Boothless audiometry: Ambient noise considerations.

Ambient noise in the test environment will impact signal detection during hearing threshold measurements due to psychoacoustic masking effects. Technical standards specify the maximum permissible ambient noise levels (MPANLs) for use during audiometric testing. MPANLs are dependent on several factors, including transducer characteristics (supra-aural, circumaural, type of ear cushions or earphone enclosures, and insert earphones), the nature of the hearing test being performed (air conduction vs bone conduction and threshold test vs screen at a suprathreshold level), and measurement instrumentation. The nature of the ambient noise (spectrum and constant vs variable) at the test site must be determined and continually accounted for during the boothless hearing test procedure. Ambient noise monitoring procedures are reviewed and examples of ambient noise characteristics in real-world settings, where hearing testing might be performed outside of a sound-treated environment, are provided. Practical considerations are presented, including examples of available tools for ambient noise monitoring, selection of test locations, and transducer attenuation. These are discussed in the context of calculating MPANLs and how best to ensure that ambient noise levels are not negatively impacting the validity of hearing thresholds.

Reference equivalent threshold sound pressure levels for the Wireless Automated Hearing Test System.

This paper presents reference equivalent threshold sound pressure levels (RETSPLs) for the Wireless Automated Hearing Test System (WAHTS), a recently commercialized device developed for use as a boothless audiometer. Two initial studies were conducted following the ISO 389-9 standard [ISO 389-9 (2009). "Acoustics-Reference zero for the calibration of audiometric equipment. Part 9: Preferred test conditions for the determinations of reference hearing threshold levels" (International Organization for Standardization, Geneva)]. Although the standard recruitment criteria are intended to yield otologically normal test subjects, the recruited populations appeared to have slightly elevated thresholds [5-10 dB hearing level (HL)]. Comparison of WAHTS thresholds to other clinical audiometric equipment revealed bias errors that were consistent with the elevated thresholds of the RETSPL populations. As the objective of RETSPLs is to ensure consistent thresholds regardless of the equipment, this paper presents the RETSPLs initially obtained following ISO 389-9:2009 and suggested correction to account for the elevated HLs of the originally recruited populations. Two additional independent studies demonstrate the validity of these corrected thresholds.

Hearing-Related Health Among Adult American Indians From a Pacific Northwest Tribe.

INTRODUCTION: Hearing loss and tinnitus are common in most populations, although few data have addressed hearing-related health among tribal members and the need for public health interventions. METHODS: This cross-sectional study examined prevalence and risk factors for hearing loss and tinnitus among 217 adults in a Pacific Northwest tribe. Frequency measures were conducted for difficulty hearing certain sounds and hearing aid use. In 2006, risk factors were examined for two outcomes-hearing loss and tinnitus-with analysis conducted in the same year. RESULTS: Although self-reported hearing loss was more common in men (24%) than women (13%), a larger percentage of women compared with men reported difficulty hearing certain sounds. Only 8% of study participants reported hearing aid use. After age adjustment, significant noise exposure was associated with hearing loss (OR=8.30, 95% CI=1.84, 37.52). The overall prevalence of tinnitus was 33% (similar in men and women). After adjusting for age, the odds of tinnitus in individuals with more than four ear infections was 4.77 (95% CI=1.89, 12.02) times the odds in those who never had an ear infection. Tinnitus was also associated with significant noise exposure (OR=2.24, 95% CI=1.28, 6.73) even after age adjustment. CONCLUSIONS: Increasing age and significant noise exposure were associated with hearing loss in this tribe. Tinnitus was associated with significant noise exposure and history of otitis media, even after age adjustment. Public health efforts are needed to improve hearing-related health in this tribe through messages about noise exposure and use of hearing protection.

Program Sustainability: Hearing Loss and Tinnitus Prevention in American Indian Communities.

INTRODUCTION: An important goal of any health promotion effort is to have it maintained in delivery and effectiveness over time. The purpose of this study was to establish a community-based noise-induced hearing loss and tinnitus prevention program in three different types of American Indian communities and evaluate them for evidence of long-term sustainability. METHODS: The target population was fourth- and fifth-grade students from three different models of American Indian communities. The evidenced-based Dangerous Decibels® program was adapted to include local media, classroom education, family and community outreach, and web-based activities. Sustainability was attempted by promoting funding stability, political support, partnerships, organizational capacity, program adaptation, program evaluation, communications, public health impacts, and strategic planning. RESULTS: Currently, there is evidence suggesting that the hearing health promotion program is self-sustaining in all three American Indian communities. The intervention was effective at changing knowledge, attitudes, beliefs, and behaviors in the target population, but program adoption and self-sustenance faced challenges that required patience, persistence, and creativity by the program team. Components of the intervention continue to be delivered by local members of each community. CONCLUSIONS: Critical factors that led to self-sustaining programs included approval of community leaders and engagement of community members in the design, administration, and evaluation of the effort; use of a well-developed, evidence-based intervention; and high-level training of local participants who could confidently and effectively continue delivering the program following a gradual transition to independence.

Experimental, controversial, and futuristic treatments for chronic tinnitus.

BACKGROUND: Because chronic tinnitus is a condition that negatively impacts the quality of life of millions of people worldwide, a safe and effective treatment for tinnitus has been sought for millennia. However, effective treatments for tinnitus are greatly outnumbered by ineffective strategies, medications, devices, and surgeries that continue to be developed and promoted for the condition. PURPOSE: This article describes and critiques experimental, controversial, and potential treatments for chronic tinnitus. The purpose of this review is to provide information that should help patients and clinicians to select tinnitus treatment and management strategies most likely to be effective for each set of symptoms and circumstances. RESEARCH DESIGN: PubMed and MEDLINE databases (National Center for Biotechnology Information, U.S. National Library of Medicine) were searched for the term tinnitus in articles published from 1940 to 2012. Other historical documents and publications were also reviewed as needed for particular topics. STUDY SAMPLE: Studies included in this review were selected to represent a sampling of treatment methodologies that have been used for tinnitus. DATA COLLECTION AND ANALYSIS: Due to the heterogeneity of the studies reviewed, it was not appropriate to perform a meta-analysis. A selective review of the literature was conducted to summarize and critique published research results. RESULTS: Most invasive treatments for tinnitus should be avoided because (1) at best, there is scant evidence that any of these treatments is effective, and (2) the risk to patients for most invasive procedures is much greater than the risk posed by the tinnitus perception. Effective and noninvasive treatments for tinnitus include acoustic therapy (which includes hearing aids and other types of environmental sound enrichment); cognitive-behavioral therapy; psychological counseling; hypnosis; biofeedback; and relaxation training. Over-the-counter or prescription medications may be used as needed to facilitate sleep and to reduce anxiety, depression, or obsessive-compulsiveness. CONCLUSIONS: Patients and clinicians should be especially cautious when considering invasive (and potentially harmful) treatments for tinnitus, which is a non-life-threatening symptom. Unless well-designed clinical trials verify that a tinnitus therapy demonstrates effectiveness above and beyond the placebo effect, consumers should be wary of medications, devices, or procedures promoted as a "cure." Although a true cure for tinnitus has not yet been found, effective and noninvasive tinnitus management strategies are available now. If progress is made to medically (or genetically) treat sensorineural hearing loss in humans, this breakthrough should also help to simultaneously reduce the perception of tinnitus for many patients.

Randomized trial of four noise-induced hearing loss and tinnitus prevention interventions for children.

OBJECTIVE: To evaluate the effectiveness of four NIHL prevention interventions at improving knowledge, attitudes, and intended behaviors regarding sound exposure and appropriate use of hearing protective strategies in children. DESIGN: A randomized trial of the four interventions with a non-intervention comparison group. Questionnaires were completed prior to, immediately after, and three months after each intervention. STUDY: Interventions included: (1) A classroom presentation by older-peer educators, (2) A classroom presentation by health professionals, (3). Exploration of a museum exhibition, and (4). Exploration of an internet-based virtual museum. A comparison group received no intervention. STUDY SAMPLE: Fifty-three fourth grade classrooms (1120 students) participated in the study. RESULTS: All interventions produced significant improvements but the number of improvements decreased over time. In terms of effectiveness, the classroom programs were more effective than the internet-based virtual exhibit, which was more effective than the visit to the museum exhibition. Self-reported exposures indicated that as many as 94.5% of participants were at risk for NIHL. CONCLUSIONS: Interpersonal, interactive educational interventions such as the classroom program are more effective and have longer impact than self-directed learning experiences for NIHL and tinnitus prevention, however each may have an important role in promoting hearing health in elementary school students.

Deep brain stimulation effects in patients with tinnitus.

OBJECTIVE: To report deep brain stimulation (DBS) effects in patients with tinnitus. STUDY DESIGN: Case series with chart review. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Seven patients implanted with DBS systems for movement disorders who also reported having tinnitus were interviewed about their tinnitus conditions. Four were available for testing in a specialized tinnitus clinic with their DBS systems turned off or on. Testing included matching of self-rated and psychoacoustically measured tinnitus loudness to measure the impact of DBS on tinnitus. RESULTS: Three of the seven patients reported reduced tinnitus loudness when DBS was turned on. Of the four patients tested in the clinic, results indicated that DBS of the ventralis intermedius nucleus of the thalamus caused decreases in tinnitus loudness in two patients with relatively prolonged residual inhibition. CONCLUSION: These results suggest that DBS of nonauditory thalamus structures may provide tinnitus relief for some patients.

Obsessive-compulsiveness in a population of tinnitus patients.

The purpose of this study was to use the Maudsley Obsessional-Compulsive Inventory (MOCI) to assess obsessive-compulsiveness in a population of 196 tinnitus patients and to correlate MOCI scores with measures of anxiety, depression, and tinnitus severity. Tinnitus severity was positively correlated with measures of anxiety and depression. Depression was positively correlated with MOCI and anxiety scores. MOCI scores exhibited weaker positive correlations with tinnitus severity and anxiety. Effective management of tinnitus requires identification of psychological disorders or symptoms when they are present so that patients can receive appropriate treatment as soon as possible. The MOCI can be used to assess obsessive-compulsiveness in tinnitus patients.

Effectiveness of "Dangerous Decibels," a school-based hearing loss prevention program.

PURPOSE: To evaluate the effectiveness of the "Dangerous Decibels" educational program in increasing students' knowledge and positively changing their attitudes and intended behaviors related to hearing and hearing loss prevention. METHOD: Baseline questionnaires were completed by 478 4th-grade students and 550 7th-grade students. Approximately half of the students in each grade received a 35-min interactive classroom presentation on hearing and hearing loss prevention. The remaining students served as comparison groups. Students who received the curriculum filled out questionnaires immediately after the presentation. All students filled out follow-up questionnaires 3 months after baseline. RESULTS: Fourth-grade students who participated in the Dangerous Decibels presentation exhibited significant improvements in knowledge and attitudes related to hearing and hearing loss prevention. These improvements were maintained 3 months after the presentation. Seventh-grade students also experienced long-term improvements in their knowledge base. However, attitudes and intended behaviors in 7th graders returned to baseline levels 3 months postpresentation. CONCLUSION: The Dangerous Decibels hearing loss prevention program was effective at producing long-term improvements in the knowledge base of 4th- and 7th-grade students. Future studies should include components on peer pressure and should incorporate repeated, multimodality interventions to increase the likelihood of long-term improvement in adolescents.

Hearing conservation education programs for children: a review.

Prevalence of noise-induced hearing loss (NIHL) among children is increasing. Experts have recommended implementation of hearing conservation education programs in schools. Despite these recommendations made over the past three decades, basic hearing conservation information that could prevent countless cases of NIHL remains absent from most school curricula. This paper reviews existing hearing conservation education programs and materials designed for children or that could be adapted for classroom use. This information will be useful as a resource for educators and school administrators and should encourage further development, implementation, and dissemination of hearing conservation curricula. The overall, and admittedly ambitious, goal of this review is to facilitate implementation of hearing conservation curricula into all US schools on a continuing basis. Ultimately, implementation of such programs should reduce the prevalence of noise-induced hearing loss among children and adults.