Evaluating Hearing Status and Word Recognition Ability in the Hmong Population Using Four Validated Monosyllabic White Hmong Dialect Word Recognition Tests.

PURPOSE: The study's aims were (a) to evaluate hearing status and (b) word recognition ability of Hmong speakers using four validated monosyllabic word recognition tests in the White Hmong dialect and (c) to assess the relationship between the participant's language and the average word recognition percent correct scores, adjusting for age, gender, and degree of hearing loss. METHOD: Participants listened to two randomly assigned validated Hmong word lists (male/female talker) for each ear. Pure-tone air- and bone-conduction thresholds as well as word recognition ability were measured. Descriptive statistics were calculated to analyze the percent correct of word lists and classify hearing status. A nonparametric regression analysis was used to assess the relationship between the participant's language and the average word recognition percent correct scores, adjusting for age, gender, and degree of hearing loss. RESULTS: Forty-eight Hmong (25 females, 23 males; Mage = 44.4) participated in this study. Thirty-three participants had hearing loss in at least one ear, and 15 had hearing within normal limits bilaterally. Participants with normal, mild, or steeply sloping hearing loss reached an average word recognition score of > 94% on Hmong lists by both male and female talkers. Participants with moderate-to-severe hearing loss scored 68% on average for the male talker Hmong lists and 60% on average for the female talker Hmong lists. Gender was significantly positively associated with average word recognition percent correct on the female word lists (b = -0.224, p = .047) but not statistically significant for the male word lists (b = 7.579, p = .141). CONCLUSION: Findings provide support for the use of the four Hmong word lists in clinical settings.

Breaking Down Communication Barriers: Assessing the Need for Audiologists to Have Access to Clinically Relevant Sign Language.

BACKGROUND: Research suggests Deaf individuals have longstanding negative perceptions of their interactions with health care providers, primarily due to communication barriers. One way to improve relations would be for audiologists to learn clinically relevant sign language. PURPOSE: The aim of the study is to gain a better understanding of audiologists' knowledge of Deaf culture and American Sign Language (ASL) and evaluate motivation for instruction in signing abilities. RESEARCH DESIGN: A 21-question survey was emailed and advertised in a social media group for audiologists. The survey was divided into four sections: (1) demographics, (2) education of ASL and Deaf culture, (3) experience with ASL and Deaf culture, and (4) motivation to learn clinical signs. DATA ANALYSIS: Descriptive statistics were analyzed for quantitative analysis of survey responses. RESULTS: A total of 489 responses were obtained and analyzed. Majority of respondents (82.6%) completed a manual ASL course, though only a third reported exposure to clinically relevant signs (37.4%). The majority of respondents rated their signing abilities at the word level, and knowing somewhere between 5 and 20 signs, expressively (50.5%) and receptively (53.9%). Results illustrate the majority of audiologists (54.5%) feel their clinical signing abilities need to be improved and were either highly (30.9%) or somewhat motivated (42.1%) to do so. CONCLUSION: Study results suggest that although participants are enrolling in and completing ASL courses, clinical signs are not routinely included. This omission leads to reduced signing ability, potentially harming the provider-patient relationship. The majority of survey respondents reported that they are strongly motivated to improve their signing abilities. Results of the present study suggest there is need for a comprehensive clinical signs resource for audiologists to provide quality patient care to their Deaf patients. At present, there is no known, available tool to help accomplish this need.

Systematic Comparison of Trial Exclusion Criteria for Pupillometry Data Analysis in Individuals With Single-Sided Deafness and Normal Hearing.

The measurement of pupil dilation has become a common way to assess listening effort. Pupillometry data are subject to artifacts, requiring highly contaminated data to be discarded from analysis. It is unknown how trial exclusion criteria impact experimental results. The present study examined the effect of a common exclusion criterion, percentage of blinks, on speech intelligibility and pupil dilation measures in 9 participants with single-sided deafness (SSD) and 20 participants with normal hearing. Participants listened to and repeated sentences in quiet or with speech maskers. Pupillometry trials were processed using three levels of blink exclusion criteria: 15%, 30%, and 45%. These percentages reflect a threshold for missing data points in a trial, where trials that exceed the threshold are excluded from analysis. Results indicated that pupil dilation was significantly greater and intelligibility was significantly lower in the masker compared with the quiet condition for both groups. Across-group comparisons revealed that speech intelligibility in the SSD group decreased significantly more than the normal hearing group from quiet to masker conditions, but the change in pupil dilation was similar for both groups. There was no effect of blink criteria on speech intelligibility or pupil dilation results for either group. However, the total percentage of blinks in the masker condition was significantly greater than in the quiet condition for the SSD group, which is consistent with previous studies that have found a relationship between blinking and task difficulty. This association should be carefully considered in future experiments using pupillometry to gauge listening effort.

Review of Hearing Loss Among Racial/Ethnic Minorities in the United States.

The purpose of this study is to synthesize the literature on hearing loss among racial/ethnic minorities in the United States. A scoping review of primary source articles from 1950 to 2019 was conducted across four databases-CINAHL, PsycINFO, PubMed, and Scopus-to identify peer-reviewed studies. Twenty-two research studies were included. Of the 22 studies, 19 were descriptive, and 3 were interventions. Among the 19 descriptive studies, five themes related to hearing loss were identified: hearing loss prevalence, accuracy of hearing loss assessment, hearing loss risk factors, access to hearing care, and attitudes toward hearing loss. The three interventional studies focused on measuring hearing loss prevalence and promoting access to hearing care. Findings from this scoping review highlight that hearing loss is prevalent in racial/ethnic minorities. More research is needed on how economic, cultural, and age-related factors may influence hearing outcomes for racial/ethnic minorities.

Auditory Attention and Spatial Unmasking in Children With Cochlear Implants.

The ability to attend to target speech in background noise is an important skill, particularly for children who spend many hours in noisy environments. Intelligibility improves as a result of spatial or binaural unmasking in the free-field for normal-hearing children; however, children who use bilateral cochlear implants (BiCIs) demonstrate little benefit in similar situations. It was hypothesized that poor auditory attention abilities might explain the lack of unmasking observed in children with BiCIs. Target and interferer speech stimuli were presented to either or both ears of BiCI participants via their clinical processors. Speech reception thresholds remained low when the target and interferer were in opposite ears, but they did not show binaural unmasking when the interferer was presented to both ears and the target only to one ear. These results demonstrate that, in the most extreme cases of stimulus separation, children with BiCIs can ignore an interferer and attend to target speech, but there is weak or absent binaural unmasking. It appears that children with BiCIs mostly experience poor encoding of binaural cues rather than deficits in ability to selectively attend to target speech.

Auditory motion tracking ability of adults with normal hearing and with bilateral cochlear implants.

Adults with bilateral cochlear implants (BiCIs) receive benefits in localizing stationary sounds when listening with two implants compared with one; however, sound localization ability is significantly poorer when compared to normal hearing (NH) listeners. Little is known about localizing sound sources in motion, which occurs in typical everyday listening situations. The authors considered the possibility that sound motion may improve sound localization in BiCI users by providing multiple places of information. Alternatively, the ability to compare multiple spatial locations may be compromised in BiCI users due to degradation of binaural cues, and thus result in poorer performance relative to NH adults. In this study, the authors assessed listeners' abilities to distinguish between sounds that appear to be moving vs stationary, and track the angular range and direction of moving sounds. Stimuli were bandpass-filtered (150-6000 Hz) noise bursts of different durations, panned over an array of loudspeakers. Overall, the results showed that BiCI users were poorer than NH adults in (i) distinguishing between a moving vs stationary sound, (ii) correctly identifying the direction of movement, and (iii) tracking the range of movement. These findings suggest that conventional cochlear implant processors are not able to fully provide the cues necessary for perceiving auditory motion correctly.

Restoration of spatial hearing in adult cochlear implant users with single-sided deafness.

In recent years, cochlear implants (CIs) have been provided in growing numbers to people with not only bilateral deafness but also to people with unilateral hearing loss, at times in order to alleviate tinnitus. This study presents audiological data from 15 adult participants (ages 48 ± 12 years) with single sided deafness. Results are presented from 9/15 adults, who received a CI (SSD-CI) in the deaf ear and were tested in Acoustic or Acoustic + CI hearing modes, and 6/15 adults who are planning to receive a CI, and were tested in the unilateral condition only. Testing included (1) audiometric measures of threshold, (2) speech understanding for CNC words and AzBIO sentences, (3) tinnitus handicap inventory, (4) sound localization with stationary sound sources, and (5) perceived auditory motion. Results showed that when listening to sentences in quiet, performance was excellent in the Acoustic and Acoustic + CI conditions. In noise, performance was similar between Acoustic and Acoustic + CI conditions in 4/6 participants tested, and slightly worse in the Acoustic + CI in 2/6 participants. In some cases, the CI provided reduced tinnitus handicap scores. When testing sound localization ability, the Acoustic + CI condition resulted in improved sound localization RMS error of 29.2° (SD: ±6.7°) compared to 56.6° (SD: ±16.5°) in the Acoustic-only condition. Preliminary results suggest that the perception of motion direction, whereby subjects are required to process and compare directional cues across multiple locations, is impaired when compared with that of normal hearing subjects.

Spatial Release From Masking in 2-Year-Olds With Normal Hearing and With Bilateral Cochlear Implants.

This study evaluated spatial release from masking (SRM) in 2- to 3-year-old children who are deaf and were implanted with bilateral cochlear implants (BiCIs), and in age-matched normal-hearing (NH) toddlers. Here, we examined whether early activation of bilateral hearing has the potential to promote SRM that is similar to age-matched NH children. Listeners were 13 NH toddlers and 13 toddlers with BiCIs, ages 27 to 36 months. Speech reception thresholds (SRTs) were measured for target speech in front (0°) and for competitors that were either Colocated in front (0°) or Separated toward the right (+90°). SRM was computed as the difference between SRTs in the front versus in the asymmetrical condition. Results show that SRTs were higher in the BiCI than NH group in all conditions. Both groups had higher SRTs in the Colocated and Separated conditions compared with Quiet, indicating masking. SRM was significant only in the NH group. In the BiCI group, the group effect of SRM was not significant, likely limited by the small sample size; however, all but two children had SRM values within the NH range. This work shows that to some extent, the ability to use spatial cues for source segregation develops by age 2 to 3 in NH children and is attainable in most of the children in the BiCI group. There is potential for the paradigm used here to be used in clinical settings to evaluate outcomes of bilateral hearing in very young children.

Does Bilateral Experience Lead to Improved Spatial Unmasking of Speech in Children Who Use Bilateral Cochlear Implants?

HYPOTHESIS: In children with bilateral cochlear implants (BiCIs), experience over a 1 to 3-year period can improve speech understanding and spatial unmasking of speech. BACKGROUND: One reason for providing children with BiCIs is to improve spatial hearing abilities. Little is known about changes in performance with added bilateral experience, and the relation between sound localization and spatial unmasking of speech. METHODS: Twenty children with BiCIs participated. Testing was conducted typically within a year of bilateral activation, and at 1, 2, or 3 follow-up annual intervals. All testing was done while children listened with both devices activated. Target speech was presented from front (co-located); interfering speech was from front, right (asymmetrical), or right and left (symmetrical). Speech reception thresholds (SRTs) were measured in each condition. Spatial release from masking (SRM) was quantified as the difference in SRTs between conditions with interferers at 0 degrees and 90 degrees. For 11 of the children, data are also compared with sound localization measures obtained on the same visit to the laboratory but published elsewhere. RESULTS: Change in SRM with bilateral experience varied; some children showed improvement and others did not. Regression analyses identified relationships between SRTs and SRM. Comparison of the SRM with localization data suggests little evidence for correlations between the two spatial tasks. CONCLUSION: In children with BiCIs spatial hearing mechanisms involved in SRM and sound localization may be different. Reasons for reduced SRM include asymmetry between the ears, and individual differences in the ability to inhibit interfering information, switch and/or sustain attention.

Spatial release from masking in children with bilateral cochlear implants and with normal hearing: Effect of target-interferer similarity.

In complex auditory environments, it is often difficult to separate a target talker from interfering speech. For normal hearing (NH) adult listeners, similarity between the target and interfering speech leads to increased difficulty in separating them; that is, informational masking occurs due to confusability of the target and interferers. This study investigated performance of children with bilateral cochlear implants (BiCIs) when target and interferers were either same-sex (male) talkers, or different-sex talkers (male target, female interferer). Comparisons between children with BiCIs and NH, when matched for age, were also conducted. Speech intelligibility was measured for target and interferers spatially co-located, or spatially separated with the interferers positioned symmetrically (+90° and -90°) or asymmetrically (both at +90°, right). Spatial release from masking (SRM) was computed as the difference between co-located and separated conditions. Within group BiCI comparisons revealed that in the co-located condition speech intelligibility was worse with the same-sex vs different-sex stimuli. There was also a trend for more SRM with the same-sex vs different-sex stimuli. When comparing BiCI to NH listeners, SRM was larger for the NH groups, suggesting that NH children are better able to make use of spatial cues to improve speech understanding in noise.

Spatial release from masking in children with normal hearing and with bilateral cochlear implants: effect of interferer asymmetry.

Spatial release from masking (SRM) was measured in groups of children with bilateral cochlear implants (BiCIs, average ages 6.0 and 7.9 yr) and with normal hearing (NH, average ages 5.0 and 7.8 yr). Speech reception thresholds (SRTs) were measured for target speech in front (0°), and interferers in front, distributed asymmetrically toward the right (+90°/+90°) or distributed symmetrically toward the right and left (+90°/-90°). In the asymmetrical condition both monaural "better ear" and binaural cues are available. In the symmetrical condition, listeners rely heavily on binaural cues to segregate sources. SRM was computed as the difference between SRTs in the front condition and SRTs in either the asymmetrical or symmetrical conditions. Results showed that asymmetrical SRM was smaller in BiCI users than NH children. Furthermore, NH children showed symmetrical SRM, suggesting they are able to use binaural cues for source segregation, whereas children with BiCIs had minimal or absent symmetrical SRM. These findings suggest that children who receive BiCIs can segregate speech from noise under conditions that maximize monaural better ear cues. Limitations in the CI devices likely play an important role in limiting SRM. Thus, improvement in spatial hearing abilities in children with BiCIs may require binaural processing strategies.