Systematic Review and Meta-Analysis of the Application of Virtual Reality in Hearing Disorders.

BACKGROUND AND OBJECTIVES: Trendy technologies, such as artificial intelligence, virtual reality (VR), and augmented reality (AR) are being increasingly used for hearing loss, tinnitus, and vestibular disease. Thus, we conducted this systematic review and meta-analysis to identify the possible benefits of the use of VR and AR technologies in patients with hearing loss, tinnitus, and/or vestibular dysfunction, with the aim of suggesting potential applications of these technologies for both researchers and clinicians. MATERIALS AND METHODS: Published articles from 1968 to 2022 were gathered from six electronic journal databases. Applying our specified inclusion and/or exclusion criteria, 23 studies were analyzed. As only one article on hearing loss and two articles on tinnitus were found, 20 studies on vestibular dysfunction were only finally included for the meta-analysis. Standardized mean differences (SMDs) were chosen as estimates to compare the studies. A funnel plot and Egger's regression analysis were used to identify any risk of bias. RESULTS: High heterogeneity (I2: 83%, τ2: 0.5431, p<0.01) was identified across the studies on vestibular dysfunction. VR-based rehabilitation was significantly effective for individuals with vestibular disease (SMDs: 0.03, 95% confidence interval [CI]: -0.08 to 0.15, p<0.05). A subgroup analysis revealed that only improvement in the subjective questionnaire was meaningful and statistically significant (SMDs: -0.66, 95% CI: -1.10 to -0.22). CONCLUSIONS: VR-based vestibular rehabilitation showed potential for subjective rating measures like Dizziness Handicap Index. The negative effect of aging on vestibular disease was indirectly confirmed. More clinical trials and an evidence-based approach are needed to confirm the implementation of state-of-the-art technology for hearing loss and tinnitus, representative diseases in neurotology.

Proficiency in Using Level Cue for Sound Localization Is Related to the Auditory Cortical Structure in Patients With Single-Sided Deafness.

Spatial hearing, which largely relies on binaural time/level cues, is a challenge for patients with asymmetric hearing. The degree of the deficit is largely variable, and better sound localization performance is frequently reported. Studies on the compensatory mechanism revealed that monaural level cues and monoaural spectral cues contribute to variable behavior in those patients who lack binaural spatial cues. However, changes in the monaural level cues have not yet been separately investigated. In this study, the use of the level cue in sound localization was measured using stimuli of 1 kHz at a fixed level in patients with single-sided deafness (SSD), the most severe form of asymmetric hearing. The mean absolute error (MAE) was calculated and related to the duration/age onset of SSD. To elucidate the biological correlate of this variable behavior, sound localization ability was compared with the cortical volume of the parcellated auditory cortex. In both SSD patients (n = 26) and normal controls with one ear acutely plugged (n = 23), localization performance was best on the intact ear side; otherwise, there was wide interindividual variability. In the SSD group, the MAE on the intact ear side was worse than that of the acutely plugged controls, and it deteriorated with longer duration/younger age at SSD onset. On the impaired ear side, MAE improved with longer duration/younger age at SSD onset. Performance asymmetry across lateral hemifields decreased in the SSD group, and the maximum decrease was observed with the most extended duration/youngest age at SSD onset. The decreased functional asymmetry in patients with right SSD was related to greater cortical volumes in the right posterior superior temporal gyrus and the left planum temporale, which are typically involved in auditory spatial processing. The study results suggest that structural plasticity in the auditory cortex is related to behavioral changes in sound localization when utilizing monaural level cues in patients with SSD.

Topic Modeling for Analyzing Patients' Perceptions and Concerns of Hearing Loss on Social Q&A Sites: Incorporating Patients' Perspective.

Hearing loss is the most common human sensory deficit, affecting normal communication. Recently, patients with hearing loss or at risk of hearing loss are increasingly turning to the online health community for health information and support. Information on health-related topics exchanged on the Internet is a useful resource to examine patients' informational needs. The ability to understand the patients' perspectives on hearing loss is critical for health professionals to develop a patient-centered intervention. In this paper, we apply Latent Dirichlet Allocation (LDA) on electronic patient-authored questions on social question-and-answer (Q&A) sites to identify patients' perceptions, concerns, and needs on hearing loss. Our results reveal 21 topics, which are both representative and meaningful, and mostly correspond to sub-fields established in hearing science research. The latent topics are classified into five themes, which include "sudden hearing loss", "tinnitus", "noise-induced hearing loss", "hearing aids", "dizziness", "curiosity about hearing loss", "otitis media" and "complications of disease". Our topic analysis of patients' questions on the topic of hearing loss allows achieving a thorough understanding of patients' perspectives, thereby leading to better development of the patient-centered intervention.

Quantitative criteria for age-related hearing loss using audiometric configuration analysis.

OBJECTIVES: To suggest the most adaptable criteria of age-related hearing loss (ARHL) using prevalence matching with population-based data. METHODS: We chose 30, 25, 20, and 15 dB as gap ranges of cutoff values of the descending type of hearing loss, between an average of low (500 Hz, 1 kHz) and high (4 kHz, 6 kHz) frequencies. Interaural difference was defined as 10 or 15 dB. Hearing loss was defined over 25 dB. We compared the prevalence results of the cross-matching criteria. We used population-based data from the Korea National Health and Nutrition Examination Survey. We assumed that the prevalence of ARHL ranged from 25 to 35%, and this prevalence will increase gradually with age. RESULTS: Among the eight possible criteria, age ≥ 65 years, average of all frequencies > 25 dB at the each sides, gap between low- and high frequencies ≥ 20 dB, and interaural difference ≤ 10 dB were the most suitable criteria to suggest a quantitative definition of ARHL audiometrically. CONCLUSION: In the current study, we recommend the new, quantitative ARHL criteria. The suggested criteria for ARHL might be easily accessed by other researchers to demonstrate their own hypotheses.

Effect of low frequency on speech performance with bimodal hearing in bilateral severe hearing loss.

OBJECTIVES/HYPOTHESIS: Unilateral cochlear implantation has emerged as a widely accepted procedure to treat severe to profound hearing loss, but many studies have reported benefits in terms of speech comprehension when listeners with residual low-frequency hearing in the nonimplanted ear use a hearing aid. STUDY DESIGN: Retrospective study. METHODS: In this study, we analyzed the speech performance and satisfaction of bimodal hearing according to the residual low-frequency hearing level in the nonimplanted ear. Based on low-frequency pure-tone audiometry (average of 250 Hz and 500 Hz) in the nonimplanted ear, we classified individuals into three groups as follows: group A (under 70 dB), group B (71-90 dB), and group C (over 91 dB). Listeners were tested using the Word Recognition Score, the Korea-Central Institute for Deaf sentence recognition test, and the Korean version of the Hearing Handicap Inventory for the Elderly questionnaire. RESULTS: We observed a bimodal benefit when the residual low-frequency threshold was less than 70 dB HL and a greater satisfaction with bimodal hearing compared to cochlear implant alone, when the residual low-frequency threshold was less than 70 dB HL. CONCLUSIONS: This study supports the benefits of bimodal hearing in listeners with bilateral severe to profound sensorineural hearing loss as standard clinical practice, when the residual low-frequency hearing threshold is under 70 dB in the nonimplanted ear. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:2817-2822, 2016.

Test-Retest Reliability of Word Recognition Score Using Korean Standard Monosyllabic Word Lists for Adults as a Function of the Number of Test Words.

BACKGROUND AND OBJECTIVES: The purpose was to establish the test-retest reliability of word recognition score (WRS) using Korean standard monosyllabic word lists for adults (KS-MWL-A) recently developed based on the international standard for speech audiometry (ISO 8253-3:2012). SUBJECTS AND METHODS: Subjects consisted of 159 adults aged to 18 to 25 years with normal hearing sensitivity. WRSs were obtained in 2 dB steps from the level of speech recognition thresholds to the level of 86% correct responses or greater. After one or two weeks, retest was performed. Correlation, confidence interval (CI) and prediction interval (PI) were calculated for the reliability. RESULTS: Correlation coefficients were 0.88 for 50 test words, 0.76 for 25 and 0.61 for 10 words. Results also showed that 95% CIs and PIs were narrower for 25 and 50 test words than those for 10 test words. CONCLUSIONS: Korean WRS using the KS-MWL-A has high reliability for 25 and 50 test words, but relatively low for 10 words. It suggested that 95% CIs for each test words would be criteria for significant differences in WRS for groups and 95% PIs at each score of WRS could be utilized for a considerable difference for each individual at retest.

Measurement of Acceptable Noise Level with Background Music.

BACKGROUND AND OBJECTIVES: Acceptable noise level (ANL) is a measure of the maximum background noise level (BNL) that a person is willing to tolerate while following a target story. Although researchers have used various sources of target sound in ANL measures, a limited type of background noise has been used. Extending the previous study of Gordon-Hickey & Moore (2007), the current study determined the effect of music genre and tempo on ANLs as possible factors affecting ANLs. We also investigated the relationships between individual ANLs and the familiarity of music samples and between music ANLs and subjective preference. SUBJECTS AND METHODS: Forty-one participants were seperated into two groups according to their ANLs, 29 low-ANL listeners and 12 high-ANL listeners. Using Korean ANL material, the individual ANLs were measured based on the listeners' most comfortable listening level and BNL. The ANLs were measured in six conditions, with different music tempo (fast, slow) and genre (K-pop, pop, classical) in a counterbalanced order. RESULTS: Overall, ANLs did not differ by the tempo of background music, but music genre significantly affected individual ANLs. We observed relatively higher ANLs with K-pop music and relatively lower ANLs with classical music. This tendency was similar in both low-ANL and high-ANL groups. However, the subjective ratings of music familiarity and preference affected ANLs differently for low-ANL and high-ANL groups. In contrast to the low-ANL listeners, the ANLs of the high-ANL listeners were significantly affected by music familiarity and preference. CONCLUSIONS: The genre of background music affected ANLs obtained using background music. The degree of music familiarity and preference appears to be associated with individual susceptibility to background music only for listeners who are greatly annoyed by background noise (high-ANL listeners).

Hearing Thresholds for a Geriatric Population Composed of Korean Males and Females.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to provide the hearing threshold levels in the elderly Korean population, and to compare Korean data with that in the International Organization for Standardization (ISO) 7029 (2000). SUBJECTS AND METHODS: Data were collected from a total of 526 ears from 112 males and 151 females aged 60-84 years. All participants were screened otologically by the procedure given in ISO 8253-1 (2010). RESULTS: Results showed that the pure-tone average was gradually elevated with increasing age. The amount of hearing loss was greater in males than in females, and the high frequency hearing thresholds were worse than the low frequency hearing thresholds in males and females. The hearing threshold levels were higher at low frequencies in males and at all frequencies in females than the norms of ISO 7029 (2000). CONCLUSIONS: Results from this study will be partly used for standardization of hearing thresholds as a function of age in Korea and for updating the ISO 7029.

Weighting of static and transition cues in voiceless fricatives and stops in children wearing cochlear implants.

OBJECTIVES: To determine how normal-hearing adults (NHA), normal-hearing children (NHC) and children wearing cochlear implants (CI) differ in the perceptual weight given cues for fricative consonants (having a comparatively long static cue and short transition cue) versus stop consonants (having a comparatively short static cue and long transition cue). METHODS: Ten NHA, eleven 5- to 8-year-old NHC and eight 5- to 8-year-old children wearing CI were participated. Fricative /su/-/∫u/ and stop /pu/-/tu/continua were constructed by varying the fricative/burst cue and the F2 onset transition cue. A quantitative method of analysis (analysis of variance model) was used to determine cue weighting and measure cue interaction within groups. RESULTS: For the fricative consonant, all groups gave more weight to the frication spectral cue than to the formant transition. For the voiceless stop consonant, all groups gave more weight to the transition cue than to the burst cue. The CI group showed similar cue weighting strategies to age-matched NHC, but integration of cues by the CI group was not significant. CONCLUSION: All groups favored the longer-duration cue in both continua to make phonemic judgments. Additionally, developmental patterns across groups were evident. Results of the current study may be used to guide development of CI devices and in efforts to improve speech and language of children wearing CIs.

The effects of auditory short-term training in passive oddball paradigm with novel stimuli.

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine how human neural activity might be changed through auditory short-term training when listening to novel stimuli. SUBJECTS AND METHODS: Among the twenty young normal hearing adult listeners who participated, ten were randomly assigned to a training group and ten were assigned to a non-training group as a control. Two synthesized novel stimuli were used: /su/ and /∫u/. Both stimuli similarly sounded like /su/, but had two different onset transition frequencies and fricative pole frequencies. In the experiment, behavioral identification test (i.e., /su/ vs. /∫u/) and the mismatch negativity (MMN) were measured before and after training for the training group. To gauge the training effect, the listeners in the training group were taught by discrimination and identification of two novel stimuli for about 20 minutes. RESULTS: The results showed that scores for the behavioral test increased significantly after auditory short-term training. Also, onset latency, duration, and area of the MMN were significantly changed when elicited by the training stimuli. CONCLUSIONS: These findings indicated that auditory short-term training could change human neural activity, suggesting future clinical applications for auditory training.

Weighting of cues for fricative place of articulation perception by children wearing cochlear implants.

OBJECTIVE: To determine how children wearing cochlear implants weight cues for fricative perception compared to age-matched children with normal hearing. DESIGN: Two seven-step continua of synthetic CV syllables were constructed, with frication pole varied from /s/ to /ƒ/ within the continuum, and appropriate formant transition values varied across continua. Relative weights applied to the frication, transition, and interaction cues were determined. STUDY SAMPLE: Ten 5?7-year-old children with normal hearing and ten 5?8-year-old children wearing cochlear implants participated. RESULTS: Both groups of children gave more perceptual weight to the frication spectral cue than to the formant transition cue. Children with normal hearing gave small but significant weight to formant transitions, but the children wearing cochlear implants did not. The degree of cue interaction was significant for children with normal hearing but was not for children wearing cochlear implants. CONCLUSIONS: Children wearing a cochlear implant use similar cue-weighting strategies as normal listeners (i.e. all apply more weight to the frication noise than to the transition cue), but may have limitations in processing formant transitions and in cue interaction.

The acceptance of background noise in adult cochlear implant users.

PURPOSE: The purpose of this study was to determine (a) if acceptable noise levels (ANLs) are different in cochlear implant (CI) users than in listeners with normal hearing, (b) if ANLs are related to sentence reception thresholds in noise in CI users, and (c) if ANLs and subjective outcome measures are related in CI users. METHOD: ANLs and the Hearing in Noise Test (HINT; M. Nilsson, S. Soli, & J. Sullivan, 1994) were examined in 9 adult CI users and 15 adult listeners with normal hearing. In addition, the Abbreviated Profile of Hearing Aid Benefit (APHAB; R. M. Cox & G. C. Alexander, 1995) and a satisfaction questionnaire were administered to CI users only. RESULTS: Results indicated that (a) ANLs were not significantly different for CI users and listeners with normal hearing, (b) ANLs were not correlated with HINT values for either group, (c) ANL was not significantly correlated with APHAB scores, and (d) ANL was significantly correlated with overall CI benefit on the satisfaction questionnaire. CONCLUSIONS: CI users with large ANLs reported more benefit from implants than those with small ANLs. The results of this preliminary study of ANL in CI users suggest that ANL can be used as a tool for evaluating processing in noise in individual CI users.

Acceptance of background noise levels in bilingual (Korean-English) listeners.

The acceptable noise level (ANL) is the maximum amount of background noise that listeners are willing to accept while listening to speech. ANL has not been studied in listeners who use languages other than English. The purpose of this study was to explore whether ANLs obtained from Korean listeners in both English and Korean were comparable to ANLs obtained from monolingual English listeners. The results showed that ANLs obtained in English (ANL-E) did not differ significantly for the bilingual and monolingual listeners. Additionally, a cross-language comparison, within bilinguals, showed that ANLs obtained using Korean (ANL-K) speech stimuli were not significantly different from ANL-E. Finally, speech perception in noise did not correlate with ANLs in English or Korean for the bilingual listeners. Results suggest that the ANL measure is language independent within bilinguals and may be of potential clinical use in minority language groups.