Tools for telehealth: A correlational analysis of app-based hearing testing.

Objective: Telehealth evaluation of hearing is rapidly evolving; however, the lack of consensus on the most accurate remote hearing test application has made hearing evaluation complicated. The objective of this study was to evaluate the correlation between the pure tone audiometry results obtained from app-based hearing testing programs and a traditional audiogram. Methods: A prospective within-subject and between-subject study design was used to correlate audiogram results between app-based hearing programs and a traditional audiogram. All participants completed a traditional audiogram, 1 commercial app-based test (ShoeBox), 2 consumer app-based tests (EarTrumpet and Hearing Test and Ear Age Test [HTEAT]), and a Hearing Handicap Inventory screening version (HHI-S). Testing was conducted in an acoustically controlled environment (traditional) and a quiet room (app-based hearing tests). Results: A total of 39 participants were enrolled in the study (21 with normal hearing and 18 with hearing loss). In patients with normal hearing, only the commercial hearing testing app (ShoeBox) had a statistically significant pure tone average correlation in both ears with traditional audiometry (Right ear-r = 0.7, p = .005, Left ear-r = 0.66, p = .001). Both consumer and commercial apps had statistically significant correlations with both ears in patients with hearing loss (ranging from r = 0.62 to r = 0.9). Regarding accuracy within 10 dB of the pure tone average of the traditional audiogram of all tested ears, the commercial app-based test was accurate in 94% for all ears (normal and hearing loss), while consumer app-based tests were between 14% and 36% for all ears. The HHI-S indicated no hearing impairment in 95% of those with normal hearing and indicated hearing impairment in 89% of those with hearing loss. Conclusion: Commercial-grade app-based pure tone audiometry demonstrates overall strong correlation and accuracy with traditional audiometry. The HHI-S assessment remains a valid and useful tool to predict normal hearing and hearing impairment. Level of Evidence: 2.

Behavioral and Hemodynamic Changes Following Dichotic Training in Patients with Neurological Deficits of the Auditory Nervous System: A Case Series.

BACKGROUND: Dichotic listening occurs when one attends to different acoustical messages presented simultaneously to both ears. This is important for understanding speech in compromised listening situations, such as background noise. Deficits in dichotic listening can be remediated by participating in auditory training. We present two patients with binaural integration deficits who underwent dichotic interaural intensity difference (DIID) training. PURPOSE: The purpose of this investigation is to demonstrate improvement of dichotic listening deficits following DIID training in neurological patients seen clinically for hearing issues. RESEARCH DESIGN: This was a case series utilizing a pre- and posttreatment design. STUDY SAMPLE: This case series utilized two female participants who demonstrated binaural integration deficits during an auditory processing evaluation. INTERVENTION: The participants underwent a pretraining auditory processing evaluation and functional magnetic resonance imaging (fMRI). Participants then underwent 12, 30-minute DIID training sessions followed by posttreatment auditory processing evaluations and fMRI. DATA COLLECTION AND ANALYSIS: Data was collected at the pretreatment appointment and then immediately following the completion of the training. RESULTS: Each patient demonstrated varying degrees of improvement on the posttreatment assessment. Case 1 showed significant improvement on the Speech-in-Noise-Revised (SPIN-R) test. fMRI showed changes in activation patterns following training. Case 2 demonstrated improved scores on the Dichotic Digits Test and SPIN-R and increased activation of the calcarine sulcus following training. CONCLUSION: Dichotic training can be an efficacious treatment for binaural integration deficits and may show evidence of improving speech understanding in noise. This case series demonstrates a promising therapy to help patients improve auditory function by improving dichotic listening skills.

Audiology Telemedicine Evaluations: Potential Expanded Applications.

There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal-hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant-nucleus-consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in-person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. Testing conditions were acceptable to audiologists and subjects. Further study to validate this method in cochlear implant candidates and a larger population is warranted.

Hormones and Hearing: Central Auditory Processing in Women.

BACKGROUND: Estrogen has been identified as playing a key role in many organ systems. Recently, estrogen has been found to be produced in the human brain and is believed contribute to central auditory processing. After menopause, a low estrogen state, many women report hearing loss but demonstrate no deficits in peripheral hearing sensitivity, which support the notion that estrogen plays an effect on central auditory processing. Although animal research on estrogen and hearing loss is extensive, there is little in the literature on the human model. PURPOSE: The aim of this study was to evaluate relationships between hormonal changes and hearing as it relates to higher auditory function in pre- and postmenopausal (Post-M) females. RESEARCH DESIGN: A prospective, group comparison study. STUDY SAMPLE: Twenty eight women between the ages of 18 and 70 at the University of Kentucky were recruited. DATA COLLECTION AND ANALYSIS: Participants were separated into premenopausal and peri-/Post-M groups. Participants had normal peripheral hearing sensitivity and underwent a behavioral auditory processing battery and electrophysiological evaluation. An analysis of variance was performed to address the aims of the study. RESULTS: Results from the study demonstrated statistically significant difference between groups, where Post-M females had difficulties in spatial hearing abilities as reflected on the Listening in Spatialized Noise Test-Sentences test. In addition, measures on the auditory brainstem response and the middle latency response reflected statistically significant differences between groups with Post-M females having longer latencies. CONCLUSIONS: Results from the present study demonstrated significant differences between groups, particularly listening in noise. Females who present with auditory complaints in spite of normal hearing thresholds should have a more extensive audiological evaluation to further evaluate possible central deficits.