DigiSpan: Development and Evaluation of a Computer-Based, Adaptive Test of Short-Term Memory and Working Memory.

PURPOSE: This article describes DigiSpan, a new computer-controlled auditory test of forward and reverse digit span, designed to be administered by clinicians, and presents normative and test-retest reliability data for adults. METHOD: DigiSpan mimics conventional live-voice tests in that it commences with trials that ascend in length until a stopping criterion is met, giving rise to a conventional scaled score. It then administers five additional adaptive trials, the length of which depends on the correctness of the response to the previous trial. Each of these two segments of the measurement gives rise to a scaled score. The ascending and adaptive scores are averaged to give an overall score and subtracted to produce an internal measure of consistency, and hence reliability. Young adults with an Mage of 25 years (N = 163) were tested, of whom 65 were retested on a separate day. RESULTS: The scaled scores from the conventional ascending trials were highly consistent with existing normative data based on live-voice tests. Combination of the conventional scaled score with a scaled score based on the adaptive trials led to 44% reduction in error variance for forward memory span and 20% reduction for reverse memory span. The average of these (32%) is similar to but (insignificantly) less than the 42% reduction in error variance that can be predicted based on adding the five adaptive trials. CONCLUSIONS: Replacing live-voice production of digits by a clinician with recorded, computer-controlled production has not affected the difficulty of the test. Adding five additional trials around the sequence length that a test participant can just remember has produced a decrease in measurement error. In addition, the availability of separate scaled scores for the ascending and adaptive phases enables the reliability of the combined score to be checked, for both forward and reverse measurements. The combination of standardized delivery, increased accuracy, internal reliability check, and fast automated scoring makes the test highly suitable for clinical use.

Low-Dose Aspirin and Progression of Age-Related Hearing Loss: A Secondary Analysis of the ASPREE Randomized Clinical Trial.

Importance: Age-related hearing loss is common in an aging population, affecting communication and contributing to a worsened quality of life. It occurs as a result of cochlear degeneration and may be further exacerbated by inflammation and microvascular changes, as observed in animal models. Objective: To compare the effect of daily low-dose aspirin vs placebo on the progression of age-related hearing loss in healthy older adults. Design, Setting, and Participants: A prespecified secondary analysis was conducted of the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial. Participants were 279 healthy community-dwelling individuals living in Australia who were aged 70 years or older and free of overt cardiovascular diseases, dementia, and life-limiting illnesses. Participants were recruited between January 1, 2010, and December 31, 2014, and followed up over 3 years. Statistical analysis was completed from June to December 2023. Intervention: A 100-mg daily dose of enteric-coated aspirin or matching placebo. Main Outcomes and Measures: Hearing measures were air conduction audiometry and binaural speech perception in noise. Assessments were conducted at baseline, 18 months, and 3 years. The change from baseline hearing measures were analyzed using an intention to treat approach. Aspirin and placebo were compared using mixed linear regression models adjusting for age, sex, diabetes, and smoking. Results: Of 279 participants, 154 (55%) were male, and the median age at baseline was 73.1 years (IQR, 71.5-76.2 years). A total of 98 of 138 participants (71%) in the aspirin group and 94 of 141 participants (67%) in the placebo group reported experiencing hearing loss at baseline. Compared with placebo, aspirin did not affect the changes in mean (SD) 4-frequency average hearing threshold from baseline to year 3 (aspirin: baseline, 27.8 [13.3] dB; year 3, 30.7 [13.7] dB; difference, 3.3 [3.9] dB; placebo: baseline, 27.5 [12.6] dB; year 3, 30.9 [13.8] dB; difference, 3.0 [4.8] dB; P = .55) nor any other tested frequencies. An increase in air conduction threshold indicates a deterioration in hearing. Similarly, for the mean (SD) speech reception threshold, there was no significant difference observed between the aspirin and placebo group at the year 3 follow-up assessment (aspirin: baseline, -9.9 [3.8] dB; year 3, -9.1 [3.8] dB; difference, 0.9 [2.9] dB; placebo: baseline, -10.5 [7.1] dB; year 3, -9.6 [4.1] dB; difference, 0.9 [5.9] dB; P = .86). The findings were consistent across sex, age groups, diabetic and smoking status. Conclusions and Relevance: In this secondary analysis of the ASPREE randomized clinical trial, low-dose aspirin did not affect the progression of age-related hearing loss. More investigation is warranted on whether a longer follow-up or the use of a more powerful anti-inflammatory agent might prove beneficial. Trial Registration: anzctr.org.au Identifier: ACTRN12614000496617.

Masked speech recognition by 6-13-year-olds with early-childhood otitis media: effects of acoustic condition and otologic history.

OBJECTIVE: To investigate speech recognition in school-age children with early-childhood otitis media (OM) in conditions with noise or speech maskers with or without interaural differences. To also investigate the effects of three otologic history factors. DESIGN: Using headphone presentation, speech recognition thresholds (SRTs) were measured with simple sentences. As maskers, stationary speech-shaped noise (SSN) or two-talker running speech (TTS) were used. The stimuli were presented in a monaural and binaural condition (SSN) or a co-located and spatially separated condition (TTS). Based on the available medical records, overall OM duration, OM onset age, and time since the last OM episode were estimated. STUDY SAMPLE: 6-13-year-olds with a history of recurrent OM (N = 42) or without any ear diseases (N = 20) with normal tympanograms and audiograms at the time of testing. RESULTS: Mixed-model regression analyses that controlled for age showed poorer SRTs for the OM group (Δ-value = 0.84 dB, p = 0.009). These appeared driven by the spatially separated, binaural, and monaural conditions. The OM group showed large inter-individual differences, which were unrelated to the otologic history factors. CONCLUSIONS: Early-childhood OM can affect speech recognition in different acoustic conditions. The effects of the otologic history warrant further investigation.

Listening Preferences of New Adult Hearing Aid Users: A Registered, Double-Blind, Randomized, Mixed-Methods Clinical Trial of Initial Versus Real-Ear Fit.

Hearing aid verification with real-ear measurement (REM) is recommended in clinical practice. Improvements, over time, in accuracy of manufacturers' initial fit mean the benefit of routine REM for new adult users is unclear. This registered, double-blinded, randomized, mixed-methods clinical trial aimed to (i) determine whether new adult hearing aid users prefer initial or real-ear fit and (ii) investigate the reasons for preferences. New adult hearing aid users (n = 45) were each fitted with two programs: the initial fit and real-ear fit, both with adjustments based on immediate feedback from the patient. Participants were asked to complete daily paired-comparisons of the two programs with a magnitude estimation of the preference, one for each of clarity/comfort in quiet/noise as well as overall preference. The results revealed gain adjustment requests were low in number and small in magnitude. Deviation from NAL-NL2 targets (after adjustment for a 65 dB SPL input) was close to zero, except at high frequencies where real-ear fits were around 3 dB closer to target. There was no difference in clarity ratings between programs, but comfort ratings favored initial fit. Overall, 10 participants (22%) expressed a preference for real-ear fit. Reasons for preference were primarily based on comfort with the initial fit and clarity with real-ear fit. It may be acceptable to fit new adult users with mild-to-moderate hearing loss without the need for REMs, if the primary outcome of interest is user preference. It remains to be seen if the findings generalize to other fitting software, other outcome measures and more severe hearing loss.

List Equivalency and Critical Differences of a Mandarin Bamford-Kowal-Bench Sentence in Babble Noise Test for Adults and Preschool Children With Normal Hearing.

PURPOSE: The purpose of this study was to determine the speech recognition equivalence of Mandarin Bamford-Kowal-Bench (BKB) sentence lists with adults and children with normal hearing. METHOD: A total of 32 lists, each of nine sentences, were compiled from a corpus of BKB-like sentences with paired babble in Mandarin. Interlist equivalence, critical differences, and sensitivity of performance to signal-to-noise ratio (SNR) were examined. Experiment 1 included 64 native Mandarin-speaking adults with normal hearing. Experiment 2 included 54 native Mandarin-speaking children with normal hearing aged 4-6 years. RESULTS: Among the 32 sentence lists, 28 lists were confirmed to be equivalent in adults, with a mean SNR required for 50% correct (SNR50) of -5.9 ± 0.1 dB, a mean slope of 22.3%/dB ± 1.5%/dB, and a grand 95% critical difference subsequently calculated as 27.2% for score. From the 28 equivalent lists, 27 lists were selected and observed to be equivalent in children, with a mean SNR50 threshold of -2.0 ± 0.2 dB, a mean slope of 15.8%/dB ± 1.1%/dB, and a grand 95% critical difference of 24.6% for score. CONCLUSIONS: The Mandarin BKB sentences in babble noise test offers an opportunity for clinicians and researchers to assess speech understanding in adults and preschool children in an efficient manner. For comparisons of performance in different test conditions, 28 equivalent lists are available for adults and 27 equivalent lists for preschool children. The 95% critical difference values can be used for total percentage correct or SNR for 50% performance. Future work will examine the clinical utility for school-age children and children who are deaf and hard of hearing. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24400066.

Toward a Real-World Technical Test Battery for Remote Microphone Systems Used with Hearing Prostheses.

Remote microphones (RMs) enable clearer reception of speech than would be normally achievable when relying on the acoustic sound field at the listener's ear (Hawkins, J Sp Hear Disord 49, 409-418, 1984). They are used in a wide range of environments, with one example being for children in educational settings. The international standards defining the assessment methods of the technical performance of RMs rely on free-field (anechoic) delivery, a rarely met acoustic scenario. Although some work has been offered on more real-world testing (Husstedt et al., Int J Audiol 61, 34-45. 2022), the area remains under-investigated. The electroacoustic performance of five RMs in a low-reverberation room was compared in order to assess just the RM link, rather than measurements at the end of the signal chain, for example, speech intelligibility in human observers. It pilots physical- and electro-acoustic measures to characterize the performance of RMs. The measures are based on those found in the IEC 60118 standards relating to hearing aids, but modified for diffuse-field delivery, as well as adaptive signal processing. Speech intelligibility and quality are assessed by computer models. Noise bands were often processed into irrelevance by adaptive systems that could not be deactivated. Speech-related signals were more successful. The five RMs achieved similar levels of good predicted intelligibility, for each of two background noise levels. The main difference observed was in the transmission delay between microphone and ear. This ranged between 40 and 50 ms in two of the systems, on the upper edge of acceptability necessary for audio-visual synchrony.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults.

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.

Aided Cortical Auditory Evoked Potentials in Infants With Frequency-Specific Synthetic Speech Stimuli: Sensitivity, Repeatability, and Feasibility.

OBJECTIVES: The cortical auditory evoked potential (CAEP) test is a candidate for supplementing clinical practice for infant hearing aid users and others who are not developmentally ready for behavioral testing. Sensitivity of the test for given sensation levels (SLs) has been reported to some degree, but further data are needed from large numbers of infants within the target age range, including repeat data where CAEPs were not detected initially. This study aims to assess sensitivity, repeatability, acceptability, and feasibility of CAEPs as a clinical measure of aided audibility in infants. DESIGN: One hundred and three infant hearing aid users were recruited from 53 pediatric audiology centers across the UK. Infants underwent aided CAEP testing at age 3 to 7 months to a mid-frequency (MF) and (mid-)high-frequency (HF) synthetic speech stimulus. CAEP testing was repeated within 7 days. When developmentally ready (aged 7-21 months), the infants underwent aided behavioral hearing testing using the same stimuli, to estimate the decibel (dB) SL (i.e., level above threshold) of those stimuli when presented at the CAEP test sessions. Percentage of CAEP detections for different dB SLs are reported using an objective detection method (Hotellings T 2 ). Acceptability was assessed using caregiver interviews and a questionnaire, and feasibility by recording test duration and completion rate. RESULTS: The overall sensitivity for a single CAEP test when the stimuli were ≥0 dB SL (i.e., audible) was 70% for the MF stimulus and 54% for the HF stimulus. After repeat testing, this increased to 84% and 72%, respectively. For SL >10 dB, the respective MF and HF test sensitivities were 80% and 60% for a single test, increasing to 94% and 79% for the two tests combined. Clinical feasibility was demonstrated by an excellent >99% completion rate, and acceptable median test duration of 24 minutes, including preparation time. Caregivers reported overall positive experiences of the test. CONCLUSIONS: By addressing the clinical need to provide data in the target age group at different SLs, we have demonstrated that aided CAEP testing can supplement existing clinical practice when infants with hearing loss are not developmentally ready for traditional behavioral assessment. Repeat testing is valuable to increase test sensitivity. For clinical application, it is important to be aware of CAEP response variability in this age group.

Acoustic change complex for assessing speech discrimination in normal-hearing and hearing-impaired infants.

OBJECTIVE: This study examined (1) the utility of a clinical system to record acoustic change complex (ACC, an event-related potential recorded by electroencephalography) for assessing speech discrimination in infants, and (2) the relationship between ACC and functional performance in real life. METHODS: Participants included 115 infants (43 normal-hearing, 72 hearing-impaired), aged 3-12 months. ACCs were recorded using [szs], [uiu], and a spectral rippled noise high-pass filtered at 2 kHz as stimuli. Assessments were conducted at age 3-6 months and at 7-12 months. Functional performance was evaluated using a parent-report questionnaire, and correlations with ACC were examined. RESULTS: The rates of onset and ACC responses of normal-hearing infants were not significantly different from those of aided infants with mild or moderate hearing loss but were significantly higher than those with severe loss. On average, response rates measured at 3-6 months were not significantly different from those at 7-12 months. Higher rates of ACC responses were significantly associated with better functional performance. CONCLUSIONS: ACCs demonstrated auditory capacity for discrimination in infants by 3-6 months. This capacity was positively related to real-life functional performance. SIGNIFICANCE: ACCs can be used to evaluate the effectiveness of amplification and monitor development in aided hearing-impaired infants.

Perceived Sound Quality of Hearing Aids With Varying Placements of Microphone and Receiver.

PURPOSE: Perceived sound quality was variously compared between either no aiding or aiding with three models of hearing aid that varied the microphone position around the pinna, depth of the receiver in the auditory meatus, degree of meatal occlusion, and processing sophistication. The hearing aids were modern designs and commercially available at the time of testing. METHOD: Binaural recordings of multichannel spatially separated speech and music excerpts were made in a manikin, either open ear or aided. Recordings were presented offline over wide-bandwidth, high-quality insert earphones. Participants listened to pairs of the recordings and made preference ratings both by clarity and externality (a proxy for "spaciousness"). Two separate groups of adults were tested, 20 with audiometrically normal hearing (NH) and 20 with mild-to-moderate sensorineural hearing loss (hearing impaired [HI]). RESULTS: For ratings of speech clarity, the NH group expressed no preference between the open ear and a deeply inserted occluding aid, both of which were preferred to a low-pass filtered output of the same aid. For the music signal, a small preference emerged for the open-ear recording over that of the aid. For the HI group, clarity of the deeply inserted aid was similar to in-the-ear and behind-the-ear devices for speech, but worse for music. Ratings of spaciousness produced no clear result in either group, which can be attributed to study limitations and/or participant factors. CONCLUSION: Based on clarity, a wide bandwidth, particularly to beyond 5 kHz generally and below 300 Hz for music, is desirable, independent of hearing aid design.

Do we need audiogram-based prescriptions? A systematic review.

OBJECTIVE: Hearing aids are typically programmed using the individual's audiometric thresholds and verified using real-ear measures. Developments in technology have resulted in a new category of direct-to-consumer devices, which are not necessarily programmed using the individual's audiometric thresholds. This review aimed to identify whether programming hearing aids using the individual's validated audiogram-based prescription, and verified using real-ear measures, results in better outcomes for adults with hearing loss. DESIGN: The review was registered in PROSPERO and reported in accordance with PRISMA guidelines. STUDY SAMPLE: After screening more than 1370 records, seven experimental studies met the eligibility criteria. RESULTS: Studies were categorised under three methods of fitting: (i) comparative fitting evaluating different settings based on the beliefs of the audiologist; (ii) client choice of preset responses; and (iii) self-fit by adjustment. The findings suggest that using a prescription based on the individual's audiogram improves outcomes relative to the comparative and client choice fitting approaches. Self-adjustment during daily use may produce equivalent (or better) outcomes than an audiogram-based prescription. The quality of evidence for the outcomes ranged from low to very low. CONCLUSIONS: This review has highlighted the dearth of high-quality studies on which to make evidence-based decisions on hearing aid fitting methods.

The development of the Language-Independent Speech in Noise and Reverberation test (LISiNaR) and evaluation in listeners with English as a second language.

OBJECTIVE: Create a language-independent, ecologically valid auditory processing assessment and evaluate relative stimuli intelligibility in native and non-native English speakers. DESIGN: The Language-Independent Speech in Noise and Reverberation Test (LISiNaR) targets comprised consonant-vowel (CVCV) pseudo-words. Distractors comprised CVCVCVCV pseudo-words. Stimuli were presented over headphones using an iPad either face-to-face or remotely. Scoring occurred adaptively to establish a participant's speech reception threshold in noise (SRT). The listening environment was simulated using reverberant and anechoic head-related transfer functions. In four test conditions, targets originated from 0°. Distractors originated from either ±90°, ±67.5° and ±45° (spatially separated) or 0° azimuth (co-located). Reverberation impact (RI) was calculated as the difference in SRTs between the anechoic and reverberant conditions and spatial advantage (SA) as the difference between the spatially separated and co-located conditions. STUDY SAMPLE: Young adult native speakers of Australian (n = 24) and Canadian (25) and non-native English speakers (34). RESULTS: No significant effects of language occurred for the test conditions, RI or SA. A small but significant effect of delivery mode occurred for RI. Reverberation impacted SRT by 5 dB relative to anechoic conditions. CONCLUSION: Performance on LISiNaR is not affected by the native language or accent of groups tested in this study.

Web- and app-based tools for remote hearing assessment: a scoping review.

OBJECTIVE: Remote hearing screening and assessment may improve access to, and uptake of, hearing care. This review, the most comprehensive to date, aimed to (i) identify and assess functionality of remote hearing assessment tools on smartphones and online platforms, (ii) determine if assessed tools were also evaluated in peer-reviewed publications and (iii) report accuracy of existing validation data. DESIGN: Protocol was registered in INPLASY and reported according to PRISMA-Extension for Scoping Reviews. STUDY SAMPLE: In total, 187 remote hearing assessment tools (using tones, speech, self-report or a combination) and 101 validation studies met the inclusion criteria. Quality, functionality, bias and applicability of each app were assessed by at least two authors. RESULTS: Assessed tools showed considerable variability in functionality. Twenty-two (12%) tools were peer-reviewed and 14 had acceptable functionality. The validation results and their quality varied greatly, largely depending on the category of the tool. CONCLUSION: The accuracy and reliability of most tools are unknown. Tone-producing tools provide approximate hearing thresholds but have calibration and background noise issues. Speech and self-report tools are less affected by these issues but mostly do not provide an estimated pure tone audiogram. Predicting audiograms using filtered language-independent materials could be a universal solution.

The one-up one-down adaptive (staircase) procedure in speech-in-noise testing: Standard error of measurement and fluctuations in the track.

The one-up one-down adaptive (staircase or up-down) procedure is often used to estimate the speech recognition threshold (SRT) in speech-in-noise testing. This article provides a brief historical overview of the one-up one-down procedure in psychophysics, discussing the groundbreaking early work that is still relevant to clinical audiology and scientific research. Next, this article focuses on two aspects of the one-up one-down adaptive procedure: first, the standard error of measurement (SEM) and, second, the fluctuations in the track [i.e., the standard deviation of the signal-to-noise ratios of the stimuli within the track (SDtrack)]. Simulations of ideal and non-ideal listeners and experimental data are used to determine and evaluate different relationships between the parameters slope of the speech recognition function, SRT, SEM, and SDtrack. Hearing loss and non-ideal behavior (inattentiveness, fatigue, and giving up when the task becomes too difficult) slightly increase the average value of SDtrack. SDtrack, however, poorly discriminates between reliable and unreliable SRT estimates.

Development and Evaluation of a Language-Independent Test of Auditory Discrimination for Referrals for Cochlear Implant Candidacy Assessment.

OBJECTIVES: The purpose of this study was to (1) develop a Language-independent Test of Auditory Discrimination (LIT-AD) between speech sounds so that people with hearing loss who derive limited speech perception benefits from hearing aids (HAs) may be identified for consideration of cochlear implantation and (2) examine the relationship between the scores for the new discrimination test and those of a standard sentence test for adults wearing either HAs or cochlear implants (CIs). DESIGN: The test measures the ability of the listener to correctly discriminate pairs of nonsense syllables, presented as sequential triplets in an odd-one-out format, implemented as a game-based software tool for self-administration using a tablet computer. Stage 1 included first a review of phonemic inventories in the 40 most common languages in the world to select the consonants and vowels. Second, discrimination testing of 50 users of CIs at several signal to noise ratios (SNRs) was carried out to generate psychometric functions. These were used to calculate the corrections in SNR for each consonant-pair and vowel combination required to equalize difficulty across items. Third, all items were individually equalized in difficulty and the overall difficulty set. Stage 2 involved the validation of the LIT-AD in English-speaking listeners by comparing discrimination scores with performance in a standard sentence test. Forty-one users of HAs and 40 users of CIs were assessed. Correlation analyses were conducted to examine test-retest reliability and the relationship between performance in the two tests. Multiple regression analyses were used to examine the relationship between demographic characteristics and performance in the LIT-AD. The scores of the CI users were used to estimate the probability of superior performance with CIs for a non-CI user having a given LIT-AD score and duration of hearing loss. RESULTS: The LIT-AD comprises 81 pairs of vowel-consonant-vowel syllables that were equalized in difficulty to discriminate. The test can be self-administered on a tablet computer, and it takes about 10 min to complete. The software automatically scores the responses and gives an overall score and a list of confusable items as output. There was good test-retest reliability. On average, higher LIT-AD discrimination scores were associated with better sentence perception for users of HAs (r = -0.54, p <0.001) and users of CIs (r = -0.73, p <0.001). The probability of superior performance with CIs for a certain LIT-AD score was estimated, after allowing for the effect of duration of hearing loss. CONCLUSIONS: The LIT-AD could increase access to CIs by screening for those who obtain limited benefits from HAs to facilitate timely referrals for CI candidacy evaluation. The test results can be used to provide patients and professionals with practical information about the probability of potential benefits for speech perception from cochlear implantation. The test will need to be evaluated for speakers of languages other than English to facilitate adoption in different countries.

Cost-Effectiveness of Screening Preschool Children for Hearing Loss in Australia.

OBJECTIVES: While all newborns in Australia are tested for congenital hearing loss through universal newborn hearing screening programs, some children will acquire hearing loss in their first five years of life. Delayed diagnosed or undiagnosed hearing loss in children can have substantial immediate- and long-term consequences. It can significantly reduce school readiness, language and communication development, social and emotional development, and mental health. It can also compromise lifetime educational achievements and employment opportunities and future economic contribution to society through lost productivity. The need for a universal hearing screening program for children entering their first year of primary school has been noted in two separate Australian Government hearing inquiries in the last decade. Sound Scouts is a hearing screening application (app) that tests for hearing loss in children using a tablet or mobile device, supervised by parents at home. It tests for sensorineural or permanent conductive hearing loss and central auditory processing disorder in children. In 2018 the Australian Government funded the roll-out of Sound Scouts to allow up to 600,000 children to test their hearing using Sound Scouts. This study estimated the cost-effectiveness of screening 5-year-old children for hearing loss using Sound Scouts at home, compared with no screening. DESIGN: A decision-analytic model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of administering Sound Scouts over a 20-year time horizon. Testing accuracy was based on comparing Sound Scouts test results to clinical test results while other parameters were based on published data. Costs were estimated from the perspective of the Australian health care system. Univariate and probabilistic sensitivity analyses were undertaken. RESULTS: Sound Scouts is estimated to result in an average incremental cost of A$61.02 and an average incremental increase in QALYs of 0.01. This resulted in an incremental cost-effectiveness ratio of A$5392 per QALY gained, which is likely to be considered cost-effective by Australian decision makers. Screening with Sound Scouts was found to have a 96.2 per cent probability of being cost-effective using a threshold of A$60,000 per QALY gained. CONCLUSIONS: Using Sound Scouts to screen five-year-old children for hearing loss (at home) is likely to be cost-effective. Screening children using Sound Scouts will result in early identification and intervention in childhood hearing loss, thereby reducing early childhood disadvantage through cumulative gains in quality of life, education, and economic outcomes over their lifetime.

Comment on Ahmmed (2021): The Search for Evidence-Based Auditory Processing Disorder Diagnostic Criteria.

PURPOSE: Ahmmed (2021) presented a study to advance the goal of an evidence-based diagnostic criteria for auditory processing disorder. We offer some cautions about the interpretation of these results, as well as suggestions for future strategies for developing evidence-based criteria for auditory processing disorder.

Is the outcome of fitting hearing aids to adults affected by whether an audiogram-based prescription formula is individually applied? A systematic review protocol.

INTRODUCTION: Hearing aids are typically programmed using the individual's audiometric thresholds. Developments in technology have resulted in a new category of direct-to-consumer devices, which are not programmed using the individual's audiometric thresholds. This review aims to identify whether programming hearing aids using the individual's audiogram-based prescription results in better outcomes for adults with hearing loss. METHODS AND ANALYSIS: The methods of this review are reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. On 23 August 2020, eight different databases were systematically searched without any restrictions: EMBASE, MEDLINE, PubMed, PsycINFO, Web of Science, Cochrane Library, Emcare and Academic Search Premier. To ensure that this review includes the most recent evidence, the searches will be repeated at the final write-up stage. The population of interest of this review will be adults with any degree or type of hearing loss. The studies should compare hearing aids programmed using an audiogram-based prescription (and verified in the real ear) with those not programmed on the basis of the individual's audiogram. The primary outcome of interest is consumers' listening preferences. Hearing-specific health-related quality of life, self-reported listening ability, speech intelligibility of words and sentences in quiet and noisy situations, sound quality ratings and adverse events are the secondary outcomes of interest. Both randomised and non-randomised controlled trials will be included. The quality of each individual study and the overall evidence will be assessed using Downs and Black's checklist and the Grading of Recommendations, Assessment, Development and Evaluations tool, respectively. ETHICS AND DISSEMINATION: We will only retrieve and analyse data from published studies, so no ethical approval is required. The review findings will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42020197232.

Separating the Causes of Listening Difficulties in Children.

Auditory processing disorder, defined here as a deficit in the way sounds are analyzed by the brain, has remained a controversial topic within audiology for decades. Some of the controversy concerns what it is called. More substantively, even its existence has been questioned. That view has likely emerged because there has not been sufficient rigor in determining when difficulty in understanding speech has been the consequence of some type of auditory processing deficit, versus when it is the consequence of a cognitive deficit or a language deficit. This article suggests that the field use the term "listening difficulty" as an umbrella term to indicate a reported deficit in recognizing sounds or understanding speech, one possible cause of which is an auditory processing disorder. Other possible causes are hearing deficits, cognitive deficits, and language deficits. This article uses a plausible, and hopefully noncontroversial, model of speech understanding that comprises auditory processing, speech processing, and language processing, all potentially affected by the degree of attention applied and the listener's memory ability. In a fresh approach to the construction of test batteries, the stages of the model are linked to tests designed to assess either all or selected parts of the processes involved. For two of the stages, a listener's performance is quantified as the additional signal to noise ratio that he or she needs to function equivalently to his or her age peers. Subtraction of the deficits revealed by each test enables the contributions of each processing stage to a listening deficit to be quantified. As a further novel contribution, the impact of memory and attention on each test score is quantitatively allowed for, by an amount that depends on each test's dependence on memory and attention. Attention displayed during the test is estimated from the fluctuations in performance during the test. The article concludes with a summary of the research that must be conducted before the structured tests can be used to quantify the extent to which different potential causes of listening difficulties are responsible for real-life difficulties in an individual child.

Factor Analysis on Multiple Auditory Processing Assessment-2 and Listening in Spatialized Noise-Sentences Test in Children.

Introduction There is need for greater understanding of tests used in assessing all aspects of auditory processing disorder (APD). This is important so that specific deficits can be identified and later remediated with the smallest possible test battery. The American Speech-Language-Hearing Association (ASHA) recommends five areas/domains for behavioral assessment: (a) temporal, (b) binaural (dichotic) separation/integration, (c) monaural low redundancy, (d) binaural interaction/localization/lateralization, and (e) auditory discrimination. Multiple-factor studies support the first three domains, which are most often used for APD assessment and which can be measured in a test battery normed within the United States (Multiple Auditory Processing Assessment-2 [MAPA-2]). This study was designed to determine if factored results from children would clarify whether a behavioral test (Listening in Spatialized Noise-Sentences Test [LiSN-S]) would factor within one of the first three domains or be separate, possibly within the fourth domain, binaural interaction. Method Fifty-one 8- and 9-year-olds with normal development and normal otoscopy and hearing responses bilaterally from 500 to 4000 Hz at 20 dB HL were recruited. Two sets of APD tests were administered: MAPA-2 and LiSN-S. Results Results verified the expected three-factor structure for MAPA-2. LiSN-S did not factor within one of those three, suggesting that some processes involved in the LiSN-S tasks require interactions between the two ears different from those involved in dichotic perception and thus better belong in the ASHA binaural interaction/lateralization domain. Conclusions Auditory processing abilities are sufficiently independent of each other that test batteries spanning the first three ASHA domains are not sensitive to at least some abilities in the fourth domain. This additional factor evidence is helpful. Future research should examine the utility of measuring additional factors within APD in order to achieve the most efficient and comprehensive test battery.