Patient and public involvement in hearing research: opportunities, impact and reflections with case studies from the Manchester Centre for Audiology and Deafness.

OBJECTIVE: Patient and public involvement (PPI) in research improves relevance to end users and improves processes including recruitment participants. PPI in our research has gone from being non-existent to ubiquitous over a few years. We provide critical reflections on the benefits and challenges of PPI. DESIGN: Case studies are reported according to a modified GRIP2 framework; the aims, methodology, impact of PPI and critical reflections on each case and our experiences with PPI in general. STUDY SAMPLE: We report five UK projects that included PPI from teenagers, families, people living with dementia, autistic people, and people from South Asian and d/Deaf communities. RESULTS: Our experience has progressed from understanding the rationale to grappling methodologies and integrating PPI in our research. PPI took place at all stages of research, although commonly involved input to design including recruitment and development of study materials. Methodologies varied between projects, including PPI co-investigators, advisory panels and online surveys. CONCLUSION: On-going challenges include addressing social exclusion from research for people that lack digital access following increasing on-line PPI and involvement from underserved communities. PPI was initially motivated by funders; however the benefits have driven widespread PPI, ensuring our research is relevant to people living with hearing loss.

But that's possible! Infants, pupils, and impossible events.

Infants' expectations of the world around them have been extensively assessed through the violation of expectation paradigm and related habituation tasks. Typically, in these tasks, longer looking to impossible events following familiarisation with possible equivalents is taken to reflect surprise at their occurrence, thus revealing infants' knowledge. In this study, the role of learning during the task itself is explored by switching the archetypal approach on its head and familiarising infants to impossible events. In a partial replication of Jackson and Sirois (2009), nine-month-old infants were presented with short video clips of toy trains moving around a circular track. A tunnel over a short section of the track meant trains were briefly occluded as they completed a circuit. In impossible versions of events, the train switched colours while occluded by the tunnel. Both looking times and pupil dilation were used as dependent measures. Using a factorial design in which perceptual (novelty-familiarity) and conceptual (possible-impossible) variables were independently and jointly analysed, we show that infants showed greater responding to possible events than to impossible events following familiarisation. Pupil dilation data successfully allowed for more precise interpretation of infants' perception of events than could have been achieved through looking times alone. These findings suggest a central role for learning in violation of expectation tasks, and also further support the use of pupil dilation as a dependent measure in infancy work.

Preschool children's evaluations of their own unjustified requests.

To make a fair request, requesters should consider the perspective of the requestee and contrast his or her needs with their own needs. Making an unjustified request (e.g., requesting something we do not need but the requestee does need) can induce some negative feelings such as guilt. Here, we investigated whether making unjustified requests resulted in negative emotions in 3- and 5-year-old children. Participants (N = 83; 34 girls) requested resources that they did or did not need from an experimenter who either did or did not need them. Both age groups were slower and more hesitant to make an unjustified request (children did not need the sticker, but the experimenter did) and also showed lowered body posture when making an unjustified request compared with when making a justified request (children needed the sticker, but the experimenter did not). Three-year-olds showed more pronounced changes in their posture, whereas 5-year-olds' emotional expression was overall more blunted. Rather, older children relied more on verbal indirect utterances (e.g., "You've got lovely stickers"), as opposed to direct requests (e.g., "Can I have that sticker?"), when making unjustified requests. These results suggest that preschool children already apply impartial normative standards to their requests for help, account for the fairness of their requests, and consider the needs of others when requesting.

Impacts of face coverings on communication: an indirect impact of COVID-19.

OBJECTIVE: To understand the impact of face coverings on hearing and communication. DESIGN: An online survey consisting of closed-set and open-ended questions distributed within the UK to gain insights into experiences of interactions involving face coverings, and of the impact of face coverings on communication. SAMPLE: Four hundred and sixty members of the general public were recruited via snowball sampling. People with hearing loss were intentionally oversampled to more thoroughly assess the effect of face coverings in this group. RESULTS: With few exceptions, participants reported that face coverings negatively impacted hearing, understanding, engagement, and feelings of connection with the speaker. Impacts were greatest when communicating in medical situations. People with hearing loss were significantly more impacted than those without hearing loss. Face coverings impacted communication content, interpersonal connectedness, and willingness to engage in conversation; they increased anxiety and stress, and made communication fatiguing, frustrating and embarrassing - both as a speaker wearing a face covering, and when listening to someone else who is wearing one. CONCLUSIONS: Face coverings have far-reaching impacts on communication for everyone, but especially for people with hearing loss. These findings illustrate the need for communication-friendly face-coverings, and emphasise the need to be communication-aware when wearing a face covering.

Coronectomy: a retrospective outcome study.

PURPOSE: Inferior alveolar nerve (IAN) injury is reported as a complication following surgical removal of lower third molars. In cases where the IAN is intimately related to the roots of the tooth, coronectomy may be performed as an alternative. The objectives of this study were to record operative indications for coronectomy and assess the short- and long-term post-operative outcomes following coronectomy. METHODS: This retrospective study included patients (19-95 years old) that had coronectomies carried out in the Edinburgh Dental Institute and Chalmers Dental Centre within the last 10 years. The patients were invited by letter to attend a review appointment. High-risk radiographic signs and short- (≤ 3 months) and long-term complications (> 3 months) were recorded. RESULTS: A total of 124 patients were invited to participate and a total 28 patients returned for review. From the rest of the patients, data was extracted from their dental records. IAN injury was reported in 5 cases (4.3%) as a short-term complication and in 2 cases (3.5%) as a long-term complication. One patient presented with eruption of roots at the review appointment 7 years following surgery. In this study, 'very' long-term complications were recorded as the 28 patients that returned for a review, were seen on an average of 4.8 years post-operation. CONCLUSIONS: Coronectomy is a relatively safe technique for preservation of the IAN. However, prospective large scale research is needed to more accurately report on the prevalence of short- and long-term complications.

Microphone Handling Noise: Measurements of Perceptual Threshold and Effects on Audio Quality.

A psychoacoustic experiment was carried out to test the effects of microphone handling noise on perceived audio quality. Handling noise is a problem affecting both amateurs using their smartphones and cameras, as well as professionals using separate microphones and digital recorders. The noises used for the tests were measured from a variety of devices, including smartphones, laptops and handheld microphones. The signal features that characterise these noises are analysed and presented. The sounds include various types of transient, impact noises created by tapping or knocking devices, as well as more sustained sounds caused by rubbing. During the perceptual tests, listeners auditioned speech podcasts and were asked to rate the degradation of any unwanted sounds they heard. A representative design test methodology was developed that tried to encourage everyday rather than analytical listening. Signal-to-noise ratio (SNR) of the handling noise events was shown to be the best predictor of quality degradation. Other factors such as noise type or background noise in the listening environment did not significantly affect quality ratings. Podcast, microphone type and reproduction equipment were found to be significant but only to a small extent. A model allowing the prediction of degradation from the SNR is presented. The SNR threshold at which 50% of subjects noticed handling noise was found to be 4.2 ± 0.6 dBA. The results from this work are important for the understanding of our perception of impact sound and resonant noises in recordings, and will inform the future development of an automated predictor of quality for handling noise.

Perception and automatic detection of wind-induced microphone noise.

Wind can induce noise on microphones, causing problems for users of hearing aids and for those making recordings outdoors. Perceptual tests in the laboratory and via the Internet were carried out to understand what features of wind noise are important to the perceived audio quality of speech recordings. The average A-weighted sound pressure level of the wind noise was found to dominate the perceived degradation of quality, while gustiness was mostly unimportant. Large degradations in quality were observed when the signal to noise ratio was lower than about 15 dB. A model to allow an estimation of wind noise level was developed using an ensemble of decision trees. The model was designed to work with a single microphone in the presence of a variety of foreground sounds. The model outputted four classes of wind noise: none, low, medium, and high. Wind free examples were accurately identified in 79% of cases. For the three classes with noise present, on average 93% of samples were correctly assigned. A second ensemble of decision trees was used to estimate the signal to noise ratio and thereby infer the perceived degradation caused by wind noise.

Pupil Dilation and Object Permanence in Infants.

This paper examines the relative merits of looking time and pupil diameter measures in the study of early cognitive abilities of infants. Ten-month-old infants took part in a modified version of the classic drawbridge experiment used to study object permanence (Baillargeon, Spelke, & Wasserman, 1985). The study involved a factorial design where angle of rotation and presence or absence of an object were crossed. Looking time results are consistent with previous work and could suggest object permanence if one ignored data from all cells of the factorial design. When all cells are considered, the data rather suggest a perceptual interpretation. Dynamic changes in pupil diameter uniquely support this interpretation, illustrating which aspects of events (and when) infants primarily respond to. Overall, the results fail to support object permanence in 10-month-olds, and pupil dilation provides a much finer-grained interpretation of infants' information processing, relative to looking time.

Infant cognition: going full factorial with pupil dilation.

The violation-of-expectation (VOE) paradigm and related methods are the main tools used to study high-level cognition in preverbal infants. Infants' differential looking to conceptually implausible/impossible events has been used as an index of early cognitive competence in many areas, including object knowledge, physics, language, and number. However, an event's plausibility is commonly confounded with its perceptual novelty or familiarity, leading to a variety of interpretations for looking time data (Bogartz, Shinskey & Speaker, 1997). This illustrative study demonstrates the value of factorial designs, in which perceptual (novelty-familiarity) and conceptual (possible-impossible) variables are independently and jointly explored. It also introduces pupil dilation as a viable and complementary dependent measure to study infant cognition. We show that pupil data can assist in the interpretation of otherwise equivocal looking time data. The discussion focuses on methodological considerations in infancy research.

Lingual mucosal ulceration with mandibular sequestration.

UNLABELLED: Lingual mucosal ulceration with mandibular sequestration is a condition that presents most commonly in the lower molar region and may be influenced by a variety of local and systemic factors. Three such cases are reported, two involving a history of recent dental extraction and one of seemingly spontaneous onset with the possibility of an underlying association with bisphosphonate therapy. An overview of the surgical and non-surgical management strategies for such cases is described. CLINICAL RELEVANCE: This condition presents most commonly following extraction of mandibular molar teeth. Patients may require referral to secondary care for further management if failing to respond to local non-surgical measures or in the presence of underlying systemic factors.