Ear and Hearing 2022-05-01

The Use of Person-centered Language in Medical Research Articles Focusing on Hearing Loss or Deafness

Nicks, Savannah; Johnson, Austin L.; Traxler, Brett; Bush, Matthew L.; Brame, Lacy; Hamilton, Tom; Hartwell, Micah

Publication date 01-05-2022


Background: Hearing loss represents one of the most common disabilities worldwide. Despite its prevalence, there is a degree of stigmatization within the public’s perception of, or attitude toward, individuals diagnosed with hearing loss or deafness. This stigmatization is propagated by the way hearing loss is referenced, especially in writing. Although the medical community is familiar with hearing loss, medical research is not consistently compliant with nonstigmatizing terminology, like person-centered language (PCL). This study aims to quantify the use of PCL in medical research related to hearing loss.
Methods: A cross-sectional analysis of articles related to hearing loss was performed using Pub Med as the primary search engine. The search encompassed articles from January 1, 2016, to November 17, 2020. Journals had to have at least 20 search returns to be included in this study. The primary search resulted in 2392 articles from 31 journals. The sample was then randomized and the first 500 articles were chosen for data extraction. Article screening was performed systematically. Each article was evaluated for predetermined non-PCL terminology to determine adherence to the American Medical Association Manual of Style (AMAMS) guidelines. Articles were included if they involved research with human participants and were available in English. Commentaries and editorials were excluded.
Results: Four hundred eighty-two articles were included in this study. Results from this study indicate that 326 articles were not adherent to AMAMS guidelines for PCL (326/482; 68%). Emotional language (i.e., burden, suffer, afflicted) was employed to reference hearing loss in 114 articles (114/482; 24%). Non-PCL adherent labels (i.e., impaired and handicapped) were identified in 46% (221/482) of articles related to hearing loss or deafness. Sixty-seven articles (67/482; 14%) used person-first language in reference to the word “deaf” and 15 articles (15/482; 3%) used “deaf” as a label.
Conclusions: Based on the findings from this cross-sectional analysis, the majority of medical research articles that address hearing loss contain terminology that does not conform to PCL guidelines, as established by AMAMS. Many respected organizations, like the American Medical Association, have encouraged the use of PCL in interactions between patient and medical provider. This encompasses communication in person and in writing. This recommendation stems from the understood role that language plays in how we build impressions of others, especially in a medical context. Implementing PCL to destigmatize language used in reference to deafness or hearing loss is essential to increase advocacy and protect the autonomy of these individuals.

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A Systematic Review on the Association Between Vestibular Dysfunction and Balance Performance in Children With Hearing Loss

Singh, Anisha; Heet, Hannah; Guggenheim, Dana S.; Lim, Margaret; Garg, Bhavika; Bao, Matthew; Smith, Sherri L.; Garrison, Doug; Raynor, Eileen M.; Lee, Janet W.; Wrigley, Jordan; Riska, Kristal M.

Publication date 01-05-2022


Objectives: The objective of this study was to understand the functional impact of vestibular dysfunction on balance control in children with hearing loss. The vestibular system is an important contributor to maintaining balance. In adults, vestibular dysfunction is known to lead to unsteadiness and falls. Considerably less is known about the effects of vestibular dysfunction in children with hearing loss.
Design: We conducted a systematic review in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included articles on children with hearing loss who underwent vestibular and balance testing. The Downs and Black checklist was used to assess the risk of bias.
Results: A total of 20 articles were included in this systematic review, of which, 17 reported an association between vestibular dysfunction and balance abnormalities in children with hearing loss. Bias (as measured by the Downs and Black Checklist) was a concern, as most studies were nonblinded cohort studies or case series selected through convenience sampling.
Conclusions: Research to date has predominantly found that children with concomitant hearing loss and vestibular impairment tend to perform more poorly on balance measures than either children with hearing loss and normal vestibular function or children with both normal-hearing and normal vestibular function. A standardized approach to assessing both vestibular function and balance would better characterize the impact of vestibular dysfunction in children with hearing loss at the population level.

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Early Life Influences on Hearing in Adulthood: a Systematic Review and Two-Step Individual Patient Data Meta-Analysis

Dawes, Piers; Newall, John; Graham, Petra L.; Osmond, Clive; von Bonsdorff, Mikaela B.; Gunnar Eriksson, Johan

Publication date 01-05-2022


Objectives: Adverse prenatal and early childhood development may increase susceptibility of hearing loss in adulthood. The objective was to assess whether indices of early development are associated with adult-onset hearing loss in adults ≥18 years.
Design: In a systematic review and meta-analysis, four electronic databases were searched for studies reporting associations between indices of early development (birth weight and adult height) and adult-onset hearing loss in adults ≥18 years. We screened studies, extracted data, and assessed risk of bias. Authors were contacted to provide adjusted odds ratios from a logistic regression model for relationships between birth weight/adult height and normal/impaired hearing enabling a two-step individual patient data random-effects meta-analysis to be carried out. The study is registered with PROSPERO, CRD42020152214.
Results: Four studies of birth weight and seven of adult height were identified. Three studies reported smaller birth weight associated with poorer adult hearing. Six studies reported shorter height associated with poorer hearing. Risk of bias was low to moderate. Four studies provided data for two-step individual patient data random-effects meta-analysis. Odds of hearing impairment were 13.5% lower for every 1 kg increase in birth weight OR: 0.865 (95% confidence interval: 0.824 to 0.909) in adulthood over two studies (N=81,289). Every 1 cm increase in height was associated with a 3% reduction in the odds of hearing impairment OR: 0.970 (95% confidence interval: 0.968 to 0.971) over four studies (N=156,740).
Conclusions: Emerging evidence suggests that adverse early development increases the likelihood of hearing impairment in adulthood. Research and public health attention should focus on the potential for prevention of hearing impairment by optimizing development in early life.

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Identifying the Factors that Affect Consistent Hearing Aid Use in Young Children With Early Identified Hearing Loss: A Scoping Review

Nailand, Lisa; Munro, Natalie; Purcell, Alison

Publication date 01-05-2022


Objectives: This study is a scoping review examining factors that affect consistent hearing aid use in young children with early identified hearing loss (HL).
Design: Online databases were used to identify journal articles published between 2009 and 2019, yielding over 1800 citations. The citations were uploaded into an online software product called Covidence that enables scoping/systematic review management. After duplicates were removed, 857 articles were screened by abstract and title name, 93 of which were put through for full-text screening. Twenty-five articles met predetermined inclusion and exclusion criteria. Appraisal tools were utilized to establish the quality of the studies included. Numerical summaries were used to synthesize and describe the data set. Thematic analysis was utilized to identify global and subthemes within the data set.
Results: Numerical summaries revealed that over half of the studies in the data set used a quantitative design. Thematic analysis of the data identified four global themes namely, “each child is an individual,” “parents are key,” “parents require support,” and “professionals make a difference.” Each global theme was further divided into subthemes, most of which centered around the parents of children with HL. Each subtheme was categorized as a malleable or a fixed factor that impacts on hearing aid use in young children with HL.
Conclusions: This scoping review identified malleable and fixed factors that impact on hearing aid use in young children with HL. These factors centered around the individual characteristics of children with HL, the key responsibility their parents have, and the important contribution that professionals can make. Irrespective of whether factors are malleable or fixed, parents and professionals working with children with HL can have a positive impact on hearing aid use. This is likely to have a flow on, positive impact on their overall communication and learning outcomes.

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Cogmed Training Does Not Generalize to Real-World Benefits for Adult Hearing Aid Users: Results of a Blinded, Active-Controlled Randomized Trial

Henshaw, Helen; Heinrich, Antje; Tittle, Ashana; Ferguson, Melanie

Publication date 01-05-2022


Objectives: Performance on working memory tasks is positively associated with speech-in-noise perception performance, particularly where auditory inputs are degraded. It is suggested that interventions designed to improve working memory capacity may improve domain-general working memory performance for people with hearing loss, to benefit their real-world listening. We examined whether a 5-week training program that primarily targets the storage component of working memory (Cogmed RM, adaptive) could improve cognition, speech-in-noise perception and self-reported hearing in a randomized controlled trial of adult hearing aid users with mild to moderate hearing loss, compared with an active control (Cogmed RM, nonadaptive) group of adults from the same population.
Design: A preregistered randomized controlled trial of 57 adult hearing aid users (n = 27 experimental, n = 30 active control), recruited from a dedicated database of research volunteers, examined on-task learning and generalized improvements in measures of trained and untrained cognition, untrained speech-in-noise perception and self-reported hearing abilities, pre- to post-training. Participants and the outcome assessor were both blinded to intervention allocation. Retention of training-related improvements was examined at a 6-month follow-up assessment.
Results: Per-protocol analyses showed improvements in trained tasks (Cogmed Index Improvement) that transferred to improvements in a trained working memory task tested outside of the training software (Backward Digit Span) and a small improvement in self-reported hearing ability (Glasgow Hearing Aid Benefit Profile, Initial Disability subscale). Both of these improvements were maintained 6-month post-training. There was no transfer of learning shown to untrained measures of cognition (working memory or attention), speech-in-noise perception, or self-reported hearing in everyday life. An assessment of individual differences showed that participants with better baseline working memory performance achieved greater learning on the trained tasks. Post-training performance for untrained outcomes was largely predicted by individuals’ pretraining performance on those measures.
Conclusions: Despite significant on-task learning, generalized improvements of working memory training in this trial were limited to (a) improvements for a trained working memory task tested outside of the training software and (b) a small improvement in self-reported hearing ability for those in the experimental group, compared with active controls. We found no evidence to suggest that training which primarily targets storage aspects of working memory can result in domain-general improvements that benefit everyday communication for adult hearing aid users. These findings are consistent with a significant body of evidence showing that Cogmed training only improves performance for tasks that resemble Cogmed training. Future research should focus on the benefits of interventions that enhance cognition in the context in which it is employed within everyday communication, such as training that targets dynamic aspects of cognitive control important for successful speech-in-noise perception.

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Distortion of Spectral Ripples Through Cochlear Implants Has Major Implications for Interpreting Performance Scores

Winn, Matthew B.; O’Brien, Gabrielle

Publication date 01-05-2022


The spectral ripple discrimination task is a psychophysical measure that has been found to correlate with speech recognition in listeners with cochlear implants (CIs). However, at ripple densities above a critical value (around 2 RPO, but device-specific), the sparse spectral sampling of CI processors results in stimulus distortions resulting in aliasing and unintended changes in modulation depth. As a result, spectral ripple thresholds above a certain number are not ordered monotonically along the RPO dimension and thus cannot be considered better or worse spectral resolution than each other, thus undermining correlation measurements. These stimulus distortions are not remediated by changing stimulus phase, indicating these issues cannot be solved by spectrotemporally modulated stimuli. Speech generally has very low-density spectral modulations, leading to questions about the mechanism of correlation between high ripple thresholds and speech recognition. Existing data showing correlations between ripple discrimination and speech recognition include many observations above the aliasing limit. These scores should be treated with caution, and experimenters could benefit by prospectively considering the limitations of the spectral ripple test.

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Understanding Self-reported Hearing Disability in Adults With Normal Hearing

Kamerer, Aryn M.; Harris, Sara E.; Kopun, Judy G.; Neely, Stephen T.; Rasetshwane, Daniel M.

Publication date 01-05-2022


Objectives: Despite a diagnosis of normal hearing, many people experience hearing disability (HD) in their everyday lives. This study assessed the ability of a number of demographic and auditory variables to explain and predict self-reported HD in people regarded as audiologically healthy via audiometric thresholds.
Design: One-hundred eleven adults (ages 19 to 74) with clinically normal hearing (i.e., audiometric thresholds ≤25 dB HL at all octave and interoctave frequencies between 0.25 and 8 k Hz and bilaterally symmetric hearing) were asked to complete the 12-item version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) as a measure of self-reported HD. Patient history and a number of standard and expanded measures of hearing were assessed in a multivariate regression analysis to predict SSQ12 score. Patient history included age, sex, history of noise exposure, and tinnitus. Hearing-related measures included audiometry at standard and extended high frequencies, word recognition, otoacoustic emissions, auditory brainstem response, the Montreal Cognitive Assessment, and FM detection threshold.
Results: History of impulse noise exposure, speech-intelligibility index, and FM detection threshold accurately predicted SSQ12 and were able to account for 40% of the SSQ12 score. These three measures were also able to predict whether participants self-reported HD with a sensitivity of 89% and specificity of 86%.
Conclusions: Although participant audiometric thresholds were within normal limits, higher thresholds, history of impulse noise exposure, and FM detection predicted self-reported HD.

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Descriptions of Hearing Aids Influence the Experience of Listening to Hearing Aids

Rakita, Lori; Goy, Huiwen; Singh, Gurjit

Publication date 01-05-2022


Objectives: Experiences can be strongly influenced by expectations. In hearing healthcare, previous studies have shown that descriptions of hearing aids or contextual factors during the hearing aid fitting process can change subjective and even objective outcomes with hearing aids via the placebo effect. Personality factors have also been shown to affect susceptibility to placebo effects. The purposes of the present study were to (a) investigate the effects of communicating narratives designed to foster positive, negative, or neutral expectations about hearing aids on short-term patient outcomes, and (b) to determine if the degree to which the narratives affected end-user outcomes could be predicted by personality factors.
Design: Nineteen adults between the ages of 54 and 81 (mean age = 68.5, SD = 8.9) had 3 separate research appointments, each exposing them to a different narrative condition: positive, negative, or neutral. the appointment was designed to look and feel like a “traditional” hearing aid fitting appointment, during which the experimenter introduced (i.e., the narrative condition) and fit a pair of hearing aids, the participant was asked to provide their initial feedback about the hearing aids, and the participant performed speech-in-noise testing. Unbeknownst to the research participant, the hearing aids fitted at all three appointments were the same, and the only difference between the three appointments was the way the hearing aids were described to the participants.
Results: The results of this study showed that communication of a positive narrative about hearing aids before a hearing aid fitting led to better speech-in-noise performance on the QuickSIN as compared with performance following the negative or neutral narrative conditions. Also, the positive narrative led to the perception that acclimatization to the hearing aids would occur faster than the negative or neutral narrative conditions. Notably, the effect of communication of a positive narrative was stronger for individuals who scored higher on agreeableness, and susceptibility to positive and negative messaging was stronger for individuals low in neuroticism.
Conclusions: The study suggests that short-term evaluations of hearing aids can be strongly influenced by narratives as provided by the hearing healthcare provider at the time of a hearing aid fitting.

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Ototoxicity After Cisplatin-Based Chemotherapy: Factors Associated With Discrepancies Between Patient-Reported Outcomes and Audiometric Assessments

Ardeshirrouhanifard, Shirin; Fossa, Sophie D.; Huddart, Robert; Monahan, Patrick O.; Fung, Chunkit; Song, Yiqing; Dolan, M. Eileen; Feldman, Darren R.; Hamilton, Robert J.; Vaughn, David; Martin, Neil E.; Kollmannsberger, Christian; Dinh, Paul; Einhorn, Lawrence; Frisina, Robert D.; Travis, Lois B.

Publication date 01-05-2022


Objectives: To provide new information on factors associated with discrepancies between patient-reported and audiometrically defined hearing loss (HL) in adult-onset cancer survivors after cisplatin-based chemotherapy (CBCT) and to comprehensively investigate risk factors associated with audiometrically defined HL.
Design: A total of 1410 testicular cancer survivors (TCS) ≥6 months post-CBCT underwent comprehensive audiometric assessments (0.25 to 12 k Hz) and completed questionnaires. HL severity was defined using American Speech-Language-Hearing Association criteria. Multivariable multinomial regression identified factors associated with discrepancies between patient-reported and audiometrically defined HL and multivariable ordinal regression evaluated factors associated with the latter.
Results: Overall, 34.8% of TCS self-reported HL. Among TCS without tinnitus, those with audiometrically defined HL at only extended high frequencies (EHFs) (10 to 12 k Hz) (17.8%) or at both EHFs and standard frequencies (0.25 to 8 k Hz) (23.4%) were significantly more likely to self-report HL than those with no audiometrically defined HL (8.1%) odds ratio (OR) = 2.48; 95% confidence interval (CI), 1.31 to 4.68; and OR = 3.49; 95% CI, 1.89 to 6.44, respectively. Older age (OR = 1.09; 95% CI, 1.07 to 1.11, p 300 mg/m2, OR = 1.47; 95% CI, 1.21 to 1.80, p = 0.0001), and hypertension (OR = 1.80; 95% CI, 1.28 to 2.52, p = 0.0007) were associated with greater American Speech-Language-Hearing Association-defined HL severity, whereas postgraduate education (OR = 0.58; 95% CI, 0.40 to 0.85, p = 0.005) was associated with less severe HL.
Conclusions: Discrepancies between patient-reported and audiometrically defined HL after CBCT are due to several factors. For survivors who self-report HL but have normal audiometric findings at standard frequencies, referral to an audiologist for additional testing and inclusion of EHFs in audiometric assessments should be considered.

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Amplification Self-Adjustment: Controls and Repeatability

Boothroyd, Arthur; Retana, Jennifer; Mackersie, Carol L.

Publication date 01-05-2022


Objectives: This study was a continuation of work on an explore-and-select approach to the self-adjustment of amplification. Goals were to determine (i) the effect of changing the number of adjustment controls from three to two, (ii) the effect of changing the initial adjustment from overall output to high-frequency output, (iii) individual repeatability, (iv) the effect on phoneme recognition of increasing and decreasing overall output relative to the starting and adjusted conditions, and (v) listener reactions to, and opinions of, the self-adjustment procedure.
Design: Twenty-two adults with hearing loss, 10 of whom were hearing aid users, adjusted level and spectrum of connected speech to preference, using three configurations of number and order of adjustment parameters. The three adjustments were replicated to give a total of six. Presentation was monaural, in quiet, using the ear with the better threshold at 2 k Hz. The starting condition was a generic prescription for a typical mild-to-moderate hearing loss. Real ear output spectra were measured for the 6 self-adjustments, the generic starting condition, and the individual NAL-NL2 prescriptions for speech at 65 dB SPL. Monaural phoneme recognition in monosyllables was assessed, in quiet, at levels of −14, −7, 0 and +7 dB relative to both the starting and the self-adjusted conditions. Participants completed a questionnaire and their comments on each question were transcribed.
Results: Changing the number of listener controls from 3 to 2 reduced mean adjustment time by around 50% but had negligible effect on group-mean output response. Starting adjustment with high-frequency output rather than overall output resulted in a 2 to 3 dB reduction of group-mean self-adjusted output below 1 k Hz. Individual self-adjustments were within ±5 dB of NAL-NL2 prescription (for a 65 dB SPL speech input) for two-thirds of the participants in the high frequencies and for just over half in the low frequencies. In six self-adjustments, individuals self-adjusted, on average, to within ±4 dB of their own mean in both high and low frequencies. There was no evidence that these findings differed for hearing aid users and nonusers. Changes of overall output by ±7 dB after self-adjustment did not significantly affect group mean phoneme recognition. Preference for number and order of self-adjustment differed among participants, as did opinions on self-fitting of hearing aids.
Conclusions: These findings support the conclusion that, for many adults with hearing loss, an explore-and-select procedure for self-adjustment of amplification leads to output values that are repeatable within a few dB, are relatively immune to the number and order of adjustment parameters, and place the average listener well along the plateau of a phoneme recognition versus amplitude function.

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Extended High-frequency Hearing Impairment Despite a Normal Audiogram: Relation to Early Aging, Speech-in-noise Perception, Cochlear Function, and Routine Earphone Use

Mishra, Srikanta K.; Saxena, Udit; Rodrigo, Hansapani

Publication date 01-05-2022


Objectives: Humans can hear up to 20 k Hz. Emerging evidence suggests that hearing in the extended high frequencies (EHFs; >8 k Hz) contributes to speech perception in noise. The objective of the present study was to describe the features of EHF hearing impairment in young adults with normal standard audiograms (0.25–8 k Hz). Specifically, the study goals were to: (1) characterize the EHF hearing impairment and identify potential risk factors; (2) elucidate the age-related changes in EHF hearing; (3) determine the effect of EHF hearing impairment on speech-in-noise recognition; and (4) examine the extent to which EHF hearing impairment influences cochlear functioning in the standard frequencies.
Design: Hearing thresholds at standard frequencies and EHFs (10, 12.5, 14, and 16 k Hz), and speech recognition thresholds (SRTs) using digit triplets in multi-talker babble were measured in both ears from 222 participants (19–38 years; n = 444 ears) with normal audiograms (≤20 dB HL at standard frequencies). Test–retest measurement of hearing thresholds was obtained in a subset of 50 participants (100 ears), and clinical distortion product otoacoustic emissions (f2 frequency = 2, 3, 4, and 5 k Hz) were recorded in 49 participants (98 ears).
Results: Forty-two of 222 participants had EHF hearing impairment (>20 dB HL for at least one EHF in either ear). Only seven individuals with EHF impairment had significant case history and/or listening-in-noise complaints. A breakpoint in the threshold-age function was observed for the EHFs for males but not for females. Linear mixed models revealed a significant effect of age, pure-tone averages for speech frequencies (0.5, 1, 2, and 4 k Hz), and EHFs and group (NH versus EHF hearing impairment) independent of each other on the SRTs. Individuals with EHF hearing impairment had less measurable emissions and when present, had a lower magnitude of otoacoustic emissions relative to NH controls. There was no difference in hearing thresholds, SRTs, or otoacoustic emissions between earphone users and nonusers.
Conclusions: The hearing thresholds for the EHFs exhibit signs of early auditory aging. Age-related deterioration in auditory function can be observed in the third decade of human life. A breakpoint in the threshold-age function suggests that rapid aging processes are operational at a relatively younger age (21 years) for males. The audibility of EHFs contributes to speech-in-noise recognition. EHF hearing impairment independent of age and speech frequencies can affect speech-in-noise recognition. Reduced distortion product otoacoustic emissions in the standard frequencies may suggest preclinical cochlear degeneration in individuals with EHF hearing impairment.

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Reduced Semantic Context and Signal-to-Noise Ratio Increase Listening Effort As Measured Using Functional Near-Infrared Spectroscopy

Rovetti, Joseph; Goy, Huiwen; Zara, Michael; Russo, Frank A.

Publication date 01-05-2022


Objectives: Understanding speech-in-noise can be highly effortful. Decreasing the signal-to-noise ratio (SNR) of speech increases listening effort, but it is relatively unclear if decreasing the level of semantic context does as well. The current study used functional near-infrared spectroscopy to evaluate two primary hypotheses: (1) listening effort (operationalized as oxygenation of the left lateral PFC) increases as the SNR decreases and (2) listening effort increases as context decreases.
Design: Twenty-eight younger adults with normal hearing completed the Revised Speech Perception in Noise Test, in which they listened to sentences and reported the final word. These sentences either had an easy SNR (+4 dB) or a hard SNR (−2 dB), and were either low in semantic context (e.g., “Tom could have thought about the sport”) or high in context (e.g., “She had to vacuum the rug”). PFC oxygenation was measured throughout using functional near-infrared spectroscopy.
Results: Accuracy on the Revised Speech Perception in Noise Test was worse when the SNR was hard than when it was easy, and worse for sentences low in semantic context than high in context. Similarly, oxygenation across the entire PFC (including the left lateral PFC) was greater when the SNR was hard, and left lateral PFC oxygenation was greater when context was low.
Conclusions: These results suggest that activation of the left lateral PFC (interpreted here as reflecting listening effort) increases to compensate for acoustic and linguistic challenges. This may reflect the increased engagement of domain-general and domain-specific processes subserved by the dorsolateral prefrontal cortex (e.g., cognitive control) and inferior frontal gyrus (e.g., predicting the sensory consequences of articulatory gestures), respectively.

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Effect of Noise Reduction on Cortical Speech-in-Noise Processing and Its Variance due to Individual Noise Tolerance

Kim, Subong; Wu, Yu-Hsiang; Bharadwaj, Hari M.; Choi, Inyong

Publication date 01-05-2022


Objectives: Despite the widespread use of noise reduction (NR) in modern digital hearing aids, our neurophysiological understanding of how NR affects speech-in-noise perception and why its effect is variable is limited. The current study aimed to (1) characterize the effect of NR on the neural processing of target speech and (2) seek neural determinants of individual differences in the NR effect on speech-in-noise performance, hypothesizing that an individual’s own capability to inhibit background noise would inversely predict NR benefits in speech-in-noise perception.
Design: Thirty-six adult listeners with normal hearing participated in the study. Behavioral and electroencephalographic responses were simultaneously obtained during a speech-in-noise task in which natural monosyllabic words were presented at three different signal-to-noise ratios, each with NR off and on. A within-subject analysis assessed the effect of NR on cortical evoked responses to target speech in the temporal-frontal speech and language brain regions, including supramarginal gyrus and inferior frontal gyrus in the left hemisphere. In addition, an across-subject analysis related an individual’s tolerance to noise, measured as the amplitude ratio of auditory-cortical responses to target speech and background noise, to their speech-in-noise performance.
Results: At the group level, in the poorest signal-to-noise ratio condition, NR significantly increased early supramarginal gyrus activity and decreased late inferior frontal gyrus activity, indicating a switch to more immediate lexical access and less effortful cognitive processing, although no improvement in behavioral performance was found. The across-subject analysis revealed that the cortical index of individual noise tolerance significantly correlated with NR-driven changes in speech-in-noise performance.
Conclusions: NR can facilitate speech-in-noise processing despite no improvement in behavioral performance. Findings from the current study also indicate that people with lower noise tolerance are more likely to get more benefits from NR. Overall, results suggest that future research should take a mechanistic approach to NR outcomes and individual noise tolerance.

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Cochlear Implant Compression Optimization for Musical Sound Quality in MED-EL Users

Gilbert, Melanie L.; Deroche, Mickael L. D.; Jiradejvong, Patpong; Chan Barrett, Karen; Limb, Charles J.

Publication date 01-05-2022


Objectives: Variations in loudness are a fundamental component of the music listening experience. Cochlear implant (CI) processing, including amplitude compression, and a degraded auditory system may further degrade these loudness cues and decrease the enjoyment of music listening. This study aimed to identify optimal CI sound processor compression settings to improve music sound quality for CI users.
Design: Fourteen adult MED-EL CI recipients participated (Experiment No.
1: n = 17 ears; Experiment No.
2: n = 11 ears) in the study. A software application using a modified comparison category rating (CCR) test method allowed participants to compare and rate the sound quality of various CI compression settings while listening to 25 real-world music clips. The two compression settings studied were (1) Maplaw, which informs audibility and compression of soft level sounds, and (2) automatic gain control (AGC), which applies compression to loud sounds. For each experiment, one compression setting (Maplaw or AGC) was held at the default, while the other was varied according to the values available in the clinical CI programming software. Experiment No. 1 compared Maplaw settings of 500, 1000 (default), and 2000. Experiment No. 2 compared AGC settings of 2.5:1, 3:1 (default), and 3.5:1.
Results: In Experiment No. 1, the group preferred a higher Maplaw setting of 2000 over the default Maplaw setting of 1000 (p = 0.003) for music listening. There was no significant difference in music sound quality between the Maplaw setting of 500 and the default setting (p = 0.278). In Experiment No. 2, a main effect of AGC setting was found; however, no significant difference in sound quality ratings for pairwise comparisons were found between the experimental settings and the default setting (2.5:1 versus 3:1 at p = 0.546; 3.5:1 versus 3:1 at p = 0.059).
Conclusions: CI users reported improvements in music sound quality with higher than default Maplaw or AGC settings. Thus, participants preferred slightly higher compression for music listening, with results having clinical implications for improving music perception in CI users.

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Intraoperative Electrocochleography in Subjects Affected by Vestibular Schwannoma and Ménière’s Disease: Comparison of Results

Trecca, Eleonora M. C.; Adunka, Oliver F.; Hiss, Meghan M.; Mattingly, Jameson K.; Moberly, Aaron C.; Dodson, Edward E.; Cassano, Michele; Prevedello, Daniel M.; Riggs, William J.

Publication date 01-05-2022


Objectives: Histologic reports of temporal bones of ears with vestibular schwannomas (VSs) have indicated findings of endolymphatic hydrops (ELH) in some cases. The main goal of this investigation was to test ears with VSs to determine if they exhibit electrophysiological characteristics similar to those of ears expected to experience ELH.
Design: Fifty-three subjects with surgically confirmed VS aged ≥18 and with normal middle ear status were included in this study. In addition, a second group of adult subjects (n = 24) undergoing labyrinthectomy (n = 6) or endolymphatic sac decompression and shunt (ELS) placement (n = 18) for poorly controlled vestibular symptoms associated with Meniere’s disease (MD) participated in this research. Intraoperative electrocochleography (ECochG) from the round window was performed using tone burst stimuli. Audiometric testing and word recognition scores (WRS) were performed preoperatively. ECochG amplitudes, cochlear microphonic/auditory nerve neurophonic (ANN) in the form of the “ongoing” response and summation potential, were analyzed and compared between the two groups of subjects. In addition, to evaluate any effect of auditory nerve function, the auditory nerve score was calculated for each subject. Pure-tone averages were obtained using the average air conduction thresholds at 0.5, 1, and 2 k Hz while WRS was assessed using Northwestern University Auditory Test No. 6 word lists.
Results: In the VS group the average pure-tone averages and WRS were 59.6 dB HL and 44.8%, respectively, while in the MD group they were 52.3 dB HL and 73.8%. ECochG findings in both groups revealed a reduced trend in amplitude of the ongoing response with increased stimulus frequency. The summation potential amplitudes of subjects with VS were found to be less negative than the MD subjects for nearly all test frequencies. Finally, the VS group exhibited poorer amounts of auditory nerve function compared to the MD group.
Conclusions: The current findings suggest cochlear pathology (e.g., hair cell loss) in both groups but do not support the hypothesis that VSs cause ELH.

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Vocal Turn-Taking in Families With Children With and Without Hearing Loss

Kondaurova, Maria V.; Zheng, Qi; VanDam, Mark; Kinney, Kaelin

Publication date 01-05-2022


Objective: Vocal turn-taking is an important predictor of language development in children with and without hearing loss. Most studies have examined vocal turn-taking in mother-child dyads without considering the multitalker context in a child’s life. The present study investigates the quantity of vocal turns between deaf and hard-of-hearing children and multiple members of their social environment.
Design: Participants were 52 families with children who used hearing aids (HA, mean age 26.3 mo) or cochlear implants (CI, mean age 63.2 mo) and 27 families with normal-hearing (NH, mean age 26.6 mo) children. The Language ENvironment Analysis system estimated the number of conversational turns per hour (CTC/hr) between all family members (i.e., adult female, adult male, target child, and other child) during full-day recordings over a period of about 1 year.
Results: The CTC/hr was lower between the target child and the adult female or adult male in the CI compared with the HA and NH groups. Initially, CTC/hr was higher between the target child and the adult female than between the adult male or the other child. As the child’s age increased, turn-taking between the target child and the adult female increased in comparison to that between the target child and the adult male. Over time, turn-taking between the target child and the other child increased and exceeded turn-taking between the target child and the adult caregivers. The increase was observed earlier in families with siblings compared with those without.
Conclusions: The quantity of vocal turn-taking depends on the degree of child hearing loss and the relationship between the children and the members of their social environment. Longitudinally, the positive effect of an assistive device on the quantity of turns between the children and their family members was found. The effect was stronger in families with siblings.

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Listening Effort Measured Using a Dual-task Paradigm in Adults With Different Amounts of Noise Exposure

Degeest, Sofie; Kestens, Katrien; Keppler, Hannah

Publication date 01-05-2022


Objectives. Excessive noise levels can result in hearing damage and/or hearing-related symptoms, thereby leading to impaired communication and, eventually a decrease in the quality of life. Moreover, in daily practice, subjects often indicate that listening in noisy situations is a challenging and often exhausting experience, even in the absence of a clinically significant hearing loss. Hence, a person’s perceived difficulty of the listening situation will also be important to consider. It has been suggested that beyond the peripheral factors, there are some central cognitive correlates of speech understanding that are essential for communication abilities. The aim of the present study was to evaluate the effect of the amount of noise exposure on hearing as measured by pure-tone audiometry and otoacoustic emissions (OAEs) on the one hand and listening effort measured using a dual-task paradigm on the other hand.
Design: The study included 152 adults between 18 and 40 years of age. First, participants completed a self-administered questionnaire regarding the amount of noise exposure. Second, hearing status was evaluated using pure-tone audiometry and transient evoked OAEs (TEOAEs) as well as distortion product OAEs (DPOAEs). Finally, listening effort was evaluated using a dual-task paradigm, which consisted of a primary speech-recognition task in different listening conditions and a secondary visual memory task that were performed both separately and simultaneously. Based on the quartiles of their subjective estimation of noise exposure, the participants were categorized into a group with low noise exposure (lower quartile), moderate noise exposure (two middle quartiles), and high noise exposure (upper quartile).
Results: There was no significant difference in hearing thresholds between the participants with low, moderate, and high noise exposure for each frequency of the pure-tone audiometry. In contrast, more absent TEOAEs and DPOAEs were found in the high noise exposed group. Regarding the primary speech-recognition task of the dual-task paradigm, no significant difference in speech recognition was found between the different groups of noise exposure. For the amount of listening effort, it was found that across all listening conditions subjects with high noise exposure expend significantly more listening effort compared with subjects with low and moderate noise exposure.
Conclusions: This study is a first exploration of the effects of different amounts of noise exposure on listening effort showing that, listening effort is increased in subjects with high noise exposure compared with subjects with low and medium noise exposure. The most plausible hypothesis pertains to an effect of noise exposure on the peripheral and central auditory system, or a combination of effects on both the auditory system and the high-level cognitive functions necessary for speech understanding in the subjects with high levels of noise exposure. As such, a test for listening effort would be useful as part of a comprehensive test battery within the assessment of subjects exposed to noise.

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The Importance of Extended High-Frequency Speech Information in the Recognition of Digits, Words, and Sentences in Quiet and Noise

Polspoel, Sigrid; Kramer, Sophia E.; van Dijk, Bas; Smits, Cas

Publication date 01-05-2022


Objectives: In pure-tone audiometry, hearing thresholds are typically measured up to 8 k Hz. Recent research has shown that extended high-frequency (EHF; frequencies >8 k Hz) speech information improves speech recognition. However, it is unclear whether the EHF benefit is present for different types of speech material. This study assesses the added value of EHF information for speech recognition in noise for digit triplets, consonant–vowel–consonant (CVC) words, and sentences; and for speech recognition in quiet for CVC.
Design: Twenty-four young adults with normal-hearing thresholds up to 16 k Hz performed a listening experiment in quiet and in noise in a within-subject repeated measures design. Stimuli were presented monaurally. Steady state speech-shaped noise at a fixed signal to noise ratio was used for measurements in noise. Listening conditions varied only in terms of available EHF information.
Stimuli were presented in three different conditions: (1) both speech and noise broadband, (2) speech broadband and noise low-pass filtered at 8 k Hz, and (3) both speech and noise low-pass filtered at 8 k Hz. In the speech-in-quiet experiment, stimuli (CVC) were high-pass filtered at 3 k Hz and presented in two conditions: (1) with EHF information and (2) without EHF information.
Results: In the speech-in-noise experiment, for all speech material, the highest scores were achieved in the condition where the noise was low-pass filtered at 8 k Hz and speech unfiltered; the lowest scores were obtained in the condition where both speech and noise were low-pass filtered at 8 k Hz. Adding speech frequencies above 8 k Hz improved the median recognition scores by 75.0%, 21.8%, and 23.8% for digit triplets, words, and sentences, respectively, at a fixed signal to noise ratio. In the speech-in-quiet experiment, median recognition scores were 7.8% higher in the condition where the EHF information was available, as opposed to when it was not.
Conclusions: Speech information for frequencies above 8 k Hz contributes to speech recognition in noise. It also contributes to speech recognition in quiet when information below 3 k Hz is absent. Our results suggest that EHFs may be relevant in challenging listening conditions and should be measured in pure-tone audiometry to get a complete picture of a person’s hearing. Further, results of speech recognition tests may vary when different recording and/or measurement equipment is used with different frequency responses above 8 k Hz.

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Smartphone-Connected Hearing Aids Enable and Empower Self-Management of Hearing Loss: A Qualitative Interview Study Underpinned by the Behavior Change Wheel

Gomez, Rachel; Habib, Alia; Maidment, David W.; Ferguson, Melanie A.

Publication date 01-05-2022


Objectives: To identify patient-reported barriers and facilitators to using smartphone-connected hearing aids, using the Behavior Change Wheel (BCW) to understand experiences and how these can be addressed.
Design: A single-center, prospective, observational study. Eight hearing aid users (new = 1, existing = 7; mean age = 71.75 years, SD = 5.23, range = 65 to 81 years) were identified through convenience sampling from 44 participants who took part in a 7-week evaluation of smartphone-connected hearing aids controlled by a prototype app. The app allowed users to manually control settings such as gain, noise reduction, and microphone directionality, preset, and customized programmes. Participants were assigned to one of two focus groups following trial of the app.
Results: Focus group transcripts were thematically analyzed and underpinned by the COM-B (Capability, Opportunity, Motivation-Behavior) model and Theoretical Domains Framework to identify barriers and facilitators to using smartphone-connected hearing aids (the target behavior). Mapping of themes to the BCW allowed use of the Behavior Change Technique Taxonomy (version 1) to identify behavior change techniques that audiologists could implement in clinical practice to address the barriers and facilitators.
Capability: The app increased participants’ knowledge of hearing aid controls, encouraging use of the app for improved hearing loss self-management. However, barriers to using the app included perception of insufficient digital literacy skills for smartphone-connected hearing aid use and an increased cognitive load caused by decisions over which controls to use.
Opportunity: Perceived smartphone norms (i.e., acceptable occasions to use smartphones) and differing listening contexts acted as both facilitators and barriers.
Motivation: The ability to control hearing aid settings in any listening situation (e.g., to reduce noise) empowered users to successfully self-manage their hearing loss, leading to greater confidence and participation in everyday life. The app also reduced hearing aid–related and self-stigma, and the ability to self-adjust hearing aids benefitted both participants and communication partners. It was the adjustability and interaction afforded by the app that empowered users, rather than the hearing aid technology itself. Perceived beliefs and knowledge about digital literacy skills, and specifically abilities to use a smartphone, were perceived to be barriers in this typically older population, particularly when they compared themselves to younger generations. Using the Behavior Change Technique Taxonomy (version 1), behavior change techniques that could be used by audiologists to address these barriers included enablement, goal setting, reframing perceptions toward technology, and addressing patient educational needs.
Conclusions: Smartphone-connected hearing aids, when used in their everyday lives, were viewed positively by participants across a range of domains, empowering them and enabling hearing loss self-management. Audiologists should consider smartphone-connected hearing aid candidacy for all who have access to smartphones and are willing to use one. Use of the BCW has identified that modifiable barriers to using smartphone-connected hearing aids exist. Audiologists could use these evidence-based behavior change techniques to support patients in adopting and using these technologies to successfully self-manage hearing loss. Overall, by reframing smartphone technologies as a tool to remain connected with society, smartphone-connected hearing aids could shift the power of managing hearing loss from clinician to patient.

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The Effect of Hearing Aid Use on the Association Between Hearing Loss and Brain Structure in Older Adults

de Boer, Tom G.; Rigters, Stephanie C.; Croll, Pauline H.; Niessen, Wiro J.; Ikram, M. Arfan; van der Schroeff, Marc P.; Vernooij, Meike W.; Goedegebure, André

Publication date 01-05-2022


Objectives: Recent studies have shown an association between poorer hearing thresholds and smaller brain tissue volumes in older adults. Several underlying causal mechanisms have been opted, with a sensory deprivation hypothesis as one of the most prominent. If hearing deprivation would lead to less brain volume, hearing aids could be hypothesized to moderate this pathway by restoration of hearing. This study aims to investigate whether such a moderating effect of hearing aids exists.
Design: The authors conducted a cross-sectional study involving aging participants of the population-based Rotterdam Study. Hearing aid use was assessed by interview and hearing loss was quantified using pure-tone audiometry. Total brain volume, gray matter and white matter volume and white matter integrity fractional anisotropy (FA) and mean diffusivity were measured using magnetic resonance imaging. Only participants with a pure tone average at 1, 2, and 4 k Hz (PTA1,2,4) of ≥35 dB HL were included. Associations of hearing loss with brain volume and global measures of white matter integrity were analyzed using linear regression, with hearing aid use and interaction between hearing aid use and PTA1,2,4 included as independent variables. Models were adjusted for age, sex, time between audiometry and magnetic resonance imaging, level of education, and cardiovascular risk factors.
Results: Out of 459 included participants with mean age (range) 70.4 (52 to 92) 41% were female. Distributions of age and sex among hearing aid users (n = 172) did not significantly differ from those without hearing aids. PTA1,2,4 was associated with lower FA, but not with a difference in total brain volume, gray matter volume, white matter volume, or mean diffusivity. Interaction between hearing aid use and PTA1,2,4 was not associated with FA or any of the other outcome measures. Additional analysis revealed that interaction between hearing aid use and age was associated with lower FA.
Conclusions: We found no evidence for a moderating effect of hearing aids on the relationship between hearing loss and brain structure in a population of older adults. However, use of hearing aids did appear as an effect modifier in the association between age and white matter integrity. Future longitudinal research is needed to clarify these results.

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Using Narrow Band CE-Chirps to Elicit Cervical Vestibular Evoked Myogenic Potentials

Mat, Quentin; Deggouj, Naïma; Duterme, Jean-Pierre; Tainmont, Sophie; Lelubre, Christophe; Manto, Mario

Publication date 01-05-2022


Objectives: To compare the effects of Narrow band CE-Chirps (NB CE-Chirps) and tone bursts (TBs) at 500 Hz and 1000 Hz on the amplitudes and latencies in cervical vestibular evoked myogenic potentials (cVEMPs).
Design: Thirty-one healthy adult volunteers of varying ages were tested by air conduction at 95 dB nHL. Recording conditions were randomized for each participant and each modality was tested twice.
Results: NB CE-Chirps showed larger corrected amplitudes than TBs at 500 Hz (p < 0.001) which were themselves larger than NB CE-Chirps and TBs at 1000 Hz (p < 0.001). In older volunteers, NB CE-Chirps 500 and 1000 Hz had significantly higher response rates than TBs 500 Hz (p = 0.039). A negative correlation was observed between the corrected amplitudes and the age of the participants regardless of the stimulus and the frequency studied. The p13 and n23 latencies were not correlated with the age of the subjects.
Conclusions: NB CE-Chirps at 500 Hz improved the corrected amplitudes of waveforms in cVEMPs as a result of a better frequency specificity compared with TBs. In the elderly, eliciting cVEMPs at a frequency of 1000 Hz might not be necessary to improve response rates with NB CE-Chirps. Additional studies including a higher number of healthy participants and patients with vestibular disorders are required to confirm these observations.

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Auditory Brainstem Response Detection Using Machine Learning: A Comparison With Statistical Detection Methods

McKearney, Richard M.; Bell, Steven L.; Chesnaye, Michael A.; Simpson, David M.

Publication date 01-05-2022


Objectives: The primary objective of this study was to train and test machine learning algorithms to be able to detect accurately whether EEG data contains an auditory brainstem response (ABR) or not and recommend suitable machine learning methods. In addition, the performance of the best machine learning algorithm was compared with that of prominent statistical detection methods.
Design: Four machine learning algorithms were trained and evaluated using nested k-fold cross-validation: a random forest, a convolutional long short-term memory network, a stacked ensemble, and a multilayer perceptron.
The best method was evaluated on a separate test set and compared with conventional detection methods: Fsp, Fmp, q-sample uniform scores test, and Hotelling’s T2 test. The models were trained and tested on simulated data that were generated based on recorded ABRs collected from 12 normal-hearing participants and no-stimulus EEG data from 15 participants. Simulation allowed the ground truth of the data (“response present” or “response absent”) to be known.
Results: The sensitivity of the best machine learning algorithm, a stacked ensemble, was significantly greater than that of the conventional detection methods evaluated. The stacked ensemble, evaluated using a bootstrap approach, consistently achieved a high and stable level of specificity across ensemble sizes.
Conclusions: The stacked ensemble model presented was more effective than conventional statistical ABR detection methods and the alternative machine learning approaches tested. The stacked ensemble detection method may have potential both in automated ABR screening devices as well as in evoked potential software, assisting clinicians in making decisions regarding a patient’s ABR threshold. Further assessment of the model’s generalizability using a large cohort of subject recorded data, including participants of different ages and hearing status, is a recommended next step.

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The Association Between Hearing Loss and Surgical Complications in Older Adults

Huang, Ryan J.; Riska, Kristal M.; Gordee, Alexander; Peskoe, Sarah B.; Francis, Howard W.; Witsell, David L.; Smith, Sherri L.

Publication date 01-05-2022


Objectives: In this study, we sought to evaluate whether older patients with hearing loss who underwent surgery were at greater risk of postsurgical complications, increased inpatient length-of-stay (LOS), and hospital readmission.
Design: This was a retrospective cohort study of patients receiving surgery at a tertiary medical center. Utilizing electronic health record data from two merged datasets, we identified patients 65 years and older, undergoing major surgery between January 1, 2014 and January 31, 2017, and who had audiometric evaluation before surgery. Patients were classified as having either normal hearing or hearing loss based on pure-tone average in the better ear. A Generalized Estimating Equations approach was used to fit multivariable regression models for outcome variables of interest.
Results: Of patients ≥65 years undergoing major surgery in our time frame, a total of 742 surgical procedures were performed on 621 patients with available audiometric data. After adjusting for age, sex, race, and comorbidities, hearing loss was associated with an increase in the odds of developing postoperative complications. Every 10 dB increase in hearing loss was associated with a 14% increase in the odds of developing a postoperative complication (odds ratio = 1.14, 95% confidence interval = 1.01–1.29, p = 0.031). Hearing loss was not significantly associated with increased hospital LOS, 30-day readmission, or 90-day readmission.
Conclusions: Hearing loss was significantly associated with developing postoperative complications in older adults undergoing major surgery. Screening for hearing impairment may be a useful addition to the preoperative assessment and perioperative management of older patients undergoing surgery.

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An Economic Evaluation of Australia’s Newborn Hearing Screening Program: A Within-Study Cost-Effectiveness Analysis

Sharma, Rajan; Gu, Yuanyuan; Sinha, Kompal; Ching, Teresa Y. C.; Marnane, Vivienne; Gold, Lisa; Wake, Melissa; Wang, Jing; Parkinson, Bonny

Publication date 01-05-2022


Objectives: Hearing loss is one of the most prevalent congenital disorders among children. Many countries have implemented universal newborn hearing screening (UNHS) for the early diagnosis and treatment of hearing loss. Despite widespread implementation, the value for money of UNHS is unclear due to lack of cost and outcomes data from rigorous study designs. The objective of this research is to conduct a within-study cost-effectiveness analysis of UNHS compared with targeted screening (targeting children with risk factors of hearing loss) from the Australian healthcare system perspective. This evaluation is the first economic evaluation to assess the cost-effectiveness of UNHS compared to targeted screening using real-world data from a natural experiment.
Design: The evaluation assumed the Australian healthcare system perspective and considered a time horizon of 5 years. Utilities were estimated using responses to the Health Utilities Index Mark III. Screening costs were estimated based on the Victorian Infant Hearing Screening Program. Ongoing costs were estimated based on administrative data, while external data sources were used to estimate costs related to hearing services. Missing data were handled using the multiple imputation method. Outcome measures included quality-adjusted life years (QALYs) and four language and communication-related outcomes: Peabody Picture Vocabulary Test, Wechsler Nonverbal Scale of Ability, Progressive Achievement Test, and comprehensive, expressive, and total language scores based on the Preschool Language Scale.
Results: On average, the UNHS cost an extra Australian dollar (A$)22,000 per diagnosed child and was associated with 0.45 more QALYs per diagnosed child compared with targeted screening to 5 years, resulting in an incremental cost-effectiveness ratio (ICER) of A$48,000 per QALY gained. The ICERs for language outcomes lay between A$3,900 (for expressive language score) and A$83,500 per one-point improvement in language score (for Wechsler Nonverbal Scale of Ability). UNHS had a 69% probability of being more cost-effective compared to targeted screening at a willingness to pay threshold of A$60,000 per QALY gained. ICERs were most sensitive to the screening costs.
Conclusions: The evaluation demonstrated the usefulness of a within-study economic evaluation to understand the value for money of the UNHS program in the Australian context. Findings from this evaluation suggested that screening costs were the key driver of cost-effectiveness results. Most outcomes were not significantly different between UNHS and targeted screening groups. The ICER may be overestimated due to the short follow-up period. Further research is warranted to include long-term resource use and outcome data, late diagnosis, transition and remission between severity levels, and timing of diagnosis and treatment.

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The Associations of Hearing Sensitivity and Different Cognitive Functions with Perception of Speech-in-Noise

Merten, Natascha; Boenniger, Meta M.; Herholz, Sibylle C.; Breteler, Monique M.B.

Publication date 01-05-2022


Objectives: Impaired speech-in-noise perception affects individuals’ daily lives and is a frequent symptom of age-related hearing loss, which is a common disabling condition and a health concern in aging populations. The relative impact of hearing sensitivity loss and different cognitive functions on speech-in-noise perception is not well understood. We aimed to assess to what extent hearing sensitivity and different cognitive functions were associated with sentence-in-noise performance across the adult lifespan.
Design: This study is based on data of 2585 participants of the Rhineland Study, which is a German community-based cohort study of persons of age 30 years and older. We assessed speech-in-noise with a sentence-in-noise test (Göttinger Satztest), hearing sensitivity thresholds (air conduction pure-tone audiometry PTA average of 0.5, 1, 2, and 4 k Hz), and the following cognitive domains: crystallized intelligence (German Mehrfachwahl-Wortschatz-Intelligenztest, MWT-B), executive functioning (Trail Making Test B, TMT), working memory (Digit Span forward, DS), and long-term memory (Verbal Learning and Memory Test delayed recall; VLMT). We examined the association between hearing sensitivity and cognitive functions with sentence-in-noise perception using a multivariable linear regression model adjusted for age, sex, and multiple potential confounders.
Results: Better hearing sensitivity was associated with better speech-in-noise perception (0.25 signal noise ratio SNR dB HL decrease per 5 dB HL decrease in PTA; 95% confidence interval CI: 0.20 to 0.25; p < 0.001). Better cognitive performance was also associated with better speech-in-noise perception, but to a lesser extent. Crystallized intelligence (MWT-B) showed an effect size of –0.10 SNR dB HL decrease per SD (95% CI: –0.14 to –0.06; p < 0.001), executive functioning (TMT) of –0.08 SNR dB HL decrease per SD (95% CI: –0.13 to –0.03; p = 0.002), working memory (DS) of –0.04 SNR dB HL decrease per SD (95% CI: –0.08 to –0.003; p = 0.03), and long-term memory (VLMT) of –0.03 SNR dB HL decrease per SD (95% CI: –0.07 to 0.01; p = 0.12). The standardized effect of hearing sensitivity (ß = 0.34) on speech-in-noise perception was four to five times larger than the effects of crystallized intelligence (ß = –0.08) and executive functioning (ß = –0.06).
Conclusions: Hearing sensitivity was the strongest determinant of sentence-in-noise perception in adults above the age of 30. We determined the relative effect of different cognitive functions on sentence-in-noise perception. Crystallized intelligence and executive functions showed stronger associations while working and long-term memory functions had much smaller independent effects. Our results contribute to the understanding of determinants of speech-in-noise perception in aging adults.

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Preoperative Visual Measures of Verbal Learning and Memory and their Relations to Speech Recognition After Cochlear Implantation

Ray, Christin; Pisoni, David B.; Lu, Emily; Kronenberger, William G.; Moberly, Aaron C.

Publication date 01-05-2022


Objectives: This study examined the performance of a group of adult cochlear implant (CI) candidates (CIC) on visual tasks of verbal learning and memory. Preoperative verbal learning and memory abilities of the CIC group were compared with a group of older normal-hearing (ONH) control participants. Relations between preoperative verbal learning and memory measures and speech recognition outcomes after 6 mo of CI use were also investigated for a subgroup of the CICs.
Design: A group of 80 older adult participants completed a visually presented multitrial free recall task. Measures of word recall, repetition learning, and the use of self-generated organizational strategies were collected from a group of 49 CICs, before cochlear implantation, and a group of 31 ONH controls. Speech recognition outcomes were also collected from a subgroup of 32 of the CIC participants who returned for testing 6 mo after CI activation.
Results: CICs demonstrated poorer verbal learning performance compared with the group of ONH control participants. Among the preoperative verbal learning and memory measures, repetition learning slope and measures of self-generated organizational clustering strategies were the strongest predictors of post-CI speech recognition outcomes.
Conclusions: Older adult CI candidates present with verbal learning and memory deficits compared with older adults without hearing loss, even on visual tasks that are independent from the direct effects of audibility. Preoperative verbal learning and memory processes reflecting repetition learning and self-generated organizational strategies in free recall were associated with speech recognition outcomes 6 months after implantation. The pattern of results suggests that visual measures of verbal learning may be a useful predictor of outcomes in postlingual adult CICs.

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Evaluating the Association Between Hearing Loss and Falls in Adults With Vestibular Dysfunction or Nonvestibular Dizziness

Huang, Ryan J.; Pieper, Carl F.; Whitson, Heather E.; Garrison, Douglas B.; Pavon, Juliessa M.; Riska, Kristal M.

Publication date 01-05-2022


Objectives: Although emerging evidence suggests that hearing loss (HL) is an independent risk factor for falls, it is unclear how HL may impact falls risk in adults with vestibular dysfunction and nonvestibular dizziness. The purpose of this study was to characterize the impact of HL on falls in patients with vestibular dysfunction and nonvestibular dizziness relative to a group of patients without dizziness. In addition, this study aimed to evaluate whether there was an interactive effect between HL and vestibular dysfunction or nonvestibular dizziness on the odds of falling.
Design: The authors conducted a retrospective cross-sectional study of 2,750 adult patients with dizziness evaluated at a tertiary care center vestibular clinic between June 1, 2015, and October 7, 2020. Only patients with available self-reported falls status, as extracted from the electronic medical record, were included.
Patients were classified into the following diagnostic groups based on rotary chair testing and videonystagmography: benign paroxysmal positional vertigo (BPPV, n = 255), unilateral vestibular hypofunction (UVH, n = 456), bilateral vestibular hypofunction (BVH, n = 38), central dysfunction (n = 208), multiple diagnoses (n = 109), and dizzy, nonvestibular (n = 1,389). A control group of patients without dizziness (n = 295) was identified by a random sample of audiology patients. Degree of HL was characterized by the 4-frequency pure tone average (PTA) (0.5, 1, 2, and 4 k Hz) of the better hearing ear. Demographic variables, comorbidities, cognitive impairment status, and falls-associated medications were extracted from the electronic medical record and included as covariates during analysis. Potential associations between PTA and falls status and possible interactions between diagnostic group and PTA were explored using multivariate logistic regression.
Results: The BVH and central dysfunction groups had the highest rates of self-reported falls at 26.3% and 26.9%, respectively. The control group had the lowest rate of self-reported falls at 6.4%. With the exception of the multiple diagnoses group, all diagnostic groups had elevated odds of falling compared with the control group, when adjusting for demographics, comorbidities, cognitive impairment status, and falls-associated medications. There was no significant association between degree of HL and falls status (odds ratio OR = 1.02; 95% confidence interval CI = 0.93, 1.11; p = 0.713) when adjusting for diagnostic group and all other covariates. Furthermore, there were no significant interactions between diagnostic group and degree of HL on the odds of falling.
Conclusions: These results indicate that HL was not associated with falls in patients with vestibular dysfunction or nonvestibular dizziness, while adjusting for demographics, comorbidities, and falls-associated medications. There was no significant interactive effect observed between HL and vestibular dysfunction or nonvestibular dizziness on the odds of falling. As previously reported, vestibular dysfunction and nonvestibular dizziness were independently associated with falls relative to a group of patients without dizziness. A population-based study utilizing more robust falls data is needed to explore a potential association between HL and falls in those with vestibular dysfunction.

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Acceptable Noise Levels and Preferred Signal-to-noise Ratios for Speech and Music

Lee, Donguk; Lewis, James D.; Johnstone, Patti M.; Plyler, Patrick N.

Publication date 01-05-2022


Objectives: The objective of this study was to evaluate the influence of music versus speech on a listener’s signal-to-noise ratio (SNR) preferences when listening in a noise background. SNR preferences were quantified using acceptable noise level (ANL) and preferred SNR metrics. The measurement paradigm for ANL allows the listener to adjust the level of background noise while listening to the target at their most comfortable loudness level. A higher ANL indicates less tolerance for noise and a lower ANL indicates high tolerance for noise. The preferred SNR is simply the SNR the listener prefers when attending to a target in a fixed-amount (level) of background noise. In contrast to the ANL, the listener does not have control over the noise. Rather, they are only able to manipulate the target level. The first aim of the study was to determine if listeners’ tolerances for noise, quantified using the ANL, when listening to music is different from that when listening to speech. The second aim of the study was to determine if listeners’ tolerances for noise, quantified using their preferred SNR, when listening to music is different from that when listening to speech. The third aim of the study was to quantify the relationship between ANL and preferred SNR.
Design: Ninety-nine normal-hearing, native-English speakers participated in this study. The ANL and preferred SNR were measured for speech and music targets. Music targets included two variations (with lyrics and without lyrics) of the song “Rocky Top.” Measurements were made in the sound field at 0° azimuth, 1.5 m from a loud speaker. For both ANL and preferred SNR, targets were presented in 12-talker babble noise. The level of the noise was adjusted by the listener during ANL measurement but was fixed in level during the preferred SNR measurement (75 dB A). Repeated-measures analysis of variance was performed to identify any significant effect of target on the ANL and preferred SNR. Correlation analysis was performed to evaluate the relationship between ANL and preferred SNR.
Results: Findings demonstrate a significant effect of target on ANL and preferred SNR. ANLs were highest for speech (mean = 7.2 dB), followed by music with lyrics (6.1 dB), and music without lyrics (2.5 dB). Preferred SNRs were highest for music with lyrics (mean = 2.3 dB), followed by speech (1.2 dB), and music without lyrics (−0.1 dB). A listener’s ANL for a given target was strongly correlated with their ANL for a different target (the same was true for preferred SNR); however, ANL for a given target was not a statistically significant predictor of preferred SNR for the same target.
Conclusions: When listening in a background of noise, the listener’s tolerance for noise depends on the target to which they are attending, whether music or speech. This dependence is especially evident for ANL measures, and less so for preferred SNR measures. Despite differences in ANL and preferred SNR across targets, a listener’s ANL and preferred SNR for one target predicts their ANL and preferred SNR, respectively, for a different target. The lack of correlation between ANL and preferred SNR suggests different mechanisms underly these listener-preference metrics.

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AudioChip: A Deep Phenotyping Approach for Deconstructing and Quantifying Audiological Phenotypes of Self-Reported Speech Perception Difficulties

Bhatt, Ishan Sunilkumar; Dias, Raquel; Wineinger, Nathan; Pratt, Sheila; Wang, Jin; Washnik, Nilesh; Guthrie, O’neil; Wilder, Jason; Torkamani, Ali

Publication date 01-05-2022


Objectives: About 15% of U.
S. adults report speech perception difficulties despite showing normal audiograms. Recent research suggests that genetic factors might influence the phenotypic spectrum of speech perception difficulties. The primary objective of the present study was to describe a conceptual framework of a deep phenotyping method, referred to as Audio Chipping, for deconstructing and quantifying complex audiometric phenotypes.
Design: In a sample of 70 females 18 to 35 years of age with normal audiograms (from 250 to 8000 Hz), the study measured behavioral hearing thresholds (250 to 16,000 Hz), distortion product otoacoustic emissions (1000 to 16,000 Hz), click-evoked auditory brainstem responses (ABR), complex ABR (cABR), QuickSIN, dichotic digit test score, loudness discomfort level, and noise exposure background. The speech perception difficulties were evaluated using the Speech, Spatial, and Quality of Hearing Scale–12-item version (SSQ). A multiple linear regression model was used to determine the relationship between SSQ scores and audiometric measures. Participants were categorized into three groups (i.e., high, mid, and low) using the SSQ scores before performing the clustering analysis. Audiometric measures were normalized and standardized before performing unsupervised k-means clustering to generate Audio Chip.
Results: The results showed that SSQ and noise exposure background exhibited a significant negative correlation. ABR wave I amplitude, cABR offset latency, cABR response morphology, and loudness discomfort level were significant predictors for SSQ scores. These predictors explained about 18% of the variance in the SSQ score. The k-means clustering was used to split the participants into three major groups; one of these clusters revealed 53% of participants with low SSQ.
Conclusions: Our study highlighted the relationship between SSQ and auditory coding precision in the auditory brainstem in normal-hearing young females. Audio Chip was useful in delineating and quantifying internal homogeneity and heterogeneity in audiometric measures among individuals with a range of SSQ scores. Audio Chip could help identify the genotype-phenotype relationship, document longitudinal changes in auditory phenotypes, and pair individuals in case-control groups for the genetic association analysis.

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Diotic and Antiphasic Digits-in-noise Testing as a Hearing Screening and Triage Tool to Classify Type of Hearing Loss

De Sousa, Karina C.; Smits, Cas; Moore, David R.; Myburgh, Hermanus C.; Swanepoel, De Wet

Publication date 01-05-2022


Objectives: The digits-in-noise test (DIN) is a popular self-test measure that has traditionally been used to screen for hearing loss by providing either a pass or refer result. Standard approaches either tested each ear monaurally or used a binaural diotic version where identical digits and noise were presented simultaneously to both ears. Recently, a dichotic, antiphasic version was developed, increasing sensitivity of the DIN to unilateral or asymmetric sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). The purpose of this study was to determine predictors and normative ranges of the antiphasic and diotic DIN and to determine if a combination of diotic and antiphasic DIN could accurately categorize hearing into (1) normal, (2) bilateral SNHL, or (3) unilateral SNHL or CHL.
Design: The analytical sample consisted of 489 participants between the ages of 18 and 92 years with varying types, symmetry, and degrees of hearing loss. Degree and type of hearing loss were determined based on standard clinical four-frequency (0.5–4 k Hz) pure-tone air and bone conduction threshold averages. The sample consisted of bilateral normal hearing (n = 293), bilateral SNHL (n = 172), unilateral SNHL (n = 42), and CHL (n = 32). All participants (n = 489) first completed an antiphasic DIN (digit stimuli 180° out-of-phase between ears), while 393 of the sample also completed a diotic DIN. Two procedures were assessed for their ability to categorize hearing into one of the three hearing groups. The first used a fixed antiphasic cutoff combined with a cutoff formed by a linear combination of antiphasic and diotic speech recognition threshold (SRT) or binaural intelligibility-level difference.
Results: Poorer ear pure-tone average was the strongest predictor of antiphasic DIN score, whereas better ear pure-tone average explained more of the variance in diotic SRT. The antiphasic DIN sensitivity and specificity was 90% and 84%, respectively, for detecting hearing loss, with outstanding area under the receiver operating characteristics values exceeding 0.93 to identify hearing loss in the poorer ear. The first fixed SRT cutoff procedure could categorize 75% of all participants correctly, while the second procedure increased correct categorization to 79%. False negative rates for both procedures were below 10%.
Conclusions: A sequential antiphasic and diotic DIN could categorize hearing to a reasonable degree into three groups of (1) normal hearing; (2) bilateral SNHL; and (3) unilateral asymmetric SNHL or CHL. This type of approach could optimize care pathways using remote and contactless testing, by identifying unilateral SNHL and CHL as cases requiring medical referral. In contrast, bilateral SNHL cases could be referred directly to an audiologist, or nontraditional models like OTC hearing aids.

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Diagnostic Yield of Targeted Hearing Loss Gene Panel Sequencing in a Large German Cohort With a Balanced Age Distribution from a Single Diagnostic Center: An Eight-year Study

Tropitzsch, Anke; Schade-Mann, Thore; Gamerdinger, Philipp; Dofek, Saskia; Schulte, Björn; Schulze, Martin; Battke, Florian; Fehr, Sarah; Biskup, Saskia; Heyd, Andreas; Müller, Marcus; Löwenheim, Hubert; Vona, Barbara; Holderried, Martin

Publication date 01-05-2022


Objectives: Hereditary hearing loss exhibits high degrees of genetic and clinical heterogeneity. To elucidate the population-specific and age-related genetic and clinical spectra of hereditary hearing loss, we investigated the sequencing data of causally associated hearing loss genes in a large cohort of hearing-impaired probands with a balanced age distribution from a single center in Southwest Germany.
Design: Genetic testing was applied to 305 hearing-impaired probands/families with a suspected genetic hearing loss etiology and a balanced age distribution over a period of 8 years (2011–2018). These individuals were representative of the regional population according to age and sex distributions. The genetic testing workflow consisted of single-gene screening (n = 21) and custom-designed hearing loss gene panel sequencing (n = 284) targeting known nonsyndromic and syndromic hearing loss genes in a diagnostic setup. Retrospective reanalysis of sequencing data was conducted by applying the current American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines.
Results: A genetic diagnosis was established for 75 (25%) of the probands that involved 75 causal variants in 35 genes, including 16 novel causal variants and 9 medically significant variant reclassifications. Nearly half of the solved cases (47%; n = 35) were related to variants in the five most frequently affected genes: GJB2 (25%), MYO15A, WFS1, SLC26A4, and COL11A1 (all 5%). Nearly one-quarter of the cases (23%; n = 17) were associated with variants in seven additional genes (TMPRSS3, COL4A3, LOXHD1, EDNRB, MYO6, TECTA, and USH2A). The remaining one-third of single cases (33%; n = 25) were linked to variants in 25 distinct genes. Diagnostic rates and gene distribution were highly dependent on phenotypic characteristics. A positive family history of autosomal-recessive inheritance in combination with early onset and higher grades of hearing loss significantly increased the solve rate up to 60%, while late onset and lower grades of hearing loss yielded significantly fewer diagnoses. Regarding genetic diagnoses, autosomal-dominant genes accounted for 37%, autosomal-recessive genes for 60%, and X-linked genes for 3% of the solved cases. Syndromic/nonsyndromic hearing loss mimic genes were affected in 27% of the genetic diagnoses.
Conclusions: The genetic epidemiology of the largest German cohort subjected to comprehensive targeted sequencing for hereditary hearing loss to date revealed broad causal gene and variant spectra in this population. Targeted hearing loss gene panel analysis proved to be an effective tool for ensuring an appropriate diagnostic yield in a routine clinical setting including the identification of novel variants and medically significant reclassifications. Solve rates were highly sensitive to phenotypic characteristics. The unique population-adapted and balanced age distribution of the cohort favoring late hearing loss onset uncovered a markedly large contribution of autosomal-dominant genes to the diagnoses which may be a representative for other age balanced cohorts in other populations.

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Cost-Effectiveness of Screening Preschool Children for Hearing Loss in Australia

Gumbie, Mutsa; Parkinson, Bonny; Dillon, Harvey; Bowman, Ross; Song, Rachel; Cutler, Henry

Publication date 01-05-2022


Objectives: While all newborns in Australia are tested for congenital hearing loss through universal newborn hearing screening programs, some children will acquire hearing loss in their first five years of life. Delayed diagnosed or undiagnosed hearing loss in children can have substantial immediate- and long-term consequences. It can significantly reduce school readiness, language and communication development, social and emotional development, and mental health. It can also compromise lifetime educational achievements and employment opportunities and future economic contribution to society through lost productivity. The need for a universal hearing screening program for children entering their first year of primary school has been noted in two separate Australian Government hearing inquiries in the last decade. Sound Scouts is a hearing screening application (app) that tests for hearing loss in children using a tablet or mobile device, supervised by parents at home. It tests for sensorineural or permanent conductive hearing loss and central auditory processing disorder in children. In 2018 the Australian Government funded the roll-out of Sound Scouts to allow up to 600,000 children to test their hearing using Sound Scouts. This study estimated the cost-effectiveness of screening 5-year-old children for hearing loss using Sound Scouts at home, compared with no screening.
Design: A decision-analytic model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of administering Sound Scouts over a 20-year time horizon. Testing accuracy was based on comparing Sound Scouts test results to clinical test results while other parameters were based on published data. Costs were estimated from the perspective of the Australian health care system. Univariate and probabilistic sensitivity analyses were undertaken.
Results: Sound Scouts is estimated to result in an average incremental cost of A$61.02 and an average incremental increase in QALYs of 0.01. This resulted in an incremental cost-effectiveness ratio of A$5392 per QALY gained, which is likely to be considered cost-effective by Australian decision makers. Screening with Sound Scouts was found to have a 96.2 per cent probability of being cost-effective using a threshold of A$60,000 per QALY gained.
Conclusions: Using Sound Scouts to screen five-year-old children for hearing loss (at home) is likely to be cost-effective. Screening children using Sound Scouts will result in early identification and intervention in childhood hearing loss, thereby reducing early childhood disadvantage through cumulative gains in quality of life, education, and economic outcomes over their lifetime.

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A Predictive Model of Bilateral Sensorineural Hearing Loss in Meniere Disease Using Clinical Data

Moleon, M. D. Carmen; Torres-Garcia, Lidia; Batuecas-Caletrio, Angel; Castillo-Ledesma, Natalia; Gonzalez-Aguado, Rocio; Magnoni, Laura; Rossi, Marcos; Di Berardino, Federica; Perez-Guillen, Vanesa; Trinidad-Ruiz, Gabriel; Lopez-Escamez, Jose A.

Publication date 01-05-2022


Objectives: Meniere disease (MD) is defined by a clinical syndrome of recurrent attacks of spontaneous vertigo associated with tinnitus, aural fullness, and sensorineural hearing loss (SNHL). Most patients have unilateral SNHL, but some of them will develop contralateral SNHL during the course of the disease. Several studies have reported a frequency of 2 to 73% SNHL in the second ear, according to the duration of disease and the period of follow-up. We hypothesize that unilateral and bilateral MD are different conditions, the first would initially involve the apical turn of the cochlea, while bilateral MD would affect the entire length of the cochlea. The aim of the study is to search for clinical predictors of bilateral SNHL in MD to build a predictive model of bilateral involvement.
Design: A retrospective, longitudinal study including two cohorts with a total of 400 patients with definite MD was carried out. The inception cohort consisted of 150 patients with MD and the validation cohort included 250 cases. All of the cases were diagnosed of unilateral MD according to their hearing loss thresholds.
The following variables were assessed as predictors of bilateral SNHL for the two cohorts: sex, age of onset, familiar history of MD, migraine and high-frequency hearing loss (HFHL, defined if hearing threshold >20 dB in two or more consecutive frequencies from 2 to 8 KHz). A descriptive analysis was carried out according to the presence of HFHL in the first audiogram for the main variables. By using multiple logistic regression, we built-up several predictive models for the inception cohort and validated it with the replication cohort and merged dataset.
Results: Twenty-three (19.3%) and 78 (41%) of patients with HFHL developed contralateral SNHL during the follow-up, in the inception and validation cohorts, respectively. In the inception cohort, the best predictive model included HFHL in the first audiogram (OR = 6.985, p = 0.063) and the absence of migraine (OR = 0.215, p = 0.144) as clinical predictors for bilateral SNHL area under the curve (AUC) = 0.641, p = 0.002. The model was validated in the second cohort (AUC = 0.621, p 35 years old (OR = 2.422, p = 0.006) as clinical predictors (AUC = 0.639, p < 0.001).
Conclusions: A predictive model including the age of onset, HFHL in the first audiogram and migraine can help to assess the risk of bilateral SNHL in MD. This model may have significant implications for clinical management of patients with MD.

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Letter to the Editor: Comment on “Evaluating the Efficacy of Intratympanic Dexamethasone in Protecting Against Irreversible Hearing Loss in Patients on Cisplatin-Based Cancer Treatment: A Randomized Controlled Phase IIIB Clinical Trial” (Moreno and Belinchon 2022)

Shupak, Avi

Publication date 01-05-2022


No abstract available

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