COMPARISON OF HEARING THRESHOLD ESTIMATION USING AUDITORY STEADY STATE RESPONSES AND BRAINSTEM AUDITORY EVOKED POTENTIALS IN CHILDREN.

Current recommendations proposed by pediatric audiologists are to commence with hearing amplification in children aged 6 months and above, after previous determination of the type and degree of hearing impairment and audiometric configuration. The goal of this study was to compare results obtained by click-evoked auditory brainstem response (c-ABR) and auditory steady state response (ASSR) in a group of children. This study included 68 children with different degrees of hearing impairment evaluated by c-ABR and ASSR. It is well-known that the c-ABR threshold highly correlates with behavioral hearing level at 2 kHz. In our study, the correlation between the c-ABR and ASSR thresholds in the whole sample was 0.58, 0.73, 0.97, 0.96, 0.95, 0.97; in the group of children with c-ABR thresholds up to 40 dBHL, it was 0.42, 0.73, 0.86, 0.74, 0.81, 0.81; and in the group with c-ABR thresholds worse than 40 dBHL, it was 0.46, 0.56, 0.89, 0.83, 0.85, 0.89 at 0.5, 1, 2, 4, 1-4, 2-4 kHz, respectively. Individual differences between the c-ABR and ASSR thresholds in the whole sample were up to 95, 90, 20, 25 dB at 0.5, 1, 2, 4 kHz, respectively. Study results indicated that there was strong correlation between the c-ABR and ASSR thresholds at 2, 4, 1-4, 2-4 kHz. The ASSR can be used as a valuable clinical tool and an excellent complementary method which, along with other audiologic techniques, provides more accurate hearing threshold estimation at an early age in children.

A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures.

OBJECTIVES: To raise awareness and propose a good practice guide for translating and adapting any hearing-related questionnaire to be used for comparisons across populations divided by language or culture, and to encourage investigators to publish detailed steps. DESIGN: From a synthesis of existing guidelines, we propose important considerations for getting started, followed by six early steps: (1) Preparation, (2, 3) Translation steps, (4) Committee Review, (5) Field testing and (6) Reviewing and finalising the translation. STUDY SAMPLE: Not applicable. RESULTS: Across these six steps, 22 different items are specified for creating a questionnaire that promotes equivalence to the original by accounting for any cultural differences. Published examples illustrate how these steps have been implemented and reported, with shared experiences from the authors, members of the International Collegium of Rehabilitative Audiology and TINnitus research NETwork. CONCLUSIONS: A checklist of the preferred reporting items is included to help researchers and clinicians make informed choices about conducting or omitting any items. We also recommend using the checklist to document these decisions in any resulting report or publication. Following this step-by-step guide would promote quality assurance in multinational trials and outcome evaluations but, to confirm functional equivalence, large-scale evaluation of psychometric properties should follow.

Hearing aid fine-tuning based on Dutch descriptions.

OBJECTIVE: The aim of this study was to derive an independent fitting assistant based on expert consensus. Two questions were asked: (1) what (Dutch) terms do hearing impaired listeners use nowadays to describe their specific hearing aid fitting problems? (2) What is the expert consensus on how to resolve these complaints by adjusting hearing aid parameters? DESIGN: Hearing aid dispensers provided descriptors that impaired listeners use to describe their reactions to specific hearing aid fitting problems. Hearing aid fitting experts were asked "How would you adjust the hearing aid if its user reports that the aid sounds…?" with the blank filled with each of the 40 most frequently mentioned descriptors. STUDY SAMPLE: 112 hearing aid dispensers and 15 hearing aid experts. The expert solution with the highest weight value was considered the best solution for that descriptor. Principal component analysis (PCA) was performed to identify a factor structure in fitting problems. RESULTS: Nine fitting problems could be identified resulting in an expert-based, hearing aid manufacturer independent, fine-tuning fitting assistant for clinical use. CONCLUSIONS: The construction of an expert-based, hearing aid manufacturer independent, fine-tuning fitting assistant to be used as an additional tool in the iterative fitting process is feasible.

Practical guidelines to minimise language and cognitive confounds in the diagnosis of CAPD: a brief tutorial.

OBJECTIVE: To provide audiologists with strategies to minimise confounding cognitive and language processing variables and accurately diagnose central auditory processing disorder (CAPD). DESIGN: Tutorial. STUDY SAMPLE: None. RESULTS: Strategies are reviewed to minimise confounding cognitive and language processing variables and accurately diagnose CAPD. CONCLUSIONS: Differential diagnosis is exceedingly important and can be quite challenging. Distinguishing between two or more conditions presenting with similar symptoms or attributes requires multidisciplinary, comprehensive assessment. To ensure appropriate interventions, the audiologist is a member of the multidisciplinary team responsible for determining whether there is an auditory component to other presenting deficits or whether one condition is responsible for the symptoms seen in another. Choice of tests should be guided both by the symptoms of the affected individual, as established in an in-depth interview and case history, the individual's age and primary language, and by the specific deficits reported to be associated with specific clinical presentations. Knowing which tests are available, their strengths and limitations, the processes assessed, task and response requirements, and the areas of the central auditory nervous system (CANS) to which each test is most sensitive provides the audiologist with critical information to assist in the differential diagnostic process.

The clinical use of Arthur Boothroyd (AB) word lists in Australia: exploring evidence-based practice.

OBJECTIVE: Limited empirical investigation exists validating the use of Arthur Boothroyd (AB) word recognition materials within the Australian clinical context. The current research was undertaken to examine the evidence base and clinical implementation/interpretation of AB words in Australia. DESIGN: An on-line 22-question survey was e-mailed to members of the peak audiology professional body in Australia. STUDY SAMPLE: Three hundred and twelve responses were recorded between April and June 2015 from audiologists of a range of ages, working in various clinical settings. RESULTS: The survey results suggested audiologists use AB words on a wide range of clients from children <5 to adults ≥80 years, for diverse purposes including diagnosis of retrocochlear pathology, candidacy and validation of rehabilitative options, and client counselling. A majority of respondents reported typically administering one or two word lists per ear, and over 99% of audiologists utilised phonemic scoring. There was no consensus regarding what constitutes a significant difference between any two given scores. CONCLUSIONS: Wide variation exists in the administration and interpretation of AB words in Australia. There appears to be a mismatch between clinical utilisation of AB words and existing evidence-based empirical data. Further research is required to improve evidence-based audiologist training, and thereby current clinical use of AB words.

Clients' perspective on quality of audiology care: Development of the Consumer Quality Index (CQI) 'Audiology Care' for measuring client experiences.

OBJECTIVE: Clients' perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire 'Audiology Care' to systematically assess client experiences with audiology care. DESIGN: The CQI Audiology Care was developed in three steps: (1) posing open-ended questions through e-mail (n = 14), (2) two small-scale surveys assessing psychometric properties of the questionnaire (n = 188) and importance of quality aspects (n = 118), and (3) a large-scale survey (n = 1793) assessing psychometric properties and discriminatory power of the questionnaire. STUDY SAMPLE: People with complex hearing impairments and/or balance and communicative disorders who visited an audiology care centre during the past year. RESULTS: Important quality aspects were translated into seven reliable scales: accommodation and facilities, employees' conduct and expertise, arrangement of appointments, waiting times, client participation and effectiveness of treatment. Client experiences differed among the participating centres concerning accommodation and facilities, arrangement of appointments, waiting times and client participation. CONCLUSION: The CQI Audiology Care is a valid and reliable instrument to assess clients' experiences with audiology care. Future implementation will reveal whether results can be used to monitor and improve the quality of audiology care.

A practical guide to cochlear implantation in adults with long durations of monaural sound deprivation.

OBJECTIVE: This paper aims to summarize published findings by the authors and integrate these within current literature to support clinical guidelines when choosing an ear for cochlear implantation in adults with long-term monaural sound deprivation. STUDY SAMPLE: Four retrospective cohort studies based on data collected in five cochlear implantation centres with adults with bilateral hearing loss who used a single hearing aid for at least 15 years prior to unilateral or bilateral cochlear implantation. DESIGN: Review, integration and interpretation of retrospective cohort studies to support clinical recommendations. RESULTS: In this population, the prelingual nature of the hearing loss and the duration of bilateral significant hearing loss were the most reliable predictors of cochlear implantation outcomes. Importantly, the duration of sound deprivation in the ear to be implanted was not a significant predictor of speech recognition scores after cochlear implantation and should carry less weight in making recommendations. CONCLUSIONS: In most adults with postlingual hearing loss and long-term monaural sound deprivation, the sound-deprived sound deprivation ear should be preferred for implantation. For adults with prelingual deafness and monaural sound deprivation, the decision should weigh the risks of obtaining poorer results with the cochlear implant compared to the benefits of accessing binaural hearing.

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults.

OBJECTIVE: Adult selection criteria for cochlear implantation have been developed based on analysis of the post-operative performance of a large group of postlingually deafened adults. Original criteria published in 2004 were reviewed and amended to reflect outcomes currently being achieved by implant recipients. DESIGN: Retrospective review of 12-month post-operative speech perception performance of adults implanted at the Eye and Ear Hospital, Melbourne, Australia. STUDY SAMPLE: A total of 382 postlingually deafened adults, using a Freedom, Nucleus 5, or CI422 Slim Straight cochlear implant were used to create a comparative set of data. RESULTS: Revised guidelines suggest that adults with postlingual hearing loss can now be considered cochlear implant candidates if they obtain scores of up to 55% for open-set phonemes in quiet in the ear to be implanted. Functional benefit may vary depending on the recipients' contralateral hearing. CONCLUSIONS: This study supports the provision of cochlear implants to candidates with significant residual hearing when at least one ear meets the criterion outlined above. Patient-specific counseling is required to ensure the potential to benefit predicted by the current model is acceptable to the individual patient and their family. Counseling regarding functional benefit must take into consideration hearing in the contralateral ear.

Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation.

OBJECTIVE: Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children. DESIGN: Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers. STUDY SAMPLE: Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25-120 dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study). RESULTS: Speech perception outcomes suggested that children with a PTA greater than 60 dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82 dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation. CONCLUSIONS: Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60 dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.

[Validation of the Russian language version of the SSQ questionnaire].

The Speech, Spatial and Qualities of Hearing Scale (SSQ) is applied worldwide as a highly reliable tool for the characteristic of the quality of life and subjective sensations of the patients presenting with hearing impairment as well as for the estimation of the efficiency of hearing aids. The objective of the present study was to validate and adapt the Russian language version of the SSQ questionnaire (SSQrus) for its application in the audiological practice under conditions of this country. After the cultural and language adaptation of SSQrus, it was validated by means of repeat interviewing of three groups of the respondents (a total of 93 subjects with normal, moderately and severely impaired hearing). The results of the validation give evidence of the high reliability of the modified questionnaire. Specifically, high reproducibility of the data estimated from the results of the second interview has been demonstrated (r=0.85--0.99). High sensitivity of SSQruswas confirmed by the agreement between the results of the estimation (in scores) and the degree of the observed loss of hearing. The estimates obtained by the application of the SSQrus questionnaire are comparable with those reported by the foreign authors. It is concluded that the SSQrus questionnaire can be used in routine audiological practice as an additional diagnostic instrument for the estimation of hearing problems experienced by a patient, monitoring efficiency of therapy and surgical treatment of hearing impairment, improvement of hearing aids, and hearing dysfunction research.

TE and DP otoacoustic emission data from an Australian cross-sectional hearing study.

OBJECTIVE: This paper presents a summary of otoacoustic emission (OAE) data collected as part of an Australian hearing health survey ( Carter, 2011 ; Williams et al, 2014 ) designed to: (1) examine the relationship between audiological indicators and participant characteristics, and (2) extract audiological data suitable for reference use. DESIGN: Cross-sectional cohort study. Distortion product (DP) OAE and transient evoked (TE) OAE measures. STUDY SAMPLE: Age range 11-35 years; N = 1386 participants (2672 test ears). RESULTS: Descriptive statistics for amplitude and signal-to-noise ratio (SNR) were calculated for 327 participants (589 test ears; age 13 to 32 years). DPOAE amplitudes down to the 25th percentile were > 0 dB SPL for test frequencies up to 6 kHz. TEOAE SNRs down to the 25th percentile were > 6 dB SPL up to 4 kHz. SUMMARY: This dataset can be used as a clinical reference for similar populations, providing that the same test parameters are used. CONCLUSIONS: The clinical significance of OAE testing would be greater if agreed criteria were available. These data could be pooled with other datasets to build a substantial OAE database, similar to the existing international standards for pure-tone hearing threshold levels (HTLs) ( ISO, 2000 ).

An evaluation of audiology service improvement documentation in England using the chronic care model and content analysis.

OBJECTIVE: Implementation of the chronic care model (CCM) is associated with improved outcomes for patients. It follows that any proposed policy or implementation plan that maps highly onto the CCM is more likely to lead to improved outcomes. The aim of this study was to compare long-term condition (LTC) policy documents and audiology quality standard documents with the CCM and to highlight the need for further research in service implementation and clinical outcome. DESIGN: We carried out a keyword-in-context content analysis of relevant documents. STUDY SAMPLE: Documents relating to health department policy on LTCs, audiology service improvement initiatives in England and the CCM. RESULTS: This analysis shows that current audiology implementation documents in England map poorly onto the CCM compared to health policy documents relating to the management of LTCs. The biggest discrepancies occur in self-management support, delivery system design, and decision support. These elements are supported by the best evidence of potential improvements in clinical outcome. CONCLUSIONS: Our content analysis of audiology service quality improvement documents in England suggests they compare poorly to some elements of the CCM. We discuss the implications this might have for future research.

Patient-centred audiological rehabilitation: perspectives of older adults who own hearing aids.

OBJECTIVE: Patient-centred care is a term frequently associated with quality health care. Despite extensive literature from a range of health-care professions that provide description and measurement of patient-centred care, a definition of patient-centredness in audiological rehabilitation is lacking. The current study aimed to define patient-centred care specific to audiological rehabilitation from the perspective of older adults who have owned hearing aids for at least one year. DESIGN: Research interviews were conducted with a purposive sample of older adults concerning their perceptions of patient-centredness in audiological rehabilitation, and qualitative content analysis was undertaken. STUDY SAMPLE: The participant sample included ten adults over the age of 60 years who had owned hearing aids for at least one year. RESULTS: Data analysis revealed three dimensions to patient-centred audiological rehabilitation: the therapeutic relationship, the players (audiologist and patient), and clinical processes. Individualised care was seen as an overarching theme linking each of these dimensions. CONCLUSIONS: This study reported two models: the first model describes what older adults with hearing aids believe constitutes patient-centred audiological rehabilitation. The second provides a guide to operationalised patient-centred care. Further research is required to address questions pertaining to the presence, nature, and impact of patient-centred audiological rehabilitation.

An Australian survey of audiologists' preferences for patient-centredness.

OBJECTIVE: Patient-centredness is becoming a core value of health services worldwide, however it remains largely unexplored in audiology. This study investigated audiologists' preferences for patient-centredness and identified factors that explain audiologists' preferences for patient-centredness. DESIGN: All members of the Audiological Society of Australia received two questionnaires: (1) a descriptive questionnaire (e.g. age, gender, place of residence, years in practice, employment characteristics), and (2) a modified patient-practitioner orientation scale (PPOS; Krupat et al, 2000) which measures preferences for two aspects of patient-centredness, sharing and caring. STUDY SAMPLE: In total 663 (46%) audiologists returned both questionnaires fully completed. RESULTS: Mean PPOS scores indicated that audiologists prefer patient-centredness. Linear regression modelling identified that older audiologists, that had practiced longer, and who worked in community education, industrial audiology, or teaching had a significantly greater preference for patient-centredness than their peers. In contrast, audiologists who practiced in a private environment and who worked in the area of assessment of adults had a significantly lesser preference for patient-centredness than their peers. CONCLUSIONS: Audiologists prefer client-centredness and age, years of experience, and employment characteristics can partly explain preferences for patient-centredness. Future research should explore the relationships between patient-centredness and intervention outcomes in audiology.

Patient-centred care: a review for rehabilitative audiologists.

OBJECTIVE: This discussion paper aims to synthesise the literature on patient-centred care from a range of health professions and to relate this to the field of rehabilitative audiology. Through review of the literature, this paper addresses five questions: What is patient-centred care? How is patient-centred care measured? What are the outcomes of patient-centred care? What are the factors contributing to patient-centred care? What are the implications for audiological rehabilitation? DESIGN: Literature review and synthesis. STUDY SAMPLE: Publications were identified by structured searches in PubMed, Cinahl, Web of Knowledge, and PsychInfo, and by inspecting the reference lists of relevant articles. RESULTS: Few publications from within the audiology profession address this topic and consequently a review and synthesis of literature from other areas of health were used to answer the proposed questions. CONCLUSION: This paper concludes that patient-centred care is in line with the aims and scope of practice for audiological rehabilitation. However, there is emerging evidence that we still need to inform the conceptualisation of patient-centred audiological rehabilitation. A definition of patient-centred audiological rehabilitation is needed to facilitate studies into the nature and outcomes of it in audiological rehabilitation practice.

[Universal newborn hearing screening : Definition of uniform parameters by the Association of German Hearing Screening Centers as a requirement for nationwide evaluation with valid results]. / Universelles Neugeborenen-Hörscreening : Definition einheitlicher Parameter durch den Verband Deutscher Hörscreening-Zentralen (VDHZ) als Voraussetzung für eine flächendeckende Evaluation mit validen Ergebnissen.

BACKGROUND: Since 2009, all newborns in Germany have been entitled to universal neonatal hearing screening (UNHS). UNHS with tracking of test results leads to earlier detection of hearing disorders. The Association of German Hearing Screening Centers (Verband Deutscher Hörscreening-Zentralen, VDHZ) was founded to promote nationwide tracking, validity and quality control of UNHS results. OBJECTIVES: A comparable data structure in the different screening centers, with uniform definitions of primary parameters is essential for the nationwide evaluation of UNHS results. To address the question of whether a data structure with comparable definitions already exists or still has to be created, the existing structures and primary parameter definitions in the hearing screening centers should be investigated and compared. METHODS: A survey was conducted in all hearing screening centers to assess how data on the primary UNHS parameters defined in pediatric guidelines was gathered. In the case of discrepancies, uniform definitions were created. Finally, the practicability of these definitions was evaluated. RESULTS: Due to differing definitions of primary parameters, some of the data were not comparable between the individual centers. Therefore, uniform definitions were created in a consensus process. In the centers, the screening method, the two-step first screening and the result of the first screening now correspond to these uniform definitions. Other parameters, e.g. the total number of newborns, still vary widely, rendering the comparison of screening rates almost impossible. CONCLUSION: Valid evaluation of UNHS not only requires nationwide establishment of hearing screening centers, but also unified data structures and parameter definitions.

[Quality of universal newborn hearing screening results : Multicenter analysis of data recorded between 2009 and 2012 in four German states]. / Ergebnisqualität im universellen Neugeborenen-Hörscreening : Multizentrische Analyse von Daten der Jahre 2009 bis 2012 aus 4 Bundesländern.

BACKGROUND: Bearing in mind the impending evaluation of newborn hearing screening in Germany, this study investigated whether multicenter analysis of the screening results from four German states is possible and to what extent the results meet national quality and outcome criteria. MATERIALS AND METHODS: The screening data from 170 hospitals and a total of 533,150 newborns (21 % of all German newborns) from 2009 to 2012 were evaluated according to definite rules and analyzed in terms of averages, as well as over time. RESULTS: During the investigated period and averaged over the hospitals, the quality criteria "percentage of screened newborns" (91.4 %) and "percentage requiring further follow-up" (5.0 %), the "day of screening" (day 4), as well as the target parameter "age at diagnosis" (4.8 months) were not met. Steady improvements were observed over time: in the last year of the evaluation, 95.3 % of children were examined; only 4.8 % required follow-up and the age at diagnosis decreased to 4.2 months. On average, 83 % of the babies were screened before day 4. The steady reduction in variance of most of the variables from the participating hospitals indicates continual improvement. CONCLUSION: A multicenter analysis of screening data is possible and valid in the case of good quality data.

Educating globally conscious speech-language pathologists for collaborative professional practice.

Speech-language pathologists (SLPs) practicing in the US are facing significant changes in reimbursement, billing and practice in both health care and educational settings. Health care professionals need to convey and demonstrate the value of their services, measure functional patient outcomes and assess patient satisfaction. Documentation procedures for patient and student progress are changing, becoming more abbreviated and electronic. The content of curricula in accredited graduate programs and professional development programs for maintenance of certification for SLPs will need modifications to address the myriad of changes in clinical practice. University programs that design interprofessional education opportunities for students in speech-language pathology programs and educate students in other health professional programs, e.g. physical therapy, occupational therapy, nursing and pharmacy, will help practitioners who are prepared to engage in collaborative practice with other health care professionals in hospitals, schools and community-based environments. The American Speech-Language-Hearing Association (ASHA) is actively engaged in several initiatives to facilitate interprofessional education for graduate students, faculties and practicing professionals. Individuals and families with communication disorders in the US represent an array of cultures, and SLPs need to be prepared to work effectively with individuals from different cultural and linguistic backgrounds.