Examining the utility of near infrared light as pre-exposure therapy to mitigate temporary noise-induced hearing loss in humans.

Introduction: This study sought to determine the effect of Occupational Safety and Health Administration (OSHA) compliant noise on auditory health and assess whether pre-noise near infrared (NIR) light therapy can mitigate the effects of noise exposure. Methods: Over four visits, participants (n = 30, NCT#: 03834714) with normal hearing completed baseline hearing health assessments followed by exposure to open ear, continuous pink noise at 94 dBA for 15 min. Immediately thereafter, post-noise hearing tests at 3000, 4000, and 6000 Hz and distortion product otoacoustic emissions (DPOAEs) were conducted along with the Modified Rhyme Test (MRT), Masking Level Difference Test (MLD), and Fixed Level Frequency Tests (FLFT) [collectively referred to as the Central and Peripheral Auditory Test Battery (CPATB)] to acquire baseline noise sensitivity profiles. Participants were then randomized to either Active or Sham NIR light therapy for 30 min binaurally to conclude Visit 1. Visit 2 (≥24 and ≤ 48 h from Visit 1) began with an additional 30-min session of Active NIR light therapy or Sham followed by repeat CPATB testing and noise exposure. Post-noise testing was again conducted immediately after noise exposure to assess the effect of NIR light therapy. The remaining visits were conducted following ≥2 weeks of noise rest in a cross-over design (i.e., those who had received Active NIR light therapy in Visits 1 and 2 received Sham therapy in Visits 3 and 4). Results: Recovery hearing tests and DPOAEs were completed at the end of each visit. Participants experienced temporary threshold shifts (TTS) immediately following noise exposure, with a mean shift of 6.79 dB HL (±6.25), 10.61 dB HL (±6.89), and 7.30 dB HL (±7.25) at 3000, 4000, and 6000 Hz, respectively, though all thresholds returned to baseline at 3000, 4000, and 6000 Hz within 75 min of noise exposure. Paradoxically, Active NIR light therapy threshold shifts were statistically higher than Sham therapy at 3000 Hz (p = 0.04), but no other differences were observed at the other frequencies tested. An age sub-analysis demonstrated that TTS among younger adults were generally larger in the Sham therapy group versus Active therapy, though this was not statistically different. There were no differences in CPATB test results across Active or Sham groups. Finally, we observed no changes in auditory function or central processing following noise exposure, suggestive of healthy and resilient inner ears. Conclusion: In this study, locally administered NIR prior to noise exposure did not induce a significant protective effect in mitigating noise-induced TTS. Further exploration is needed to implement effective dosage and administration for this promising otoprotective therapy.

Cochlear Implant Referral Criteria for the Spanish-Speaking Adult Population.

OBJECTIVE: To evaluate the effectiveness of the "60/60 Guideline" in a diverse patient population. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Data were collected for adult patients (18 years and older) who underwent a cochlear implant evaluation (CIE) between January 2016 and March 2021. MAIN OUTCOME MEASURES: Development of the "60/60 Guideline" has provided better clarity on when to refer English-speaking patients for a CIE. Our study evaluated the effectiveness of this referral tool in the Spanish-speaking population. RESULTS: In our group of patients who underwent a traditional CIE (n = 402), 209 met unaided and aided traditional cochlear implant (CI) candidacy criteria. Of the 193 individuals who did not meet both components of traditional candidacy criteria, a majority met the aided component (86%) but only 4.6% met the unaided component. When applying the 60/60 Guideline to patients who met traditional criteria, there is a sensitivity rating of 84.7% and a specificity index of 50.3%. For English and Spanish speakers who met traditional criteria but did not meet the 60/60 Guideline, a majority (83.3% English, 87.5% Spanish) had a better ear word recognition score (WRS) greater than 60%, suggesting the unaided WRS is the more restrictive component of the "60/60 Guideline." CONCLUSION: Application of the "60/60 Guideline" is an effective method to identify potential CI candidates in the English-speaking population; however, it was less effective in the Spanish-speaking population. Spanish-speaking adults should be referred for a CIE when better ear pure tone average is greater than 60 dB hearing loss, regardless of their unaided WRS. This study highlights the need for inclusion of nonlinguistic test measures in the CI referral criteria and test battery to reduce CI access barriers for patients who speak a language other than English.

Prognostic and Diagnostic Utility of Serum Biomarkers in Pediatric Traumatic Brain Injury.

Traumatic brain injury (TBI) remains a major cause of morbidity and death among the pediatric population. Timely diagnosis, however, remains a complex task because of the lack of standardized methods that permit its accurate identification. The aim of this study was to determine whether serum levels of brain injury biomarkers can be used as a diagnostic and prognostic tool in this pathology. This prospective, observational study collected and analyzed the serum concentration of neuronal injury biomarkers at enrollment, 24h and 48h post-injury, in 34 children ages 0-18 with pTBI and 19 healthy controls (HC). Biomarkers included glial fibrillary acidic protein (GFAP), neurofilament protein L (NfL), ubiquitin-C-terminal hydrolase (UCH-L1), S-100B, tau and tau phosphorylated at threonine 181 (p-tau181). Subjects were stratified by admission Glasgow Coma Scale score into two categories: a combined mild/moderate (GCS 9-15) and severe (GCS 3-8). Glasgow Outcome Scale-Extended (GOS-E) Peds was dichotomized into favorable (≤4) and unfavorable (≥5) and outcomes. Data were analyzed utilizing Prism 9 and R statistical software. The findings were as follows: 15 patients were stratified as severe TBI and 19 as mild/moderate per GCS. All biomarkers measured at enrollment were elevated compared with HC. Serum levels for all biomarkers were significantly higher in the severe TBI group compared with HC at 0, 24, and 48h. The GFAP, tau S100B, and p-tau181 had the ability to differentiate TBI severity in the mild/moderate group when measured at 0h post-injury. Tau serum levels were increased in the mild/moderate group at 24h. In addition, NfL and p-tau181 showed increased serum levels at 48h in the aforementioned GCS category. Individual biomarker performance on predicting unfavorable outcomes was measured at 0, 24, and 48h across different GOS-E Peds time points, which was significant for p-tau181 at 0h at all time points, UCH-L1 at 0h at 6-9 months and 12 months, GFAP at 48h at 12 months, NfL at 0h at 12 months, tau at 0h at 12 months and S100B at 0h at 12 months. We concluded that TBI leads to increased serum neuronal injury biomarkers during the first 0-48h post-injury. A biomarker panel measuring these proteins could aid in the early diagnosis of mild to moderate pTBI and may predict neurological outcomes across the injury spectrum.

Examining the Effect of SARS-CoV-2 Pandemic-Induced Stress and Anxiety on Humoral Immunity in Health Care Workers.

OBJECTIVE: The effect of stress on vaccine-induced humoral immunity and therapeutic interventions to mitigate pandemic-related stress remain underexplored. METHOD: Participants in a longitudinal cohort study ( n = 189) completed a validated measure, GAD-7, and 10-instrument stress measure to assess stress and anxiety after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Serum was collected to obtain SARS-CoV-2 antibody titer levels. RESULTS: Participants experienced increased stress due to the SARS-CoV-2 pandemic with a positive correlation between GAD-7 scores and peak antibody titers overall; however, there was a negative association with scores commensurate with severe anxiety. Health care workers and younger participants were more significantly affected by anxiety. CONCLUSIONS: Mild anxiety levels may have immune-enhancing effects, whereas severe anxiety may cause antibody generation reduction. Mental health-focused interventions are imperative for younger adults and health care workers. Young adults may be more resilient to increased stress levels.

Paediatric audiology measures for Spanish-speaking patients: current practice & state of knowledge.

OBJECTIVE: The objective of this study was to obtain an understanding of audiologists' knowledge of Spanish speech perception materials for the paediatric hearing loss population. DESIGN: An electronic survey, the Knowledge of Spanish Audiology & Speech Tools (KSAST) was distributed via Qualtrics to audiologists who worked with Spanish-speaking children. STUDY SAMPLE: One hundred and fifty-three audiologists practicing in the United States completed the electronic survey over a period of six months. RESULTS: Audiologists lacked knowledge of current Spanish measures and there was no consensus on what providers were administering for the paediatric population. The largest gaps in knowledge existed for the infancy through early childhood age groups. Notably, even when Spanish measures exist, audiologists reported feeling uncomfortable using them in clinic due to a variety of reasons (e.g., did not know how to access measure, did not know how to administer). CONCLUSIONS: This study highlights the lack of consensus in managing Spanish-speaking patients with hearing loss. There is a lack of validated age-appropriate measures to accurately assess speech perception for Spanish-speaking children. Future research should focus on improving training on management of Spanish-speaking patients, as well as development of speech measures and best practice guidelines for this population.

Parents of children with hearing loss: Impact and exposure of COVID-19 on mental health.

The aim of this study was to evaluate the impact and exposure of COVID-19 on parent mental health (e.g., depression, anxiety, and post-traumatic stress disorder (PTSD), for parents of children with hearing loss. The survey was distributed via an electronic survey to families subscribed to a pediatric program listserv as part of a university medical center. Fifty-five percent of parents reported elevated symptoms of anxiety, while 16% scored in the clinically significant range for depression. In addition, 20% of parents reported elevated symptoms of PTSD. Liner regressions found that impact of COVID-19 predicted anxiety symptoms, while both impact and exposure predicted depression and PTSD symptoms. In addition, both impact and exposure predicted COVID related parental distress. Exposure and impact of COVID-19 has had negative consequences on parents of children with hearing loss. Although exposure influenced parental mental health, impact uniquely affected depression and PTSD. Results highlight the need for mental health screening, as well implementation of psychological interventions using telehealth or in-person consultations. Future work should focus on post-pandemic challenges, including long-term psychological functioning due to the established relationship between parental mental health and pediatric outcomes.

Risk-taking propensity as a risk factor for noise-induced hearing loss in the general population.

OBJECTIVES: To examine general risk propensity in relation to perceptions of noise, risk behaviour, and hearing loss in the general population. DESIGN: Participants completed an online survey using the Amazon Mechanical Turk crowdsourcing platform. STUDY SAMPLE: The sample comprised 1274 adults from the United States. RESULTS: Higher general risk propensity was associated with an increased likelihood to engage in noise-risk behaviours. Lower general risk propensity was associated with increased knowledge of noise risks and an increased perception of noise as risky. The frequency of self-reported exposures to hazardous noise resulted in estimated annual noise doses exceeding standard hazard limits in 40% of the surveyed population. CONCLUSIONS: Results revealed limited knowledge of the risks and associated health consequences of noise exposure in the general population Results of this study suggest a high rate of self-exposure to hazardous noise by the general population. Those with higher general risk propensity are more likely to engage in risky noise behaviour. Risky noise behaviour is associated with age, gender, race, ethnicity, and general risk propensity. Intervention programs to modify risky noise behaviour in the general population should focus on both increasing knowledge and establishing accurate perceptions of risk.

Vocabulary Outcomes for 5-Year-Old Children Who Are Deaf or Hard of Hearing: Impact of Age at Enrollment in Specialized Early Intervention.

The aims of this study were to examine vocabulary scores of 5-year-old children who are deaf or hard of hearing (DHH), as well as the impact of early enrollment in specialized intervention on vocabulary outcomes. Receptive and expressive vocabulary scores were analyzed for 342 five-year-old children who are DHH enrolled in specialized listening and spoken language intervention programs. Regression analyses were utilized to examine the effects of age at enrollment on vocabulary outcomes. Overall, participants achieved scores within normal test limits on receptive and expressive measures of vocabulary. Children who enrolled in intervention prior to 28 months of age had better vocabulary skills at 5 years old. The findings support that children who are DHH can understand and produce vocabulary at skill levels commensurate with their typically hearing peers, regardless of severity of hearing loss. Results highlight the crucial impact of specialized programs on children's lexical readiness to participate in general education settings by kindergarten.

Development and Validation of a Parenting Stress Module for Parents of Children Using Cochlear Implants.

OBJECTIVES: The purpose of this study was to develop and validate a cochlear implant (CI)-specific parenting stress measure using the FDA Guidance on Patient-Reported Outcomes (2009). METHODS: The development and psychometric validation of the Parenting Stress-CI module for both the Early Childhood (EC; 0-5 years) and School-Age (SA; 6-12 years) versions are reported in this article. Instrument development consisted of qualitative interviews with parents of children with CIs (EC: N = 19; SA: N = 21), content analysis, item development, and cognitive testing of the instrument. Last, we conducted the psychometric validation (EC: N = 72; SA: N = 64), including analyses of internal consistency, test-retest reliability (∼2 weeks between administrations; N = 24), and convergent validity with the Parenting Stress Index-4 (PSI-4). RESULTS: The final EC version includes 15 questions, and the SA version includes 8 questions. Both the EC and SA versions had strong reliability (EC α = .88; SA α = .85), with all items significantly correlated with the overall module (r = .43-.80). Both versions also had strong test-retest reliability (r = .99, p < .001). Last, analyses of convergent validity demonstrated significant correlations with the PSI-4 Total Stress scale for both Parenting Stress-CI versions (EC r = .66, p < .00; SA r = .45, p < .001). CONCLUSIONS: The Parenting Stress-CI modules are reliable and valid condition-specific parenting stress instruments for parents of children with CIs ages 0-12 years, filling a significant gap in the literature. These fully validated instruments can be used to assess parental needs for support and guide the development of targeted, family centered interventions.

How much and what: Using a buffet to determine self-regulation of food intake among young school-age children.

Energy compensation indices are commonly used to examine self-regulation of food intake in children. However, previous studies failed to consider children's ability to self-regulate under complete autonomy. This study examined self-regulation of food intake among young children and the effect of calorie manipulation on food/nutrient intake using an unlimited lunch buffet paradigm. Participants were 66 children (Mage = 6.14, SD = 1.15 years; 68.2% male; 89.4% Latinx; 59.1% overweight/obese [OV/OB]). Children participated in a crossover research trial, one week apart. Participants consumed 2 different types of preloads followed by an ad-libitum lunch during each trial. A compensation index (COMPX) was calculated to identify the level of self-regulation in food intake. Food/nutrient intake was compared between both sessions. Results indicated OV/OB children showed poorer self-regulation compared to healthy weight children (t = 2.19, p = 0.032; Hedges' g = 0.55). There were significant differences in food intake/selection between OV/OB and healthy weight groups. OV/OB children consumed a higher amount of calorie, fat, and cholesterol after the high energy preload compared to healthy weight children (d's range: 0.31-0.48). Our findings support differences between the amount of self-regulation between normal and OV/OB children as well as the items they select in order to compensate.

Decoding Billing Practices in Cochlear Implant Programs.

OBJECTIVES: The purpose of this study was to examine current cochlear implant (CI) billing practices across CI audiologists in the United States, to determine if CI audiologists are following the National Correct Coding Initiative (NCCI) edits, and to assess the CI audiologist's exposure to billing education. DESIGN: A 48-question survey was electronically distributed to and completed by audiologists who bill for CI services. Demographic data including work setting, population served, years of experience, number of CI patients managed per week, and exposure to billing education were collected. Data were analyzed to identify codes and modifiers used to bill for commonly performed CI procedures such as unilateral and bilateral CI programming, preoperative and postoperative testing, and objective measures. RESULTS: Data were obtained from 96 audiologists. The majority (86.3%, n = 82) of respondents agreed or strongly agreed they understand billing and coding practices for cochlear implants and 94.7% (n = 89) rated themselves as somewhat to highly efficient when performing these practices. Only 16.8% (n = 16) of respondents reported receiving formal training for practice management, and half of the respondents (51.1%, n = 48) reported unfamiliarity with national billing guidelines. Those who received formal training reported higher billing efficiency. Wide variability was seen for various billing scenarios. Billing questions were presented, and answers were coded as correct or incorrect based on the NCCI edits. Respondents who reported higher agreement with understanding billing and who received formal training scored better on common billing questions related to the NCCI edits. CONCLUSIONS: Most CI audiologists rated themselves as efficient in billing; however, wide variance in billing practices was observed. Incorporating practice management and current billing education into daily practice and into audiology training programs is essential to clinic efficiency, practice management, and CI program viability. CI audiologists should be knowledgeable about appropriate billing practices to ensure long-term sustainability of programs.

Targeting Pediatric Obesity via a Healthy Lifestyle Summer Camp Intervention: How Necessary Is a Parenting Component?

Background: Pediatric obesity represents a significant public health concern, especially for Hispanic school-aged children. This study examined via a randomized trial the efficacy of a family-based intervention [Healthy Lifestyle Summer Camp and Parenting program (HLSC+HLPP)] compared with a child-based camp intervention [Healthy Lifestyle Summer Camp (HLSC)] on improving child and parent health outcomes. Methods: Participants included 24 children (n = 11 HLSC+HLPP; n = 13 HLSC) with a mean age of 6.17 years (range 4-9 years) who were mostly Hispanic (87.5%) and were classified as overweight or obese, and their primary caregiver. Various anthropometric, physical activity, nutrition, and parenting outcomes were collected pre-/post-intervention. Results: Results indicated that both interventions were feasible and acceptable. There were no statistically significant differences between groups; however, both groups demonstrated a decrease in child BMI z-score (HLSC+HLPP: g = -0.31; HLSC: g = -0.31) and increase in child fitness (HLSC+HLPP: g = 1.70; HLSC: g = 1.77), nutritional health classification (HLSC+HLPP: g = 1.54; HLSC: g = 0.82), nutrition expressive knowledge (HLSC+HLPP: g = 1.03; HLSC: g = 1.06), and parental monitoring (HLSC+HLPP: g = 0.51; HLSC: g = 0.49) after the intervention. Conclusions: These findings highlight the feasibility, acceptability, and improvement of child health outcomes after both interventions. Future research should examine group differences during a follow-up period as well as employ a larger sample.

Impact of Auditory-Oral Education on Device Use in Children With Hearing Loss.

PURPOSE: This study examined changes in datalogging for children attending an auditory-oral educational program with integrated audiology services versus children attending a mainstream or nonspecialized program. METHOD: Eighty children participated in this study, half of which were enrolled in an auditory-oral educational program versus the nonspecialized or mainstream setting. Datalogging for cochlear implant and hearing aid users was obtained via retrospective medical and educational chart review from 2016 to 2019. RESULTS: Results demonstrated that at post-enrollment, children attending the auditory-oral educational program significantly increased device wear time (as measured by average hours/day) when compared to the control group. Children using hearing aids enrolled in the specialized educational program obtained the largest improvement in overall wear time, averaging an increase of 5 hr/day of device use from pre- to post-enrollment. CONCLUSIONS: This is the first study to document the association of specialized educational programs on device use. Clinical and educational programs should collaborate to provide integrated services to lessen family burden and increase a child's device use and retention.

Peripheral vestibular system: Age-related vestibular loss and associated deficits.

Given the interdependence of multiple factors in age-related vestibular loss (e.g., balance, vision, cognition), it is important to examine the individual contributions of these factors with ARVL. While the relationship between the vestibular and visual systems has been well studied (Bronstein et al., 2015), little is known about the association of the peripheral vestibular system with neurodegenerative disorders (Cronin et al., 2017). Further, emerging research developments implicate the vestibular system as an opportunity for examining brain function beyond balance, and into other areas, such as cognition and psychological functioning. Additionally, the bidirectional impact of psychological functioning is understudied in ARVL. Recognition of ARVL as part of a multifaceted aging process will help guide the development of integrated interventions for patients who remain at risk for decline. In this review, we will discuss a wide variety of characteristics of the peripheral vestibular system and ARVL, how it relates to neurodegenerative diseases, and correlations between ARVL and balance, vision, cognitive, and psychological dysfunction. We also discuss clinical implications as well as future directions for research, with an emphasis on improving care for patients with ARVL.

Sedentary behavior moderates the relationship between physical activity and cardiometabolic risk in young Latino children.

This study investigated the role of objectively measured moderate-vigorous physical activity (MVPA) and sedentary behavior on cardiometabolic risk factors of young Latino children. We hypothesized that MVPA would be associated with lower cardiometabolic risk when sedentary behavior is low. We studied 86 primarily low-income, Latino children using a cross-sectional study design. The study sample consisted of 51 girls and 35 boys, with mean age 5.6 (SD = .53) years. Physical activity was measured by accelerometry, anthropometric measures obtained, and fasting blood samples were used to measure cardiometabolic risk factors. Greater levels of sedentary behavior were associated with increased waist circumference (rs = .24, p < .05) and metabolic risks. MVPA, however, had significant beneficial associations with all cardiometabolic risk factors (rs-range = -.20 to -.45, p < .05) with the exception of plasma insulin. MVPA predicted latent variables representing anthropometric risk (ß = -.57, p < .01), cardiac risk (ß = -.74, p < .01), and metabolic risk (ß = -.88, p < .01). Sedentary behavior significantly moderated the effect of MVPA on anthropometric (ß-interaction = .49, p < .01), cardiac (ß-interaction = .45, p < .01), and metabolic risk (ß-interaction = .77, p < .01), such that more MVPA was associated with better health outcomes under conditions of lower sedentary behavior. The model explained 13%, 22%, and 45% variance in anthropometric, cardiac, and metabolic risk factors, respectively. Increased MVPA is associated with decreased cardiometabolic risk in young Latino children, particularly when sedentary behavior is low.

This study investigated the role of objectively measured moderate­vigorous physical activity (MVPA) and sedentary behavior on cardiometabolic risk factors of young Latino children. We hypothesized that MVPA would be associated with lower cardiometabolic risk when sedentary behavior is low. The study sample consisted of 51 girls and 35 boys, with mean age 5.6 (SD = .53) years. Participants were primarily low-income, Latino children. We found that greater levels of sedentary behavior were associated with increased waist circumference and metabolic risks. MVPA, however, had significant beneficial associations with all cardiometabolic risk factors with the exception of insulin. MVPA predicted latent variables representing anthropometric risk, cardiac risk, and metabolic risk. Sedentary behavior significantly moderated the effect of MVPA on anthropometric, cardiac, and metabolic risk, such that more MVPA was associated with better health outcomes under conditions of lower sedentary behavior. We conclude that an increased MVPA is associated with decreased cardiometabolic risk in young Latino children, particularly when sedentary behavior is low.

Quality of Life-CI: Development of an Early Childhood Parent-Proxy and Adolescent Version.

OBJECTIVES: Severe to profound hearing loss is associated with communication, social, and behavioral difficulties that have been linked to worse health-related quality of life (HRQoL) compared to individuals with normal hearing. HRQoL has been identified as an important health outcome that measures functional ability, particularly for chronic conditions and disabilities. The current study developed the QoL-cochlear implant (CI) for early childhood and adolescents using the recommended Food and Drug Administration and European Medicines Agency guidelines on patient-reported outcomes. DESIGN: Three phases of instrument development were conducted for both the early childhood (0 to 5 years old; parent proxy) and adolescent/young adult (13 to 22 years old) versions of the QoL-CI. Phase 1 included the development of our conceptual framework, which informed the discussion guides for stakeholder focus groups (e.g., audiologists, physicians, and therapists) at CI clinics in Miami and Philadelphia (n = 39). Open-ended interviews with parents (N = 18 for early childhood; N = 6 for adolescent/young adult version) and adolescents/young adults using CIs (n = 17) were then completed at both sites during phase 2. All interviews were transcribed and coded to identify common themes, which were then used to draft items for the QoL-CI. Both versions of the QoL-CI were developed using Qualtrics to allow for quick, easy electronic administration of the instruments on a tablet device. Last, phase 3 included cognitive testing in a new sample (N = 19 early childhood, N = 19 adolescent) to ensure that the draft instruments were clear, comprehensive, and easy to use. RESULTS: Participant responses obtained via the open-ended interviews yielded an early childhood and adolescent version of the QoL-CI that was reportedly easy to complete and comprehensive. The final QoL-CI Early Childhood instrument yielded 35 questions across eight functional domains (environmental sounds, communication, social functioning, behavior, CI device management and routines, school, CI benefits, and early intervention). Similarly, the final QoL-CI adolescent/young adult version consisted of 46 items across eight domains (noisy environments, communication, CI usage and management, advocacy, social functioning, emotional functioning, acceptance, and independence). CONCLUSIONS: The QoL-CI is a condition-specific QoL instrument that can be used for children ages birth through 22 years. These instruments capture the "whole" child by not only focusing on communication and auditory skills but also academic, social and emotional functioning. Once validated, these CI-specific measures will enable providers to track long-term outcomes and evaluate the efficacy of new interventions to improve overall CI use and QoL for pediatric and young adult users.

Intensive Parent-Child Interaction Therapy for Children with Traumatic Brain Injury: Feasibility Study.

OBJECTIVE: This study examined the feasibility and initial outcome of a time-limited and intensive format of Parent-Child Interaction Therapy (PCIT) for families of young children who have sustained a traumatic brain injury (TBI). METHODS: The nonrandomized open trial included 15 families with a child aged 2-5 years who had sustained a TBI and displayed clinically elevated levels of externalizing behavior problems. Families received clinic-based PCIT twice per week over an average of 6 weeks, with the exception of two families that received the same intensity and format of PCIT in the home. RESULTS: Ten of the 14 families who completed the baseline assessment (71%) completed the intervention and post and follow-up assessments. On average, caregivers completed homework practice on 52% of the days in between sessions. Caregivers reported high acceptability and satisfaction following the intervention, as well as decreases in child externalizing and internalizing behavior problems at the post-assessment and 2-month follow-up. CONCLUSIONS: Results of this open trial provide preliminary support for the feasibility of a time-limited and intensive format of PCIT for families of young children who have sustained a TBI and have elevated levels of behavior problems. This study highlights a promising intervention approach for improving domains commonly affected by early childhood TBI and preventing the development of more severe and persistent problems.

Prevalence of Depression and Anxiety in Adolescents With Hearing Loss.

OBJECTIVE: To develop and implement a universal screening protocol for depression and anxiety in adolescents serviced in an otology and audiology practice and to estimate the prevalence of depression and anxiety in adolescents with hearing loss, while also comparing rates by degree of hearing loss and type of hearing device used. STUDY DESIGN: Cross-sectional. SETTING: University tertiary medical center. PATIENTS: One hundred four adolescents 12- to 18-years-old who attended an otology clinic in a large metropolitan hospital in the southeastern United States. MAIN OUTCOME MEASURE: (s): Depression (PHQ-8), anxiety (GAD-7), degree of hearing loss, type of hearing loss, and type of hearing device utilized. RESULTS: Twenty-five percent of adolescents scored above the clinical cutoff on at least one of the depression and/or anxiety measures, with 10% scoring in the elevated range on both measures. Specifically, 17% scored above the cutoff on the PHQ-8 and 16% scored in the clinically significant range for the GAD-7. An additional 30 and 21% scored in the at-risk range for depression and anxiety, respectively. Older adolescents were more likely to score within the elevated range for depression (r = 0.232, p = 0.026). Also, adolescents with severe to profound hearing loss had higher rates of depression and anxiety. CONCLUSIONS: Integration of mental health screening is needed in otology and audiology practices both to identify those who require psychological support and to provide appropriate treatment to reduce long-term impact of hearing loss on quality of life and mental health functioning in adolescents.

The impact of COVID-19 on allied health professions.

The purpose of the current study was to examine the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-19) on allied health professionals work environment, access to personal protective equipment (PPE) and COVID-19 testing, and mental health. A 34-question survey was developed and distributed electronically to allied health professionals through listservs of professional organizations and social media groups. A total of 921 responses from allied health professionals in a variety of work settings were analyzed. The majority of allied health professionals had access to medical-grade PPE and agreed with their clinics decisions to stay open or closed. Private practices appeared to be the most negatively impacted with regards to employment in the form of pay reductions, furloughs, lay-offs, or the requirement of using paid time off. Importantly, 86% of all respondents, irrespective of employment status, reported feeling stressed with regards to changes in their work environment and transmission of the virus. However, levels of stress were dependent upon access to PPE and mental health resources. Specifically, those with access to mental health support reported lower stress levels than those without such access. These results highlight the need for continuous monitoring of mental health for allied health professionals in order to inform clinic and hospital policies for PPE and the development of brief interventions to mitigate adverse long-term mental health outcomes.

Comparisons of performance in pediatric bone conduction implant recipients using remote microphone technology.

OBJECTIVES: For children with hearing loss, remote microphone (RM) technology can significantly improve access to speech in environments with poor signal-to-noise ratios (SNRs), such as classrooms. Yet, this has never been studied in bone conduction device (BCD) users, a common treatment for children with irresolvable conductive hearing loss resulting from anatomical malformations of the outer ear. The objective of this study was to investigate the benefits of RM technology on speech perception in noise in pediatric BCD users with Microtia/Atresia. A secondary aim was to assess parent and child perceptions of RM technology before and after exposure to RM technology. METHODS: Participants included 10 pediatric bone conduction implant users with unilateral conductive hearing loss ages 7-17 years, and their guardians. Speech perception in noise for soft and moderate inputs was assessed with and without RM technology. Guardians actively observed the child's hearing performance with and without the RM and were asked to complete a questionnaire assessing their perceptions about their child's performance. Children were also administered the questionnaire prior to and immediately following exposure to the RM technology. RESULTS: Participants showed improved speech understanding in noise for both soft and moderate speech inputs when using the RM with their BCD compared to their BCD alone. Questionnaire results indicated good parent-child agreement. Further, significant improvements were reported for child understanding speech, parent hearing domains after exposure to the RM. No significant differences were noted for ease of use/likability. CONCLUSIONS: Significant hearing in noise benefits were observed with RM technology for children using BCDs. Consistent with objective findings, children reported improved speech understanding with the RM. Improved parental perceptions of hearing benefit following exposure to the RM suggests that active participation may serve as an effective strategy to help improve parent understanding of the benefits of RM technology for their child.