Evaluation of a clinical method for selective electrode deactivation in cochlear implant programming.

Background: Cochlear implants are a neural prosthesis used to restore the perception of hearing in individuals with severe-to-profound hearing loss by stimulating the auditory nerve with electrical current through a surgically implanted electrode array. The integrity of the interface between the implanted electrode array and the auditory nerve contributes to the variability in outcomes experienced by cochlear implant users. Strategies to identify and eliminate poorly encoding electrodes have been found to be effective in improving outcomes with the device, but application is limited in a clinical setting. Objective: The purpose of this study was to evaluate a clinical method used to identify and selectively deactivate cochlear implants (CI) electrodes related to poor electrode-neural interface. Methods: Thirteen adult CI users participated in a pitch ranking task to identify indiscriminate electrode pairs. Electrodes associated with indiscriminate pairs were selectively deactivated, creating an individualized experimental program. Speech perception was evaluated in the baseline condition and with the experimental program before and after an acclimation period. Participant preference responses were recorded at each visit. Results: Statistically significant improvements using the experimental program were found in at least one measure of speech perception at the individual level in four out of 13 participants when tested before acclimation. Following an acclimation period, ten out of 13 participants demonstrated statistically significant improvements in at least one measure of speech perception. Statistically significant improvements were found with the experimental program at the group level for both monosyllabic words (p = 0.006) and sentences in noise (p = 0.020). Additionally, ten participants preferred the experimental program prior to the acclimation period and eleven preferred the experimental program following the acclimation period. Conclusion: Results from this study suggest that electrode deactivation may yield improvement in speech perception following an acclimation period. A majority of CI users in our study reported a preference for the experimental program. This method proved to be a suitable clinical strategy for identifying and deactivating poorly encoding electrodes in adult CI users.

Living in a Limited World: Experience of Lipreaders When Society Is Masked.

The goal of the current interpretive phenomenological study grounded in Heidegger's philosophies was to explore the experience of lipreaders when society was masked during the coronavirus disease 2019 pandemic. Participants were prelingually deafened English-speaking adults who predominantly relied on lip-reading and speaking for communication. Twelve in-depth email interviews were conducted with respondents recruited via social media. Thematic techniques of Benner were employed, and six themes emerged: Limiting of World Resulting in Negative Emotions, Increased Prominence of Deafness, Balancing Safety and Communication Access, Creative Resourcefulness, Resilience and Personal Growth, and Passage of Time to Bittersweet Freedom. Insights from this study clarify the need for psychosocial support of lipreaders during times of restricted communication access and awareness of accommodations to facilitate inclusion. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 18-26.].

Assistive Technology for Adults with Hearing Aids.

Although there is a strong trend of satisfaction with hearing aids, recent consumer surveys indicate that there are still challenges with understanding speech in background noise and low penetration of wireless technologies using many modern-day communication and audio devices, such as smartphones, tablets, and computers. For some listening and communication settings, many patients could benefit from assistive technology that exceeds the capabilities of their hearing aids. When patients are not wearing their hearing aids, such as during sleep, concerns about environmental awareness and safety begin to arise. This article describes some current assistive technologies and accessories that facilitate accessibility to other devices and to satisfy the patient's listening and communication needs.

Supporting Equity and Inclusion of Deaf and Hard-of-Hearing Individuals in Professional Organizations.

Disability is an important and often overlooked component of diversity. Individuals with disabilities bring a rare perspective to science, technology, engineering, mathematics, and medicine (STEMM) because of their unique experiences approaching complex issues related to health and disability, navigating the healthcare system, creatively solving problems unfamiliar to many individuals without disabilities, managing time and resources that are limited by physical or mental constraints, and advocating for themselves and others in the disabled community. Yet, individuals with disabilities are underrepresented in STEMM. Professional organizations can address this underrepresentation by recruiting individuals with disabilities for leadership opportunities, easing financial burdens, providing equal access, fostering peer-mentor groups, and establishing a culture of equity and inclusion spanning all facets of diversity. We are a group of deaf and hard-of-hearing (D/HH) engineers, scientists, and clinicians, most of whom are active in clinical practice and/or auditory research. We have worked within our professional societies to improve access and inclusion for D/HH individuals and others with disabilities. We describe how different models of disability inform our understanding of disability as a form of diversity. We address heterogeneity within disabled communities, including intersectionality between disability and other forms of diversity. We highlight how the Association for Research in Otolaryngology has supported our efforts to reduce ableism and promote access and inclusion for D/HH individuals. We also discuss future directions and challenges. The tools and approaches discussed here can be applied by other professional organizations to include individuals with all forms of diversity in STEMM.

Acoustic effects of non-transparent and transparent face coverings.

The widespread use of face coverings during the COVID-19 pandemic has created communication challenges for many individuals, particularly for those who are deaf or hard of hearing and for those who must speak through masks in suboptimal conditions. This study includes some newer mask options as well as transparent masks to help those who depend on lipreading and other facial cues. The results corroborate earlier published results for non-transparent masks, but transparent options have greater attenuation, resonant peaks, and deflect sounds in ways that non-transparent masks do not. Although transparent face coverings have poorer acoustic performance, the presence of visual cues remains important for both verbal and non-verbal communication. Fortunately, there are creative solutions and technologies available to overcome audio and/or visual barriers caused by face coverings.

Frequency Responses of Conventional and Amplified Stethoscopes for Measuring Heart Sounds.

BACKGROUND: Frequencies of normal and abnormal heart sounds have previously been reported, but the acoustic analyses of the frequency responses of conventional and amplified stethoscopes for different heart sounds have not yet been reported. OBJECTIVES: To compare the acoustic analysis of frequency responses of three stethoscopes (conventional and amplified) for measuring simulated heart sounds. MATERIALS AND METHODS: This exploratory study used Starkey SLI-ST3, Cardionics E-Scope II (both electronic) and Littmann Classic S.E. II (conventional) stethoscopes, as they share the same basic design with twin ear tubes coupled to ear tips and chest piece options (bell vs. diaphragm modes). Acoustic analyses using the diaphragm were performed in a soundproof booth and frequency response curves at 85 (the largest), 250, 400, 550 and 1050 Hz were compared for three different digitized heart sound simulations: normal, aortic valvular stenosis (AVS) and pulmonic valvular stenosis. RESULTS: Amplified stethoscopes provided the most amplification of normal and abnormal heart sounds across all five frequencies compared with the conventional stethoscope. The Starkey SLI-ST3 stethoscope was better at amplifying normal heartbeats than the Cardionics E-Scope II and Littman Classic S.E. II; however, it came last for amplifying normal heartbeats of ~85 Hz. Cardionics E-Scope II had advantages in amplifying abnormal heartbeats (i.e., aortic valvular stenosis and pulmonic valvular stenosis) over the other two stethoscopes. CONCLUSION: This study showed that amplified stethoscopes provided better amplification of normal and abnormal heart sounds across the five measured frequencies. Therefore, health professionals should interpret manufacturer claims regarding gain (dB) and frequency (Hz) with caution, and those with hearing loss should carefully investigate the "audio performance" of the stethoscopes. Future research should focus on these effects through coupling with hearing aids.

Readability of Individuals With Disabilities Education Act Part B Procedural Safeguards: An Update.

Purpose The purpose of this study was to analyze the readability of Individuals with Disabilities Education Act (IDEA) Part B procedural safeguard documents, as distributed by each of the 50 U.S. states. Results were compared to the 5th- to 6th-grade readability guideline for documents recommended by experts in health literacy and health communication. Method A commercially available readability software, Readability Studio ( Oleander Software, 2009 ), was used to assess document readability. Text-based files of each IDEA Part B procedural safeguard document were analyzed using four readability formulas: Flesch-Kincaid ( Flesch, 1965 ), Gunning fog index ( Gunning, 1952 ), Flesch Reading Ease ( Flesch, 1948 ), and Simple Measure of Gobbledygook ( McLaughlin, 1969 ). Results No procedural safeguard document scored below an 11th-grade reading level. Seventy-four percent of these documents were found to be written at a graduate reading level-meaning these documents are written for a reader who is currently enrolled in a master's degree or higher education program. Conclusion In an effort to decrease barriers to parent participation in the Individualized Education Planning process, those who administer IDEA Part B procedural safeguards should be sensitive to the potential mismatch between the literacy skills of the parent/guardian and the literacy skills needed to comprehend these documents. Developers of IDEA Part B procedural safeguards should account for estimated literacy skills of the general public as ongoing revisions to these safeguards are made.

Readability Level of Spanish-Language Patient-Reported Outcome Measures in Audiology and Otolaryngology.

PURPOSE: The purpose of this study was to examine the readability level of the Spanish versions of several audiology- and otolaryngology-related patient-reported outcome measures (PROMs) and include a readability analysis of 2 translation approaches when available-the published version and a "functionalist" version-using a team-based collaborative approach including community members. METHOD: Readability levels were calculated using the Fry Graph adapted for Spanish, as well as the Fernandez-Huerta and the Spaulding formulae for several commonly used audiology- and otolaryngology-related PROMs. RESULTS: Readability calculations agreed with previous studies analyzing audiology-related PROMs in English and demonstrated many Spanish-language PROMs were beyond the 5th grade reading level suggested for health-related materials written for the average population. In addition, the functionalist versions of the PROMs yielded lower grade-level (improved) readability levels than the published versions. CONCLUSION: Our results suggest many of the Spanish-language PROMs evaluated here are beyond the recommended readability levels and may be influenced by the approach to translation. Moreover, improved readability may be possible using a functionalist approach to translation. Future analysis of the suitability of outcome measures and the quality of their translations should move beyond readability and include an evaluation of the individual's comprehension of the written text.

(Central) Auditory Processing Disorder Grand Rounds: Multiple Cases, Multiple Causes, Multiple Outcomes.

PURPOSE: The purpose of this article was to provide multiple examples of how (central) auditory processing disorder ([C]APD) is being evaluated and treated at various audiology clinics throughout the United States. METHOD: The authors present 5 cases highlighting the diagnosis and treatment of (C)APD in children and adults. Similarities and differences between these cases have been showcased through detailed histories, evaluation protocol, and treatment options. When possible, the rationale for evaluation procedures and intervention processes were described and compared with guidelines and findings within the literature. RESULTS AND CONCLUSIONS: These cases illustrate the varied processes and clinical protocols by which children and adults are evaluated, diagnosed, counseled, and treated for (C)APD. In addition, similarities and differences between the referral source, evaluation team, developmental history, comorbidities, test battery, recommendations, and remediations were described. The multiple clinic sites, diversity of clinical philosophies, variety of test measures, and diversity of patient populations make these cases ideal for showcasing the assortment of methodologies used with patients who present with histories and characteristics consistent with (C)APD.

The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss.

BACKGROUND: It is generally well known that speech perception is often improved with integrated audiovisual input whether in quiet or in noise. In many health-care environments, however, conventional surgical masks block visual access to the mouth and obscure other potential facial cues. In addition, these environments can be noisy. Although these masks may not alter the acoustic properties, the presence of noise in addition to the lack of visual input can have a deleterious effect on speech understanding. A transparent ("see-through") surgical mask may help to overcome this issue. PURPOSE: To compare the effect of noise and various visual input conditions on speech understanding for listeners with normal hearing (NH) and hearing impairment using different surgical masks. RESEARCH DESIGN: Participants were assigned to one of three groups based on hearing sensitivity in this quasi-experimental, cross-sectional study. STUDY SAMPLE: A total of 31 adults participated in this study: one talker, ten listeners with NH, ten listeners with moderate sensorineural hearing loss, and ten listeners with severe-to-profound hearing loss. DATA COLLECTION AND ANALYSIS: Selected lists from the Connected Speech Test were digitally recorded with and without surgical masks and then presented to the listeners at 65 dB HL in five conditions against a background of four-talker babble (+10 dB SNR): without a mask (auditory only), without a mask (auditory and visual), with a transparent mask (auditory only), with a transparent mask (auditory and visual), and with a paper mask (auditory only). RESULTS: A significant difference was found in the spectral analyses of the speech stimuli with and without the masks; however, no more than ∼2 dB root mean square. Listeners with NH performed consistently well across all conditions. Both groups of listeners with hearing impairment benefitted from visual input from the transparent mask. The magnitude of improvement in speech perception in noise was greatest for the severe-to-profound group. CONCLUSIONS: Findings confirm improved speech perception performance in noise for listeners with hearing impairment when visual input is provided using a transparent surgical mask. Most importantly, the use of the transparent mask did not negatively affect speech perception performance in noise.

Use of Baby Isao Simulator and Standardized Parents in Hearing Screening and Parent Counseling Education.

PURPOSE: The primary purpose of this study was to test the effect of the combined use of trained standardized parents and a baby simulator on students' hearing screening and parental counseling knowledge and skills. METHOD: A one-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills and satisfaction of the educational experience with standardized parents and a baby simulator. The mean age of the 14 audiology students participating in this study was 24.79 years (SD = 1.58). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Six students (2 students in each scenario) volunteered to participate in the infant hearing screening and counseling scenarios, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each of 3 scenarios. After the last scenario, participants were asked to complete a satisfaction survey of their learning experience using simulation and standardized parents. RESULTS: Overall, the pre- and post-simulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels regarding knowledge and skills. The mean difference between pre- and postevent scores was 0.52 (p < .01). The mean satisfaction level was 4.71 (range = 3.91-5.00; SD = 0.30) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied. CONCLUSIONS: The results of this novel educational activity demonstrate the value of using infant hearing screening and parental counseling simulation sessions to enhance student learning. In addition, this study demonstrates the use of simulation and standardized parents as an important pedagogical tool for audiology students. Students experienced a high level of satisfaction with the learning experience.

Simultaneous Extratympanic Electrocochleography and Auditory Brainstem Responses Revisited.

The purpose of this study was to revisit the two-channel, simultaneous click-evoked extratympanic electrocochleography and auditory brainstem response (ECoG/ABR) recording technique for clinical use in normal hearing participants. Recording the compound action potential (AP) of the ECoG simultaneously with ABR may be useful when Wave I of the ABR is small or diminished in patients with sensorineural or retrocochlear disorder and minimizes overall test time. In contrast to some previous studies that used the extratympanic electrode both as non-inverting electrode for the ECoG and inverting electrode for ABR, this study maintained separate recording channel montages unique to conventional click-evoked ECoG and ABR recordings. That is, the ABR was recorded using a vertical channel (Cz to ipsilateral earlobe), while the ECoG with custom extratympanic electrode was recorded using a horizontal channel (tympanic membrane to contralateral earlobe). The extratympanic electrode is easy to fabricate in-house, or can be purchased commercially. Maintaining the conventional ABR montage permits continued use of traditional normative data. Broadband clicks at a fixed level of 85 dB nHL were presented with alternating polarity at stimulus rates of 9.3, 11.3, and 15.3/s. Different stimulation rates were explored to identify the most efficient rate without sacrificing time or waveform morphology. Results revealed larger ECoG AP than ABR Wave I, as expected, and no significant difference across stimulation rate and no interaction effect. Extratympanic electrode placement takes little additional clinic time and may improve the neurodiagnostic utility of the ABR.

Hearing Loss: Diagnosis and Evaluation.

Hearing loss is a common disability in the United States, most frequent among men, elderly individuals, and veterans but is increasingly affecting other younger adults. Types of hearing loss include sensorineural, conductive, and mixed. Hearing loss in children often is related to infections, time spent in a neonatal intensive care unit, and genetic etiologies. Presbycusis (ie, age-related hearing loss) is the most common etiology in adults. Adverse effects of untreated hearing loss include isolation, depression, lower income, and higher unemployment. Hearing aid use reduces levels of disability, cognitive impairment, and psychosocial distress while improving quality of life. At least 75% of individuals with hearing loss are not receiving treatment for it. All infants should be screened for hearing loss, as should children and adults with risk factors. The Joint Commission on Infant Hearing Screening has a 1-3-6 goal for screening: identification by age 1 month, confirmation by age 3 months, and intervention by age 6 months. The presence of an ongoing physician-patient relationship increases the likelihood that a patient will admit to having a hearing loss. Adults can be screened using single-question or standardized instrument screens. All patients with suspected hearing loss should undergo audiometry by an audiology subspecialist.

Hearing Loss: Hearing Augmentation.

Etiologies of hearing loss vary. When hearing loss is diagnosed, referral to an otology subspecialist, audiology subspecialist, or hearing aid dispenser to discuss treatment options is appropriate. Conventional hearing aids provide increased sound pressure in the ear canal for detection of sounds that might otherwise be soft or inaudible. Hearing aids can be used for sensorineural, conductive, or mixed hearing loss by patients with a wide range of hearing loss severity. The most common type of hearing loss is high-frequency, which affects audibility and perception of speech consonants, but not vowels. As the severity of hearing loss increases, the benefit of hearing aids for speech perception decreases. Implantable devices such as cochlear implants, middle ear implants, and bone-anchored implants can benefit specific patient groups. Hearing assistive technology devices provide auditory, visual, or tactile information to augment hearing and increase environmental awareness of sounds. Hearing assistive devices include wireless assistive listening device systems, closed captioning, hearing aid-compatible telephones, and other devices. For some patients, financial barriers and health insurance issues limit acquisition of hearing aids, implantable devices, and hearing assistive devices. Physicians should be aware that for some patients and families, hearing augmentation may not be desired for cultural reasons.

Hearing Loss: Communicating With the Patient Who Is Deaf or Hard of Hearing.

Hearing loss impairs health care communication and adversely affects patient satisfaction, treatment adherence, and use of health services. Hearing loss is the third most common chronic health condition among older patients after hypertension and arthritis, but only 15% to 18% of older adults are screened for hearing loss during health maintenance examinations. Patients with hearing loss may be reluctant to disclose it because of fear of ageism, perceptions of disability, and vanity. Lipreading and note writing often are ineffective ways to communicate with deaf and hard of hearing (DHH) patients who use American Sign Language; use of medical sign language interpreters is preferred. A variety of strategies can improve the quality of health care communication for DHH patients, such as the physician facing the patient, listening attentively, and using visual tools. Physicians should learn what hearing loss means to the DHH patient. Deaf American Sign Language users may not perceive hearing loss as a disability but as a cultural identity. Patients' preferred communication strategies will vary. Relay services, electronic communication, and other telecommunications methods can be helpful, but family physicians and medical staff should learn from each DHH patient about which communication strategies will work best.

Hearing Loss: Issues in the Deaf and Hard of Hearing Communities.

Hearing loss can lead to impairments in language and speech acquisition, educational attainment, social development, and reading achievement. More than 90% of deaf and hard of hearing (DHH) children are born to hearing parents who may lack the knowledge or experience to effectively care for a child with hearing loss. Family involvement is crucial for teaching self-advocacy and global communication skills, optimizing social development, and helping DHH individuals understand and manage external attitudes about deafness and hearing loss. American Sign Language is a naturally developed language with an always-expanding lexicon and grammatical structures different from those of English. Teaching spoken English and American Sign Language equally, often called bilingual bimodal education, can enhance academic and reading achievement as well as language and psychosocial development. Formal schooling options for a DHH child include enrollment in a public or private school system (often called inclusion, integration, or mainstreaming), a school for the deaf, or a bilingual school. Individuals with hearing loss experience stereotypes and biases that create disparities in health insurance coverage, health care access, and outcomes of mental and physical conditions. Family physicians should recognize and minimize biases to improve health care in the DHH community.

Overview of Central Auditory Processing Deficits in Older Adults.

Although there are many reported age-related declines in the human body, the notion that a central auditory processing deficit exists in older adults has not always been clear. Hearing loss and both structural and functional central nervous system changes with advancing age are contributors to how we listen, hear, and process auditory information. Even older adults with normal or near normal hearing sensitivity may exhibit age-related central auditory processing deficits as measured behaviorally and/or electrophysiologically. The purpose of this article is to provide an overview of assessment and rehabilitative approaches for central auditory processing deficits in older adults. It is hoped that the outcome of the information presented here will help clinicians with older adult patients who do not exhibit the typical auditory processing behaviors exhibited by others at the same age and with comparable hearing sensitivity all in the absence of other health-related conditions.

Are chirps better than clicks and tonebursts for evoking middle latency responses?

BACKGROUND: The middle latency response (MLR) is considered a valid clinical tool for assessing the integrity of cortical and subcortical structures. Several investigators have demonstrated that a rising frequency chirp stimulus is capable of eliciting not only larger wave V amplitudes but larger MLR components as well. However, the chirp has never been specifically examined in a hemispheric electrode montage setup that is typical for neurodiagnostic application and site-of-lesion testing. PURPOSE: The purpose of this study was to examine the effect of chirp, click, and toneburst stimuli on MLR waveform peak latency and peak-to-peak amplitude in a hemispheric electrode montage setup. RESEARCH DESIGN: This study used a repeated-measures design. STUDY SAMPLE: A total of 10 young adult participants (3 males, 7 females) with normal hearing were recruited and had negative histories of audiologic, otologic, and neurologic involvement, and no reported language or learning difficulties. DATA COLLECTION AND ANALYSIS: MLR latencies (Na, Pa, Nb, and Pb) and peak-to-peak amplitudes (Na-Pa, Pa-Nb, and Nb-Pb) were measured for all conditions and were statistically evaluated for left hemisphere-right ear (C3-A2) and right hemisphere-left ear (C4-A1) recordings. RESULTS: Statistical analyses revealed no significant difference between C3-A2 and C4-A1 peak-to-peak amplitudes; therefore, data were collapsed. Stimulus comparisons revealed that Na evoked by tonebursts were statistically prolonged compared with both chirp and click, and that both Na-Pa and Pa-Nb peak-to-peak amplitudes were statistically larger for chirps compared with both clicks and tonebursts, and for clicks compared with tonebursts. CONCLUSIONS: The results of this study support the hypothesis that a chirp would offer a clinical advantage to the click and toneburst in overall peak-to-peak amplitude. As expected, normal-hearing participants did not exhibit hemispheric differences when comparing C3-A2 and C4-A1 peak-to-peak amplitudes demonstrating symmetric auditory brain function. However, chirp-evoked MLRs will require further study to determine its usefulness in clinical practice.