necessary to compensate for the decrease in loudness, estimated average power savings of 21.15, 40.95, and 63.45%, respectively, could be possible for this set of listeners. In conclusion, removing temporally masked pulses may improve speech perception in noise and result in substantial power savings.

Mandarin lexical tone recognition in bimodal cochlear implant users.

Objective: To assess the recognition of lexical tones in Mandarin-speaking bimodal cochlear implant (CI) subjects.Design: Lexical tone recognition in quiet and noise (SNR= +5 dB) was measured with electric stimulation (CI alone) or bimodal stimulation (CI + hearing aid (HA)). The recognition and confusion rates of the four tones (T1, T2, T3 and T4) were analysed. Spearman correlation analysis was performed to examine the relationship between hearing levels in the contralateral ear and bimodal benefits.Study sample: Twenty native Mandarin-speaking bimodal CI users, with ages ranging from 16-49 years.Results: Relative to the CI alone, mean tone recognition with the CI + HA improved significantly from 84.1-92.1% correct in quiet (+8 points) and from 57.9-73.1% correct in noise (+15.2 points). Tone confusions between T2 and T3 were the most prominent in all test conditions, and T4 tended to be labelled as T3 in noise. There was no significant correlation between the bimodal benefits for tone recognition and the unaided or HA-aided pure-tone thresholds at 0.25 kHz.Conclusion: Listeners with CI + HA exhibited significantly better tone recognition than with CI alone. The bimodal advantage for tone recognition was greater in noise than in quiet, perhaps due to a ceiling effect in quiet.

The ongoing search for cochlear synaptopathy in humans: Masked thresholds for brief tones in Threshold Equalizing Noise.

This study aimed to advance towards a clinical diagnostic method for detection of cochlear synaptopathy with the hypothesis that synaptopathy should be manifested in elevated masked thresholds for brief tones. This hypothesis was tested in tinnitus sufferers, as they are thought to have some degree of synaptopathy. Near-normal-hearing tinnitus sufferers and their matched controls were asked to detect pure tones with durations of 5, 10, 100, and 200 ms presented in low- and high-level Threshold Equalizing Noise. In addition, lifetime noise exposure was estimated for all participants. Contrary to the hypothesis, there was no significant difference in masked thresholds for brief tones between tinnitus sufferers and their matched controls. Masked thresholds were also not related to lifetime noise exposure. There are two possible explanations of the results: 1) the participants in our study did not have cochlear synaptopathy, or 2) synaptopathy does not lead to elevated masked thresholds for brief tones. This study adds a new approach to the growing list of behavioral methods that attempted to detect potential signs of cochlear synaptopathy in humans.

Comparison of electrode impedance measures between a dexamethasone-eluting and standard Cochlear™ Contour Advance® electrode in adult cochlear implant recipients.

OBJECTIVE: To compare the difference in electrode impedance across discrete time points to 24 months post-activation for two groups of adult cochlear implant recipients, one using an investigational perimodiolar (Contour Advance®) array augmented with 40% concentration weight per weight (w/w) dexamethasone (the Drug Eluting Electrode, 'DEE' Group), and the other the commercially available Contour Advance ('Control' Group). DESIGN: Ten adult subjects were implanted with the DEE and fourteen with the Control. Electrode impedances were measured intra-operatively, one-week post-surgery, at initial activation (approximately two-weeks post-surgery), and at approximately one, three, six, 12 and 24 months post-activation. Two different impedance measurements were obtained: 1) in MP1+2 mode using Custom Sound programming software; and 2) 4-point impedance measures utilising BP+2 stimulation mode with recording on non-stimulating electrodes. Data were analysed with respect to both impedance averaged across all electrodes, and impedance for electrodes grouped into basal, middle and apical sections. RESULTS: Group mean MP1+2 impedance for the DEE was significantly lower than for the Control at all post-operative time points examined, and for each of the basal, middle and apical cochlear regions. Group mean 4-point impedance was significantly lower for the DEE than the Control in the basal region at six, 12 and 24 months post-activation and in the middle region at 12- and 24-months post-activation. The pattern of change in MP1+2 impedance differed significantly in the early post-operative period prior to device activation. A significant 4.8 kOhm reduction in impedance between surgery and one-week was observed for the DEE group but not for the Control. A 2.0 kOhm increase between the one and two week post-operative time points was observed for the Control but not for the DEE group. CONCLUSION: While rates of adoption of different surgical approaches differed between the groups and this may have had a confounding effect, the results suggest that passive elution of dexamethasone from the investigational device was associated with a change in the intracochlear environment following surgical implantation of the electrode array, as evidenced by the lower electrode impedance measures.

Auditory Agnosia for Environmental Sounds in Alzheimer's Disease: Not Hearing and Not Listening?

Auditory agnosia for environmental sounds (AES) is an example of central auditory dysfunction. It is presumed to be independent of language deficits and in presence of normal hearing. We undertook a detailed neuropsychological assessment including environmental sound naming and recognition in 34 clinically mild Alzheimer's disease (AD) patients and 29 age-matched healthy control subjects. In patients with AD, audiometry was performed to assess the impact on test performance, and in normal controls the Hearing Handicap Inventory for the Elderly - Screening Version to exclude more than mild hearing loss. We adapted a validated environmental sound battery and found near perfect scores in controls. We found that environmental sound agnosia is common in mild AD. We found a statistically significant difference in mean pure tone audiometry in the best ear between patients with and those patients without naming deficits of 11.3 dB (p = 0.010) and of 14.7 dB (p = 0.000) between those with and without recognition deficits. Statistical significance remained after correcting for age, aphasia, Mini-Mental State Examination score, and working memory. Slight and moderate peripheral hearing loss increases the odds ratio of recognition deficits by 13.75 (confidence interval 2.3-81.5) compared to normal hearing patients. We did not find evidence for different forms of AES. This work suggests that an interaction between peripheral hearing loss and AD pathology produces problems with environmental sound recognition. It confirms that the relationship between hearing and dementia is complex but also suggests that interventions to prevent and treat hearing loss could have an effect on AD in its clinical expression.

Hearing Impairment Increases Communication Effort During Conversations in Noise.

Purpose This article describes patterns of speech modifications produced by talkers as a function of the degree of hearing impairment of communication partners during naturalistic conversations in noise. An explanation of observed speech modifications is proposed in terms of a generalization of the concept of effort. This account complements existing theories of listening effort by extending the concept of effort to the domain of interactive communication. Method Twenty young adult normal hearing participants and 20 older adult hearing-impaired participants were tested in pairs. Each pair consisted of 1 young normal hearing participant and 1 older hearing-impaired participant. Pairs of participants took part in naturalistic conversations through the use of a referential communication task. Each pair completed a 5-min conversation in each of 5 different realistic acoustic environments. Results Talkers modified their speech, in terms of level and spectrum, in a gradient manner reflecting both the acoustic environment and the degree of hearing impairment of their conversation partner. All pairs of participants were able to maintain communication across all acoustic environments regardless of degree of hearing impairment and the level of environmental noise. Contrasting effects of noise and hearing impairment on speech production revealed distinct patterns of speech modifications produced by normal hearing and hearing-impaired talkers during conversation. This may reflect the fact that only the speech modifications produced by normal hearing talkers functioned to compensate for the hearing impairment of a conversation partner. Conclusions The data presented support the concept of communication effort as a dynamic feedback system between conversation participants. Additionally, these results provide insight into the nature of realistic speech signals, which are encountered by people with hearing impairment in everyday communication scenarios.

Psychoacoustic and electrophysiological electric-acoustic interaction effects in cochlear implant users with ipsilateral residual hearing.

Cochlear implant users with ipsilateral residual hearing combine acoustic and electric hearing in one ear, this is called electric-acoustic stimulation (EAS). In EAS users, masking can be shown for electric probes in the presence of acoustic maskers and vice versa. Masking effects in acoustic hearing are generally attributed to nonlinearities of the basilar membrane and hair cell adaptation effects. However, similar masking patterns are observed more centrally in electric hearing. Consequently, there is no consensus so far on the level of interaction between the two modalities. Animal studies have shown that electric-acoustic interaction effects can result in reduced physiological responses in the cochlear nerve and the inferior colliculus. In CI users with residual hearing, it has recently become feasible to record intracochlear potentials with a high spatial resolution via the implanted electrode array. An investigation of the electrophysiological effects during combined electric-acoustic stimulation in humans might be used to assess peripheral mechanisms of masking. Seventeen MED-EL Flex electrode users with ipsilateral residual hearing participated in both a behavioral and a physiological electric-acoustic masking experiment. Psychoacoustic methods were used to measure the changes in behavioral thresholds due to the presence of a masker of the opposing modality. Subjects were stimulated electrically with unmodulated pulse trains using a research interface and acoustically with pure tones delivered via headphones. Auditory response telemetry was used to obtain objective electrophysiological changes of electrically evoked compound action potential and electrocochleography for electric, acoustic and combined electric-acoustic presentation in the same subjects. Behavioral thresholds of probe tones, either electric or acoustic, were significantly elevated in the presence of acoustic or electric maskers, respectively. 15 subjects showed significant electric threshold elevation with acoustic masking that did not depend on the electric-acoustic frequency difference (EAFD), a measure for the proximity of stimulation sites in the cochlea. Electric masking showed significant threshold elevation in eleven subjects, which depended significantly on EAFD. In the electrophysiological masking experiment, reduced responses to electric and acoustic stimulation with additional stimulation of the opposing modality were observed. Results showed a similar asymmetry as the psychoacoustic masking experiment. Response reduction was smaller than threshold elevation, especially for electric masking. Some subjects showed reduced responses to acoustic stimulation with electric masking, especially for small EAFD. The reduction of electrically evoked responses was significant in some subjects. No correlation was observed between psychoacoustic and electrophysiological masking results. From present study, it can be concluded that both electric and acoustic stimulation mask each other when presented simultaneously. Electrophysiological measurements indicate that masking effects are already to some extent present in the periphery.

Cultivating resiliency in patients with neurofibromatosis 2 who are deafened or have severe hearing loss: a live­video randomized control trial.

INTRODUCTION: Patients with NF2 who are deaf or have significant hearing loss face numerous and unique challenges which lead to poor quality of life, and thus may benefit from resiliency programs. METHODS: We performed secondary data analyses on a single blind, randomized controlled trial of an 8 week mind-body resiliency program (the Relaxation Response and Resiliency program for Deaf NF2; d3RP-NF2) versus a health education control (Health Enhancement Program for Deaf NF2;dHEP-NF2) which showed improvement in quality of life (Funes in JAMA 2019, https://doi.org/10.1007/s11060-019-03182-3). Here we report on improvements in resiliency factors (i.e. optimism, gratitude, perceived social support, mindfulness, and perceived coping abilities) assessed at baseline, post-test and 6-month follow-up. Both programs were delivered via Skype using Communication Access Real-Time Translation. RESULTS: Patients who were randomized to the d3RP-NF2 program exhibited significant improvements from baseline to post-program in gratitude (Mdifference = 4.04, 95% CI 1.58-6.50; p = 0.002), perceived social support (Mdifference = 16.36, 95% CI 9.20-23.51; p < 0.001), mindfulness (Mdifference = 4.02, 95% CI 1.10-6.94; p = 0.008), perceived coping (Mdifference = 15.25, 95% CI 10.21-20.28; p < 0.001), and a non-significant trend of improvement in optimism (Mdifference = 1.15, 95% CI -0.14-12.44; p = 0.079). These improvements were all maintained through the 6-month follow up. Improvements in perceived coping (Mdifference = 12.34, 95% CI 4.75-19.93; p = 0.002), social support (Mdifference = 13.11, 95% CI 2.19-24.03; p = 0.02), and gratitude (Mdifference = 4.59, 95% CI 0.83-8.36; p = 0.018) were over and above the changes observed in those randomized to dHEP-NF2. CONCLUSION: The d3RP-NF2 sustainably improves multiple dimensions of resiliency. Promoting resiliency may be of utmost importance for this uderserved population.

Discrimination and identification of lexical tones and consonants in Mandarin-speaking children using cochlear implants.

Mandarin-speaking adults using cochlear implants (CI) experience more difficulties in perceiving lexical tones than consonants. This problem may result from the fact that CIs provide relatively sufficient temporal envelope information for consonant perception in quiet environments, but do not convey the fine spectro-temporal information considered to be necessary for accurate pitch perception. Another possibility is that Mandarin speakers with post-lingual hearing loss have developed language-specific use of these acoustic cues, impeding lexical tone processing under CI conditions. To investigate this latter hypothesis, syllable discrimination and word identification abilities for Mandarin consonants (place and manner) and lexical-tone contrasts (tones 1 vs 3 and 1 vs 2) were measured in 15 Mandarin-speaking children using CIs and age-matched children with normal hearing (NH). In the discrimination task, only children using CIs exhibited significantly lower scores for consonant place contrasts compared to other contrasts, including lexical tones. In the word identification task, children using CIs showed lower performance for all contrasts compared to children with NH, but they both showed specific difficulties with tone 1 vs 2 contrasts. This study suggests that Mandarin-speaking children using CIs are able to discriminate and identify lexical tones and, perhaps more surprisingly, have more difficulties when discriminating consonants.

Impact of stimulus frequency and recording electrode on electrocochleography in Hybrid cochlear implant users.

This report explores the impact of recording electrode position and stimulus frequency on intracochlear electrocochleography (ECoG) responses recorded from six Nucleus L24 Hybrid CI users. Acoustic tone bursts (250 Hz, 500 Hz, 750 Hz, and 1000 Hz) were presented to the implanted ear via an insert earphone. Recordings were obtained from intracochlear electrodes 6 (most basal), 8, 10, 12, 14, 16, 18, 20, and 22 (most apical). Responses to condensation and rarefaction stimuli were subtracted from one another to emphasize hair cell responses (CM/DIF) and added to one another to emphasize neural responses (ANN/SUM). For a fixed stimulus frequency, the CM/DIF and ANN/SUM magnitudes increased as the recording electrode moved apically. For a fixed recording electrode, as the stimulus frequency was lowered, response magnitudes increased. The CM/DIF and ANN/SUM response phase were generally stable across recording electrodes, although substantial phase shifts were noted for a few conditions. Given the recent interest in ECoG for assessing peripheral auditory function in CI users, the impact of stimulus frequency and recording electrode position on response magnitude should be considered. Results suggest optimal ECoG responses are obtained using the most apical recording electrode and a low frequency acoustic stimulus (250 Hz or 500 Hz).

Children with hearing impairment in Malawi, a cohort study.

OBJECTIVE: To assess the outcomes of children diagnosed with hearing impairment 3 years earlier in terms of referral uptake, treatment received and satisfaction with this treatment, and social participation. METHODS: We conducted a population-based longitudinal analysis of children with a hearing impairment in two rural districts of Malawi. Key informants within the community identified the cohort in 2013 (baseline). Informants clinically screened children at baseline, and by questionnaires at baseline and follow-up in 2016. We investigated associations between sociodemographic characteristics and outcomes by multivariate logistic regression. RESULTS: We diagnosed 752 children in 2013 as having a hearing impairment and traced 307 (40.8%) children of these for follow-up in 2016. Referral uptake was low (102/184; 55.4%), more likely among older children (odds ratio, OR: 3.5; 95% confidence interval, CI: 1.2-10.2) and less likely for those with an illiterate caregiver (OR: 0.5; 95% CI: 0.2-0.9). Few of the children who attended hospital received any treatment (33/102; 32.4%) and 63.6% (21/33) of caregivers reported satisfaction with treatment. Difficulty making friends and communicating needs was reported for 10.0% (30/299) and 35.6% (107/301) of the children, respectively. Lack of school enrolment was observed for 29.5% (72/244) of children, and was more likely for older children (OR: 28.6; 95% CI: 10.3-79.6), girls (OR: 2.4; 95% CI: 1.2-4.8) and those with an illiterate caregiver (OR: 2.1; 95% CI: 1.0-4.1). CONCLUSION: More widespread and holistic services are required to improve the outcomes of children with a hearing impairment in Malawi.

Validity of correction factors applied to auditory steady-state responses (ASSRs) in normal hearing adults in chartr EP system.

OBJECTIVES: Even though many patients undergoing auditory steady-state response (ASSR) testing have some degree of hearing loss, some have normal hearing and ASSR often overestimates the behavioral thresholds in this group. In most commercial ASSR systems such as Chartr EP, a default correction factor is applied to compensate for this difference. Little is known, however, as how the correction factor compensates for the difference between ASSR and pure tone audiometry (PTA) thresholds as a function of carrier or modulation frequency (MF) in a commercial ASSR system. Our goal is to evaluate this relationship. METHODS: Twenty-four normal hearing adults were examined for both PTA and ASSR (Chartr EP system, GN Otometrics). ASSR thresholds were obtained at three MFs (20, 40, and 80 Hz). The difference scores were obtained by subtracting PTA from ASSR thresholds at each frequency for each subject. The corrected ASSR thresholds, then, were compared with the PTA thresholds across MFs and carrier frequencies. RESULTS: The default correction factors in the ASSR equipment differed significantly from the difference scores at all MFs and carrier frequencies (n = 24, p < 0.005). The correlation between corrected ASSR and PTA thresholds at most MFs and carrier frequencies were medium to poor. CONCLUSIONS: At most MFs and carrier frequencies, the default correction factors defined by the manufacturer do not compensate for the difference between ASSR and PTA thresholds in normal hearing adults. The use of the default correction factors in Chartr EP system for the normal hearing adults needs special considerations.

Walk, Talk and Listen: a pilot randomised controlled trial targeting functional fitness and loneliness in older adults with hearing loss.

BACKGROUND: Age-related hearing loss (HL) is a prevalent disability associated with loneliness, isolation, declines in cognitive and physical function and premature mortality. Group audiological rehabilitation (GAR) and hearing technologies address communication and cognitive decline. However, the relationship between loneliness, physical function and GAR among older adults with HL has not been studied. OBJECTIVES: Explore the impact of a group exercise and socialisation/health education intervention and GAR on physical function and loneliness among older adults with HL. TRIAL DESIGN: A Young Men's Christian Association (YMCA)-based, 10-week, single-blind, pilot randomised controlled trial (RCT). PARTICIPANTS: Ambulatory adults aged 65 years or older with self-reported HL. INTERVENTIONS: Seventy-one participants were screened. Thirty-five were randomised to intervention (strength and resistance exercise, socialisation/health education) and GAR (hearing education, communication strategies, psychosocial support) or control (n=31): GAR only. OUTCOMES: Ninety-five per cent of eligible participants were randomised. GAR and exercise adherence rates were 80% and 85%, respectively. 88% of participants completed the study. Intervention group functional fitness improved significantly (gait speed: effect size: 0.57, 30 s Sit to Stand Test: effect size: 0.53). Significant improvements in emotional and social loneliness (effect size: 1.16) and hearing-related quality of life (effect size: 0.76) were related to GAR attendance and poorer baseline hearing-related quality of life. Forty-two per cent of participants increased social contacts outside the study. DISCUSSION: Walk, Talk and Listen was feasible and acceptable. Exercise and socialisation/health education improved loneliness and key fitness measures but provided no additional benefit to GAR only for loneliness. This is the first preliminary evidence about the benefits of exercise on fitness and GAR on loneliness among older adults with HL. IMPLICATIONS: This pilot trial provides key information on the sample size required for a larger, longer term RCT to determine the enduring effects of this holistic intervention addressing the negative psychosocial and musculoskeletal downstream effects of HL among older adults.

Individualised active communication education (I-ACE): another clinical option for adults with hearing impairment with a focus on problem solving and self-management.

Objective: This clinical note describes the Individualised - Active Communication Education (I-ACE) programme designed to improve problem solving and self-management in adults with hearing impairment. Design: The I-ACE was offered to adult clients seeking help for the first time and effects were measured for participants using self-report questionnaires: the Client Oriented Scale of Improvement (goal attainment), the Hearing Handicap Questionnaire (hearing disability), and the International Outcome Inventory - Alternative Interventions (outcomes) immediately after programme completion and 3 months later. Participants also provided qualitative feedback about I-ACE. Study sample: Twenty-three participants completed I-ACE, with 22 completing all self-report questionnaires and 23 participants providing qualitative feedback. Results: The participants reported positive outcomes and goal attainment, but no change in hearing disability post-programme. The effects were maintained 3 months later. Qualitative feedback indicated that I-ACE supported participants in recognising and increasing awareness of their hearing difficulties and in developing potential solutions to these difficulties. Participants also enjoyed the opportunity to involve communication partners. Conclusion: I-ACE is an appropriate option for adults with hearing impairment who wish to become more aware of their hearing difficulties and how to solve them.

Long-term subjective loneliness in adults after hearing loss treatment.

Objective: While hearing loss is associated with loneliness, the long term impact of hearing loss interventions remains unknown. We investigated levels of loneliness in adults at baseline, 6-months, 1-year and 5-years after receiving a hearing aid (HA) or cochlear implant (CI). Design: In this 5-year follow-up to the Studying Multiple Outcomes after Aural Rehabilitative Treatment study, participants completed the University of California, Los Angeles (UCLA) Loneliness Scale at baseline, 6-months, 1-year, and 5-year time points. Generalized estimating equations modeled the population average UCLA score over time. Study Sample: Analytic cohort of 115 participants (74% of original 156) 50 years or older who received a HA or CI at baseline and completed at least one follow up visit. Results: Loneliness scores were not different at 5 years versus baseline for HA users. CI users showed significantly reduced loneliness at 6-months and 1-year from baseline and with no significant difference at 5 years. Conclusion: Over 5 years, we observed no increase in loneliness from baseline in a cohort of adults receiving HAs and CIs. Short-term reduction in loneliness in CI users was demonstrated. Future randomized trials are needed to definitively assess the impact of treated versus untreated hearing loss on loneliness.

Neuromuscular electrical stimulation on hearing loss caused by skull base fracture: A protocol for systematic review of randomized controlled trial.

BACKGROUND: This systematic review aims to investigate the effectiveness and safety of neuromuscular electrical stimulation (NMES) on hearing loss (HL) caused by skull base fracture (SBF). METHODS: We will retrieve the following electronic databases of Cochrane Library, PUBMED, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database from the inception to January 1, 2019 for relevant RCTs of NMES for HL caused by SBF. Two experienced authors will independently perform the study selection, data extraction, and methodology quality assessment. A 3rd author will solve any disagreements between 2 authors through discussion. RESULTS: This study will provide a high-quality synthesis of latest evidence of NMES for HL caused by SBF from comprehensive assessments, including hearing loss evaluation, hearing threshold, quality of life, and any relevant adverse events. CONCLUSION: The expected results of this systematic review will provide the up-to-date evidence to assess the effectiveness and safety of NEMS for patients with HL caused by SBF. ETHICS AND DISSEMINATION: The results of this study will be disseminated through publication in a peer-reviewed journal or will be presented at an associated conference meeting. This study will not use individual patient data, thus, the ethical approval is not needed. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019120195.

Don't look at it as a miracle cure: Contested notions of success and failure in family narratives of pediatric cochlear implantation.

Cochlear implants (CIs) are a routine treatment for children identified with a qualifying hearing loss. The CI, however, must be accompanied by a long-term and intense auditory training regimen in order to possibly acquire spoken language with the device. This research investigates families' experiences when they opted for the CI and undertook the task of auditory training, but the child failed to achieve what might be clinically considered "success" - the ability to function solely using spoken language. Using a science and technology studies informed approach that places the CI within a complex sociotechnical system, this research shows the uncertain trajectory of the CI, as well as the contingency of the very notions of success and failure. To do so, data from in-depth interviews with a diverse sample of parents (n = 11) were collected. Results show the shifting definitions of failure and success within families, as well as suggest areas for further exploration regarding clinical practice and pediatric CIs. First, professionals' messaging often conveyed to parents a belief in the infallibility of the CI, this potentially caused "soft failure" to go undetected and unmitigated. Second, speech assessments used in clinical measurements of outcomes did not capture a holistic understanding of a child's identity and social integration, leaving out an important component for consideration of what a 'good outcome' is. Third, minority parents experience structural racism and clinical attitudes that may render "failure" more likely to be identified and expected in these children, an individualizing process that allows structural failures to go uncritiqued.

Long-term Average Speech Spectra of Postlingual Cochlear Implant Users.

Long term average speech spectra (LTASS) is a commonly used voice analysis method for different purposes. This method offers an acoustic representation of the language in daily conservations. Results of that method can be altered by the deteriorations in the auditory feedback loop. Hearing losses occurred in the post lingual stage of life have some serious negative effects on the auditory feedback loop. Cochlear implantation may help these patients with regards to auditory feedback loop. Therefore, we aimed to evaluate the LTASS of cochlear implant users whose have a post lingual hearing loss. We assessed the LTASS of 24 cochlear implant users and compared our findings with normal hearing subjects. Our findings revealed that cochlear implant users have similar LTASS findings with normal hearing subjects. We conclude that cochlear implantation helps to the recovery of auditory feedback loop in patients with post lingual hearing losses.