Tone-burst elicited auditory brainstem responses in full-term and pre-term infants.

OBJECTIVE: To investigate the reliability of tone-burst auditory brainstem response (TB-ABR) latencies and thresholds in pre-term and full-term infants. DESIGN: TB-ABRs to 500 Hz and 4000 Hz tone-burst stimuli were recorded at two-week intervals over the first six weeks of life in a group of full-term infants (40-46 weeks gestational age [GA]) and over ten weeks (36-46 weeks gestation) in a group of preterm infants. Linear mixed model analyses evaluated within-subject changes and the effects of the subject group, age at assessment, and stimulus frequency on ABR latency and threshold. STUDY SAMPLE: Twenty-four infants participated. Nine were full-term (GA: 39-41 weeks) and fifteen were healthy pre-term (GA: 28-34 weeks) at birth. RESULTS: TB-ABR wave V latencies at 70 dBnHL decreased throughout the study (p < 0.001) in pre-term babies for both test frequencies by approximately 0.5 ms. There were, however, no group or GA (at birth) effects indicating that response latency normalized in these children by the due date. Similarly, TB-ABR threshold levels in the premature group were elevated (p = 0.001) by approximately 5 dB in pre-term evaluation but were equivalent to those of full-term participants in the post-term assessment period. CONCLUSIONS: In healthy, pre-term infants, tone-burst ABR testing is reliable from 36 weeks gestation.

The reliability of remote diagnostic hearing assessment in school-entry-aged children.

OBJECTIVE: To explore the feasibility of remote diagnostic hearing testing within schools, for school-entry aged children (4-7 years). DESIGN: A prospective cross-sectional comparative study design was used to establish the reliability of remote hearing assessment by comparing traditional face-to-face pure tone audiometry (PTA) with remote PTA, traditional otoscopy with remote video otoscopy and interpretation of tympanograms in-person with remote analysis. STUDY SAMPLE: 464 school-entry year level children from 18 schools. RESULTS: Air conduction thresholds established by remote testing were within a clinically acceptable range of ±10 dB HL from traditional thresholds in 98% of cases at 1 kHz and 97.8% at 4 kHz. Bone conduction thresholds varied by ≤10 dB HL in 100% of cases at 1 kHz and 95.7% at 4 kHz. Remote otoscopy and tympanometry interpretation had 78.6% agreement (moderate; κ = 0.6) and 92.2% agreement (almost perfect; κ = 0.9), respectively. CONCLUSIONS: We found there to be good reliability between face-to-face PTA and remote PTA performed within the school environment. Furthermore, assessment of the outer and middle ear via video otoscopy and remote tympanometry classification were both viable. Remote diagnostic hearing tests in schools can extend reach of paediatric services in rural areas.

A scoping review exploring how adults self-describe and communicate about the listening difficulties they experience.

Objective: It is unknown how adults communicate about their experienced listening difficulties with their audiologist. This scoping review aims to explore how adults self-describe the listening difficulties that they experience, and how they communicate about them. Design: A scoping review was conducted between December 2020 and September 2022 to identify published journal articles in which adults described and communicated about their listening difficulties. Study sample: Database searches yielded 10,224 articles initially. After abstract screening and full text review, 55 articles were included for analysis. Results: The listening difficulties that adults described were varied, highlighting the fact that each person has individual experiences. Adults discussed reasons for their listening difficulties, impacts of their listening difficulties, and behavioural responses they adopted to cope with their listening difficulties. Conclusions: This review shows the broad impacts of listening difficulties, and the varied ways in which adults discuss their listening difficulties. There is no available literature reporting how adults communicate about their listening difficulties in a clinical context.

Adults' recollections of discussions with their audiologist: a qualitative study of what was and was not successfully communicated about listening difficulties.

OBJECTIVES: Some adults experience challenges in successfully communicating their listening difficulties to their audiologist, and report feeling that they are not always listened to or understood. This project examined adults' recollections of discussions with their audiologist to explore (1) how adults report describing their listening difficulties and (2) information that adults report they do not communicate, or do not communicate successfully, to their audiologist. DESIGN: Individual semi-structured interviews were conducted. Interview transcripts were analysed using a template analysis approach. STUDY SAMPLE: Fifteen adults who self-report listening difficulties, and who had previously consulted an audiologist. RESULTS: Four themes were identified from adults' recollections of how they describe their listening difficulties: (1) situation or context of listening difficulties, (2) behavioural responses, (3) impacts of listening difficulties and (4) contributing factors. Adults report not always successfully communicating (1) emotional concerns and impacts, (2) descriptions of sound quality and (3) descriptions of changed listening experiences. CONCLUSION: Results provide insights about the times when adults feel that communication with their audiologist is successful, or unsuccessful. The results are useful for informing interventions to help adults and audiologists communicate more effectively together. To further inform interventions, factors affecting adults' communication should be explored.

Family-Perceived Barriers and Facilitators Toward a Tele-Audiology Infant Diagnostic Testing Approach in Victoria, Australia.

Background: Universal newborn hearing screening programs allow for early identification of congenital hearing loss. However, some families experience difficulties accessing diagnostic audiology services following a refer screen result. Methods: This study aimed to assess the opinions of families who had experienced infant diagnostic audiology assessments regarding a telehealth option for these appointments within Victoria, Australia. Families who attended in-person infant diagnostic audiology appointments were sent a questionnaire exploring their experiences of the service and their opinion regarding a proposed telehealth option for infant diagnostic audiology (50 responses received). These results were also compared to those of families who were surveyed following testing in 2020, where the audiologist conducted the appointment remotely to comply with COVID-19-related social distancing recommendations at the time (10 responses received). Results: There were not significant differences between the duration or number of appointments, perceived understanding of results, or concerns regarding a tele-audiology model between families who experienced face-to-face and tele-audiology infant diagnostic audiology appointments. Opinions of infant diagnostic audiology appointments utilizing telehealth technology were largely positive, and minimal technological difficulties were identified. Conclusion: Overall positive attitudes of many families with infant diagnostic appointment experiences toward a tele-audiology option of this service suggest that offering a telehealth model of appointments may be an appropriate model to improve service access for families requiring infant diagnostic audiology in Victoria.

The Assistive Benefits of Remote Microphone Technology for Normal Hearing Children With Listening Difficulties.

OBJECTIVES: Children often present with listening difficulties (LiD) but with normal sound detection thresholds. These children are susceptible to learning challenges, and struggle with the suboptimal acoustics of standard classrooms. Remote microphone technology (RMT) is one way to improve the listening environment. The aim of this study was to determine the assistive potential of RMT for speech identification and attention skills in children with LiD, and to investigate whether the benefits obtained by these children were greater than for those with no listening concerns. DESIGN: A total of 28 children with LiD and 10 control participants with no listening concerns aged 6 to 12 years were included in this study. Children attended two laboratory-based testing sessions, where their speech intelligibility and attention skills were behaviorally assessed with and without the use of RMT. RESULTS: There were significant improvements in speech identification and attention skills when RMT was used. For the LiD group, use of the devices improved speech intelligibility to being comparable or better than control abilities without RMT. Auditory attention scores also improved from being poorer than controls without RMT to comparable to control performance with device assistance. CONCLUSIONS: Use of RMT was found to have a positive effect on both speech intelligibility and attention. RMT should be considered a viable option for addressing common behavioral symptoms of LiD, including for the many children that present with concerns of inattentiveness.

The Relations Between Auditory Processing Scores and Cognitive, Listening and Reading Abilities.

OBJECTIVES: To investigate associations between auditory processing abilities, cognitive abilities, listening ability, and reading ability in children. DESIGN: This was a cross-sectional study involving 155 children (105 referred for auditory processing assessment and 50 with no reported listening concerns) aged between 7 and 13 years. Each child was assessed on auditory processing tests, cognitive tests, and a reading test. Additional data on reading ability were provided by the reading score from a national test. Questionnaires about the child's listening ability were completed by a parent, a teacher, and the child. RESULTS: Structural equation models relating auditory processing abilities, cognitive abilities, listening ability, and reading ability were developed. There was evidence that listening and reading abilities were associated with cognitive abilities when adjusting for auditory processing abilities, but little evidence that listening and reading abilities were associated with auditory processing abilities when adjusting for cognitive abilities. CONCLUSIONS: It should not be assumed that auditory processing tests and cognitive tests measure separate abilities. When investigating the association between auditory processing abilities and real-world abilities, it is important to adjust for cognitive abilities. Children with listening difficulties should undergo cognitive assessments in addition to auditory processing assessments.

Efficacy of a deficit specific auditory training program for remediation of temporal patterning deficits.

Objective: To determine the efficacy of a targeted auditory training programme as a remediation approach for children diagnosed with a temporal patterning disorder. Design: Temporal Patterning scores were determined at two-time points pre-intervention and again post-training. Measures were then repeated in half of the participants after a further non-training period to determine the sustainability of effects. Cognitive skills and outcome measures were assessed at all time-points. Study Sample: Ten children aged between 7 and 12 years of age, diagnosed with a temporal patterning processing disorder, were enrolled in the training programme. Results: A group mean of 9.2 hours training was completed. Conclusion: Significant, sustainable improvements on the Frequency Pattern Test were found (2.5 SD increase in score relative to mean of age matched-peers) at the completion of training. Duration of training did not predict the degree of improvement. Cognitive skills did not show significant changes in ability. Significant, sustainable improvements in temporal patterning ability were seen after completion of the training programme. No associated changes in cognitive skills were seen, suggesting independence of the skills. Deficit-specific approaches are available across the traditional test battery, however, determining the appropriate management plan for a child diagnosed with an auditory processing disorder requires a patient-centric approach.

The relationship between peripheral hearing loss and higher order listening function on cognition in older Australians.

Objective: Peripheral hearing, central auditory processing (CAP) and cognition are all important for comprehension of speech and deteriorate with increased age. This study aimed to examine the relation between hearing impairment and cognitive impairment by assessing both peripheral hearing impairment and CAP ability.Design: Cognition was measured using the CogState Brief Battery (CSBB). Peripheral hearing was measured across eight frequencies (250 Hz-8000 Hz) using pure tone audiometry, and CAP was measured using the Listening in Spatialised Noise-Sentences test (LiSN-S) and the Dichotic Digits Test. Data were analysed using correlation and regression analyses.Study sample: Around 85 adults aged 60.33-83.08 years who attended the Melbourne Audiology clinic and had no previous diagnosis of dementia were included in the study.Results: A significant association was found between degree of peripheral hearing impairment and the cognitive skills of attention and executive function as measured by the CSBB. Additionally, CAP abilities as assessed using the LiSN-S test were significantly correlated with at least one cognitive measure.Conclusions: This study adds to the knowledge that peripheral hearing and CAP ability both share an association with cognition, specifically identifying cognitive skills and measures of "hearing" that mediate this relationship.

Peripheral and central hearing impairment and their relationship with cognition: a review.

Objective: To consider the relationships between both peripheral and central hearing impairment and cognition. Design: Narrative review. Study sample: Numerous studies exploring the relationship between hearing impairment and cognitive function, particularly in an older population. Results: In addition to the well-documented relationship between peripheral hearing loss and cognition highlighted in previous comprehensive reviews, there is also some evidence to suggest that there is a relationship between central hearing impairment and cognition. Further research is required to better understand this relationship and its effects on hearing aid benefit in people with both peripheral hearing loss and central hearing impairment. Conclusions: To fully understand the relationship between hearing impairment and cognitive impairment, not only peripheral but central hearing needs to be considered. Such knowledge could be of benefit in the clinical management of people with both peripheral hearing loss and central hearing impairment.

Remediation of spatial processing disorder (SPD).

OBJECTIVE: To determine the efficacy of deficit-specific remediation for spatial processing disorder, quantify effects of remediation on functional listening, and determine if remediation is maintained. DESIGN: Participants had SPD, diagnosed using the Listening in Spatialised Noise-Sentences test. The LiSN and Learn software was provided as auditory training. Post-training, repeat LiSN-S testing was conducted. Questionnaires pre- and post-training acted as subjective measures of remediation. A late-outcome assessment established long-term effects of remediation. STUDY SAMPLE: Sixteen children aged between 6;3 [years; months] and 10;0 completed between 20 and 146 training games. RESULTS: Post-training LiSN-S improved in measures containing spatial cues (p ≤ 0.001) by 2.0 SDs (3.6 dB) for DV90, 1.8 SDs for SV90 (3.2 dB), 1.4 SDs for spatial advantage (2.9 dB) and 1.6 SDs for total advantage (3.3 dB). Improvement was also found in the DV0 condition (1.4 dB or 0.5 SDs). Post-training changes were not significant in the talker advantage measure (1.0 dB or 0.4 SDs) or the SV0 condition (0.3 dB or 0.1 SDs). The late-outcome assessment demonstrated improvement was maintained. Subjective improvement post-remediation was observed using the parent questionnaire. CONCLUSIONS: Children with SPD had improved ability to utilise spatial cues following deficit-specific remediation, with the parent questionnaire sensitive to remediation. Effects of the remediation also appear to be sustained.

The Impact of Auditory Processing and Cognitive Abilities in Children.

OBJECTIVES: To examine the links between auditory processing (AP) test results, functional deficits, and cognitive abilities. DESIGN: One hundred and fifty-five children, ages 7-12 years, comprising 50 control children and 105 children referred for AP assessment, all with normal peripheral hearing, completed an AP and cognitive (sustained attention, auditory working memory, and nonverbal intelligence) test battery. Functional outcome measures of listening ability (developed using questionnaires from parent, teacher, and child respondents) and reading fluency were also collected. RESULTS: AP scores for dichotic digits, frequency pattern, and listening in spatialized noise-sentences test baseline scores showed significant intertask correlations, and significant correlations with functional outcomes. The gaps in noise task showed correlation with reading fluency only. The AP tasks of masking level differences and spatial advantage showed no correlation with listening ability or reading fluency. Results showed significantly poorer cognitive abilities overall in the children referred for AP assessment compared with the control group. Within the referred group, children diagnosed with an auditory processing disorder had significantly poorer cognitive abilities than those passing the test battery. Correlation and regression studies showed significant associations between AP and cognitive scores. The results of multilinear regression analyses showed that the associations of AP scores with listening and academic results were no longer significant when cognitive scores were also included as predictors. CONCLUSIONS: A complex interaction of cognitive abilities and AP scores is evident. For many children with listening difficulties, who perform poorly on AP tasks, cognitive deficits are also in place. Although the direction of causality is unclear, it is likely that these cognitive deficits are causing the perceived difficulty and/or are having a significant effect on the test results. Interpretation of AP tests requires consideration of how cognitive abilities may have impacted on not only task results but also the functional difficulties experienced by the child.

Long-term hearing deficits after childhood middle ear disease.

OBJECTIVES: To investigate the long-term impact of childhood otitis media on listening ability in school-aged children. DESIGN: Speech perception in background noise was measured in two groups of 35 children, aged 6 to 12 years, with normal middle ear function and sound detection at assessment. The first consisted of children who had previously suffered middle ear disease; the second those with no history of middle ear disease. RESULTS: Binaural speech perception ability was significantly poorer in the children with prior middle ear disease. Furthermore, spatial listening (the ability to selectively attend to a sound signal from one location) was also significantly impaired. Significant correlations were demonstrated between both the age of onset and the duration of childhood otitis media and speech perception ability (onset: r = -0.58, p < 0.001; duration: r = -0.63, p < 0.001). CONCLUSIONS: These results demonstrate the risk of long-term functional hearing deficit for children with middle ear disease history in childhood. They also indicate that this risk is increased with earlier onset and longer duration. The findings highlight the need for early intervention and an awareness of the potential for reduced functional listening ability even after sound detection has returned to normal.

Effectiveness of Noise Cancelling Earbuds in Reducing Hearing and Auditory Attention Deficits in Children with Autism.

Background/Objectives: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterised by impairments in social communication, sensory abnormalities, and attentional deficits. Children with ASD often face significant challenges with speech perception and auditory attention, particularly in noisy environments. This study aimed to assess the effectiveness of noise cancelling Bluetooth earbuds (Nuheara IQbuds Boost) in improving speech perception and auditory attention in children with ASD. Methods: Thirteen children aged 6-13 years diagnosed with ASD participated. Pure tone audiometry confirmed normal hearing levels. Speech perception in noise was measured using the Consonant-Nucleus-Consonant-Word test, and auditory/visual attention was evaluated via the Integrated Visual and Auditory Continuous Performance Task. Participants completed these assessments both with and without the IQbuds in situ. A two-week device trial evaluated classroom listening and communication improvements using the Listening Inventory for Education-Revised (teacher version) questionnaire. Results: Speech perception in noise was significantly poorer for the ASD group compared to typically developing peers and did not change with the IQbuds. Auditory attention, however, significantly improved when the children were using the earbuds. Additionally, classroom listening and communication improved significantly after the two-week device trial. Conclusions: While the noise cancelling earbuds did not enhance speech perception in noise for children with ASD, they significantly improved auditory attention and classroom listening behaviours. These findings suggest that Bluetooth earbuds could be a viable alternative to remote microphone systems for enhancing auditory attention in children with ASD, offering benefits in classroom settings and potentially minimising the stigma associated with traditional assistive listening devices.

Remediation of Perceptual Deficits in Progressive Auditory Neuropathy: A Case Study.

BACKGROUND: Auditory neuropathy (AN) is a hearing disorder that affects neural activity in the VIIIth cranial nerve and central auditory pathways. Progressive forms have been reported in a number of neurodegenerative diseases and may occur as a result of both the deafferentiation and desynchronisation of neuronal processes. The purpose of this study was to describe changes in auditory function over time in a patient with axonal neuropathy and to explore the effect of auditory intervention. METHODS: We tracked auditory function in a child with progressive AN associated with Charcot-Marie-Tooth (Type 2C) disease, evaluating hearing levels, auditory-evoked potentials, and perceptual abilities over a 3-year period. Furthermore, we explored the effect of auditory intervention on everyday listening and neuroplastic development. RESULTS: While sound detection thresholds remained constant throughout, both electrophysiologic and behavioural evidence suggested auditory neural degeneration over the course of the study. Auditory brainstem response amplitudes were reduced, and perception of auditory timing cues worsened over time. Functional hearing ability (speech perception in noise) also deteriorated through the first 1.5 years of study until the child was fitted with a "remote-microphone" listening device, which subsequently improved binaural processing and restored speech perception ability to normal levels. CONCLUSIONS: Despite the deterioration of auditory neural function consistent with peripheral axonopathy, sustained experience with the remote-microphone listening system appeared to produce neuroplastic changes, which improved the patient's everyday listening ability-even when not wearing the device.

Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study.

BACKGROUND: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. OBJECTIVE: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. METHODS: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. RESULTS: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. CONCLUSIONS: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician.

E-Learning Simulations for Teaching Clinical Decision-Making in an Audiology Training Program.

PURPOSE: Clinical decision-making is an essential component of most clinical processes across the health sector and an ongoing challenge for clinical education programs to teach to students. The traditional methods of teaching these skills outside of lectures are mainly through clinical placements and problem-based learning (PBL) sessions, but availability and consistency can be variable and resource heavy. To address these challenges, an e-simulation module specific to pediatric infant diagnostic testing has been developed and implemented into the teaching program. We aimed to establish whether e-simulation resulted in student skill acquisition. METHOD: Academic performance measures for 67 audiology students who used a traditional PBL and 108 students who used the e-simulation module were collected and analyzed. Student survey results generated both quantitative and qualitative data, which were analyzed using a thematic analysis with an inductive approach. RESULTS: Findings indicated that the e-simulation platform introduced in this study yielded learning outcomes similar to the traditional PBL format previously used. Participants experienced a significant in situ increase in understanding of infant diagnostic testing concepts following the use of the e-simulation and evaluated the e-simulation platform positively. CONCLUSION: The data support that an e-simulation-based approach in clinical education presents pedagogical benefits and can provide a meaningful sustainable inclusion in today's clinical teaching programs.

The effect of classroom environment on literacy development.

The physical characteristics of a child's learning environment can affect health, wellbeing and educational progress. Here we investigate the effect of classroom setting on academic progress in 7-10-year-old students comparing reading development in "open-plan" (multiple class groups located within one physical space) and "enclosed-plan" (one class group per space) environments. All learning conditions (class group, teaching personnel, etc.) were held constant throughout, while physical environment was alternated term-by-term using a portable, sound-treated dividing wall. One hundred and ninety-six students underwent academic, cognitive and auditory assessment at baseline and 146 of these were available for repeat assessment at the completion of 3 school terms, allowing within-child changes across an academic year to be calculated. Reading fluency development (change in words read-per-minute) was greater for the enclosed-classroom phases (P < 0.001; 95%CI 3.7, 10.0) and the children who showed the greatest condition difference (i.e. slower rate of development in the open-plan) were those with the worst speech perception in noise and/or poorest attention skills. These findings highlight the important role classroom setting plays in the academic development of young students.

Auditory processing deficits in individuals with primary open-angle glaucoma.

OBJECTIVE: The high energy demand of the auditory and visual pathways render these sensory systems prone to diseases that impair mitochondrial function. Primary open-angle glaucoma, a neurodegenerative disease of the optic nerve, has recently been associated with a spectrum of mitochondrial abnormalities. This study sought to investigate auditory processing in individuals with open-angle glaucoma. DESIGN/STUDY SAMPLE: Twenty-seven subjects with open-angle glaucoma underwent electrophysiologic (auditory brainstem response), auditory temporal processing (amplitude modulation detection), and speech perception (monosyllabic words in quiet and background noise) assessment in each ear. A cohort of age, gender and hearing level matched control subjects was also tested. RESULTS: While the majority of glaucoma subjects in this study demonstrated normal auditory function, there were a significant number (6/27 subjects, 22%) who showed abnormal auditory brainstem responses and impaired auditory perception in one or both ears. CONCLUSIONS: The finding that a significant proportion of subjects with open-angle glaucoma presented with auditory dysfunction provides evidence of systemic neuronal susceptibility. Affected individuals may suffer significant communication difficulties in everyday listening situations.

An opinion on the assessment of people who may have an auditory processing disorder.

We need to rethink how we assess auditory processing disorder (APD). The current use of test batteries, while necessary and well accepted, is at risk of failing as the size of these batteries increases. To counter the statistical, fatigue, and clinical efficiency problems of large test batteries, we propose a hierarchical approach to APD assessment. This begins with an overall test of listening difficulty in which performance is measurably affected for anyone with an impaired ability to understand speech in difficult listening conditions. It proceeds with a master test battery containing a small number of single tests, each of which assesses a different group of skills necessary for understanding speech in difficult listening conditions. It ends with a detailed test battery, where the individual tests administered from this battery are only those that differentiate the skills assessed by the failed test(s) from the master test battery, so that the specific form of APD can be diagnosed. An example of how hierarchical interpretation of test results could be performed is illustrated using the Listening in Spatialized Noise-Sentences test (LiSN-S). Although consideration of what abilities fall within the realm of auditory processing should remain an important issue for research, we argue that patients will be best served by focusing on whether they have difficulty understanding speech, identifying the specific characteristics of this difficulty, and specifically remediating and/or managing those characteristics.