Audiologic Assessment.

Prior to the fitting of hearing aids, clinicians and patients must discuss the best treatment options for the physical and audiologic needs of the patients. To be able to confidently make these decisions, the clinician should complete a medical and audiological case history. Additionally, clinicians need accurate results from a comprehensive audiologic evaluation. The evaluation should include the following: pure-tone testing, word recognition testing, speech-in-noise testing, and loudness discomfort level measures. This article will outline the process and procedures for acquiring this information in line with the Audiology Practice Standards Organization (APSO) Guidelines for Adult Hearing Aid Fittings Standards 1 and 4. This article will also discuss how results can affect decision-making during the hearing aid selection and fitting process.

The effect of narrow-band noise maskers on increment detection.

It is often assumed that listeners detect an increment in the intensity of a pure tone by detecting an increase in the energy falling within the critical band centered on the signal frequency. A noise masker can be used to limit the use of signal energy falling outside of the critical band, but facets of the noise may impact increment detection beyond this intended purpose. The current study evaluated the impact of envelope fluctuation in a noise masker on thresholds for detection of an increment. Thresholds were obtained for detection of an increment in the intensity of a 0.25- or 4-kHz pedestal in quiet and in the presence of noise of varying bandwidth. Results indicate that thresholds for detection of an increment in the intensity of a pure tone increase with increasing bandwidth for an on-frequency noise masker, but are unchanged by an off-frequency noise masker. Neither a model that includes a modulation-filter-bank analysis of envelope modulation nor a model based on discrimination of spectral patterns can account for all aspects of the observed data.

Cochlear Implant Practice Patterns: The U.S. Trends with Pediatric Patients.

BACKGROUND: Many factors affect an individual's outcomes with a cochlear implant (CI); however, quality of device programming and consistency of follow-up appointments have been shown to be crucial contributors. As audiologists' CI caseloads increase, time constraints on appointments also increase, thus fueling the need for efficient and effective programming strategies. Currently, there are no standardized guidelines describing what methods should be used during programming, nor are there standardized schedules that delineate what procedures should be performed at specific appointment intervals. Without standardized programming guidelines, clinical practices may be variable and may not align with best practice research; thus, outcomes with a CI, particularly for pediatrics, may not be reflective of the actual potential available. PURPOSE: The purpose of this study was to identify the clinical practice patterns used by U.S. audiologists when programming and providing follow-up care to children who use CIs. This study aimed to determine the following: common programming approaches, provision intervals for these procedures, common validation assessments, typical follow-up care schedules, and source(s) of CI training. In addition, this study sought to evaluate if training and/or follow-up care differed between small and large CI centers. RESEARCH DESIGN: A cross-sectional survey design was used. STUDY SAMPLE: Target population included practicing audiologists working with pediatric CI users throughout the United States. Participation was voluntary, thus random selection could not be used. A total of 167 participants opened and began the online survey and 113 successfully completed the survey instrument (23.99% return rate). DATA COLLECTION AND ANALYSIS: Potential participants were identified using the "find a clinic" function on three CI manufacturers' websites. Potential participants were asked to complete an online survey seeking information about practices they employ in their clinical setting. Survey responses were analyzed for trends. RESULTS: Overall, a common follow-up schedule was determined, which included an average of 6.8 appointments within the first year. Minor differences in training and programming practices between small and large CI centers emerged; however, no statistically significant results were noted. Results did reveal trends in the use of certain clinical practices. This was particularly evident in the limited use of objective measures. CONCLUSIONS: Overall, the findings support other recent studies that suggest the development of CI guidelines that may standardize programming and follow-up practices of CI audiologists. This could prove valuable for the continual improvement of CI outcomes, particularly in the pediatric population.

Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss.

Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.

Impact of Aging and Cognition on Hearing Assistive Technology Use.

Many factors go into appropriate recommendation and use of hearing assistive technology (HAT). The aging auditory system presents with its own complications and intricacies; there are many types of age-related hearing loss, and it is possible that the underlying cause of hearing loss can significantly impact the recommendations and performance with HATs. The audiologist should take into consideration peripheral and central auditory function when selecting HATs for the aging adult population as well as when selecting appropriate types of technology including personal sound amplification products, hearing aids, cochlear implants, and other assistive technology. The cognitive ability of the patient plays a central role in the recommendations of HAT. It is possible that the use of HATs could mitigate some of the effects of cognitive decline and thus should be considered as early as possible. Assessment of ability and appropriate recommendations are crucial to consistent use of HAT devices.

Reduction in High-Frequency Hearing Aid Gain Can Improve Performance in Patients With Contralateral Cochlear Implant: A Pilot Study.

PURPOSE: The purpose of this study was to determine whether an alternate fitting strategy, specifically adjustment to gains in a hearing aid (HA), would improve performance in patients who experienced poorer performance in the bimodal condition when the HA was fit to traditional targets. METHOD: This study was a retrospective chart review from a local clinic population seen during a 6-month period. Participants included 6 users of bimodal stimulation. Two performed poorer in the cochlear implant (CI) + HA condition than in the CI-only condition. One individual performed higher in the bimodal condition, but the overall performance was low. Three age range-matched users whose performance increased when the HA was used in conjunction with a CI were also included. The HA gain was reduced beyond 2000 Hz. Speech perception scores were obtained pre- and postmodification to the HA fitting. RESULTS: All listeners whose HA was programmed using the modified approach demonstrated improved speech perception scores with the modified HA fit in the bimodal condition when compared with the traditional HA fit in the bimodal condition. CONCLUSION: Modifications to gains above 2000 Hz in the HA may improve performance for bimodal listeners who perform more poorly in the bimodal condition when the HA is fit to traditional targets.

Legislation impacting audiology and the provision of audiological services: a review of legislation across the United States.

PURPOSE: The purpose of this review was to investigate the legislation about the provision of audiology services. Specifically, the goal of the review was to investigate the similarities and differences in legislation regarding the identification of, and audiology services provided to, children with hearing loss. METHOD: A systematic review was conducted to collect state-specific legislation regarding the audiology licensure requirements, requirements about the identification and management of children with hearing loss, and insurance coverage regulations. Compiled data were analyzed for similarities and differences between state regulations and legislature. RESULTS: All states require audiologists to hold licensure; however, many differences exist between the requirements of acquiring and maintaining the license. Some states regulate the identification and management of children with hearing loss, whereas others do not. Additionally, states differ in their regulation of services provided to children with hearing loss, who can provide these services, and what is covered by insurance. CONCLUSION: It is critical for audiologists to understand the requirements of their state in the provision of audiology services. Specifically, it is important for audiologists to understand how the laws may impact the services they provide to children with hearing loss.