Misophonia: An Evidence-Based Case Report.

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

Efficacy of Multicomponent Tympanometry in Identifying Middle Ear Disorder.

Multi component tympanometry is not widely used in clinics due lack of evidence supporting its usefulness. The present study was undertaken to investigate the efficacy of multicomponent tympanometry for 1000 Hz probe tone in detecting middle ear pathology. Data were collected from 20 ears of 10 participants with no history of middle ear pathology (Group I) and 39 ears of 26 participants (Group II) with history of middle ear infection or ear-pain or blocking sensation. Single component tympanometry for 226 Hz probe tone and Susceptancec and Conductance tympanograms for 1000 Hz probe tone was carried out on all the participants. Results revealed normal tympanogram for both the probe tones for all the participants of Group I. It was observed that 53.84% of the ears could be identified as having middle ear pathology using 226 Hz probe tone whereas the percentage of correct identification increased to 94.87% when 1000 Hz probe tone was used. They are in accordance with the concept that subtle changes in the middle ear which cannot be detected by 226 Hz tympanogram can be identified using 1000 Hz multicomponent tympanogram. These findings highlight the efficiency of 1000 Hz probe tone in detecting mass dominant middle ear pathology.

Cost and outcome of a community-based paediatric hearing screening programme in rural India with application of tele-audiology for follow-up diagnostic hearing assessment.

OBJECTIVE: This study evaluated the cost and outcome of a community-based hearing screening programme in which village health workers (VHWs) screened children in their homes using a two-step DPOAE screening protocol. Children referred in a second screening underwent tele diagnostic ABR testing in a mobile tele-van using satellite connectivity or at local centre using broadband internet at the rural location. DESIGN: Economic analysis was carried out to estimate cost incurred and outcome achieved for hearing screening, follow-up diagnostic assessment and identification of hearing loss. Two-way sensitivity analysis determined the most beneficial cost-outcome. STUDY SAMPLE: 1335 children under 5 years of age underwent screening by VHWs. RESULTS: Nineteen of the 22 children referred completed the tele diagnostic evaluation. Five children were identified with hearing loss. The cost-outcomes were better when using broadband internet for tele-diagnostics. The use of least expensive human resources and equipment yielded the lowest cost per child screened (Rs.1526; $23; €21). When follow-up expenses were thus maximised, the cost per child was reduced considerably for diagnostic hearing assessment (Rs.102,065; $1532; €1368) and for the cost per child identified (Rs.388,237; $5826; €5204). CONCLUSION: Settings with constrained resources can benefit from a community-based programme integrated with tele diagnostics.

Validation of DPOAE screening conducted by village health workers in a rural community with real-time click evoked tele-auditory brainstem response.

OBJECTIVE: This study assessed the validity of DPOAE screening conducted by village health workers (VHWs) in a rural community. Real-time click evoked tele-auditory brainstem response (tele-ABR) was used as the gold standard to establish validity. DESIGN: A cross-sectional design was utilised to compare the results of screening by VHWs to those obtained via tele-ABR. Study samples: One hundred and nineteen subjects (0 to 5 years) were selected randomly from a sample of 2880 infants and young children who received DPOAE screening by VHWs. METHOD: Real time tele-ABR was conducted by using satellite or broadband internet connectivity at the village. An audiologist located at the tertiary care hospital conducted tele-ABR testing through a remote computing paradigm. Tele-ABR was recorded using standard recording parameters recommended for infants and young children. Wave morphology, repeatability and peak latency data were used for ABR analysis. RESULTS: Tele-ABR and DPOAE findings were compared for 197 ears. The sensitivity of DPOAE screening conducted by the VHW was 75%, and specificity was 91%. The negative and positive predictive values were 98.8% and 27.2%, respectively. CONCLUSIONS: The validity of DPOAE screening conducted by trained VHW was acceptable. This study supports the engagement of grass-root workers in community-based hearing health care provision.

Parents' perceptions of tele-audiological testing in a rural hearing screening program in South India.

INTRODUCTION: Tele-diagnostic audiological testing in a hearing screening program for infants and young children is a novel practice, and this study is the first to explore its application in a rural community. It is important to understand parental perceptions and confidence when introducing a new process such as tele-audiological diagnostic testing in rural areas. METHOD: A questionnaire with 17 rater-administered items was designed to elicit comments concerning the quality of tele-hearing testing and video-conferencing, access to tele-hearing testing, and parents' attitudes regarding tele-hearing testing in the village. The questionnaire was administered by an audiologist not involved in tele-diagnostic testing to avoid bias. RESULTS: Parents perceived tele-hearing testing as equal in quality to in-person testing. Technical factors such as good video-conferencing quality and logistical factors such as ease of access due to reasonable travel time to testing facility could have influenced these perceptions. CONCLUSIONS: While these results show tele-hearing testing is an acceptable alternative, occasional poor signal quality should be addressed prior to large-scale implementation.

Age related changes in auditory processes in children aged 6 to 10 years.

OBJECTIVES: The study evaluated age related changes in auditory processing (separation/auditory closure, binaural auditory integration abilities, temporal processing abilities) and higher order cognitive function (auditory memory & sequencing abilities) in children. Additionally, the study aimed to assess the effect of gender on the auditory processes/higher cognitive function as well as ear effect for the monaural tests that were administered. METHODS: The cross-sectional experimental study evaluated 280 typically developing children aged 6 to 10 years, divided into five age groups. They were evaluated on auditory processes/higher order cognitive functions reported to be frequently affected in children with auditory processing disorders (Speech-in-Noise Test in Indian-English, Dichotic consonant-vowel test, Duration pattern test, & Revised Auditory Memory and Sequencing Test in Indian-English). RESULTS: ANOVA and MANOVA revealed no significant gender effect in all four tests. However, a significant age effect was seen, with the rate at which maturation occurred, varying across the tests. CONCLUSIONS: Thus, the findings indicate that different auditory processes have different rates of development. This reflects that the areas responsible for different auditory processes/higher cognitive function do not develop at the same pace.

Speech identification with temporal and spectral modification in subjects with auditory neuropathy.

Background. The aim of this study was to investigate the individual effects of envelope enhancement and high-pass filtering (500 Hz) on word identification scores in quiet for individuals with Auditory Neuropathy. Method. Twelve individuals with Auditory Neuropathy (six males and six females) with ages ranging from 12 to 40 years participated in the study. Word identification was assessed using bi-syllabic words in each of three speech processing conditions: unprocessed, envelope-enhanced, and high-pass filtered. All signal processing was carried out using MATLAB-7. Results. Word identification scores showed a mean improvement of 18% with envelope enhanced versus unprocessed speech. No significant improvement was observed with high-pass filtered versus unprocessed speech. Conclusion. These results suggest that the compression/expansion signal processing strategy enhances speech identification scores-at least for mild and moderately impaired individuals with AN. In contrast, simple high-pass filtering (i.e., eliminating the low-frequency content of the signal) does not improve speech perception in quiet for individuals with Auditory Neuropathy.

Perception of speech with envelope enhancement in individuals with auditory neuropathy and simulated loss of temporal modulation processing.

Individuals with auditory neuropathy (AN) often suffer from temporal processing deficits causing speech perception difficulties. In the present study an envelope enhancement scheme that incorporated envelope expansion was used to reduce the effects of temporal deficits. The study involved two experiments. In the first experiment, to simulate the effects of reduced temporal resolution, temporally smeared speech stimuli were presented to listeners with normal hearing. The results revealed that temporal smearing of the speech signal reduced identification scores. With the envelope enhancement of the speech signal prior to being temporally smeared, identification scores improved significantly compared to temporally smeared condition. The second experiment assessed speech perception in twelve individuals with AN, using unprocessed and envelope-enhanced speech signals. The results revealed improvement in speech identification scores for the majority of individuals with AN when the envelope of the speech signal was enhanced. However, envelope enhancement was not able to improve speech identification scores for individuals with AN who had very poor unprocessed speech scores. Overall, the results of the present study suggest that applying envelope enhancement strategies in hearing aids might provide some benefits to many individuals with AN.

Perception of envelope-enhanced speech in the presence of noise by individuals with auditory neuropathy.

OBJECTIVE: To investigate the effect of background noise on perception of unprocessed and envelope-enhanced speech in individuals with auditory neuropathy (AN). DESIGN: Open-set speech identification abilities were assessed for unprocessed and envelope-enhanced speech in quiet and at three signal to noise ratios (10, 5, and 0 dB signal to noise ratio) in 15 individuals with AN. RESULTS: Results revealed that speech identification ability was affected more in the presence of noise than in quiet. The participants were classified into two groups, Good Performers and Poor Performers, based on their speech identification scores in quiet. It was observed that the reduction in mean speech identification scores in noise was less for Good Performers when compared with that of Poor Performers. Envelope enhancement of the signal improved speech identification scores in both the groups. The analysis of results also showed that Good Performers showed a significant improvement in all the conditions, whereas Poor Performers showed improvement only in quiet and +10 dB signal to noise ratio. CONCLUSIONS: For individuals with AN, listening in background noise is more difficult than in quiet condition. Envelope enhancement of speech signal improves speech identification scores in quiet and in background noise for individuals with AN. However, the benefit obtained varies depending on the speech identification ability in quiet.

Effect of envelope enhancement on speech perception in individuals with auditory neuropathy.

OBJECTIVES: To investigate the ability to identify consonant-vowel (CV) stimuli by individuals with auditory neuropathy (AN) when the envelope of the speech signal is enhanced by 15 dB for different modulation bandwidths (3 to 10 Hz; 3 to 20 Hz; 3 to 30 Hz; 3 to 60 Hz). DESIGN: Eight individuals with auditory neuropathy whose pure-tone thresholds ranged from 30 to 70 dB HL participated in the present study. Speech material consisted of five lists of CV, one unprocessed and four with envelope enhancement. The magnitude of envelope enhancement was 15 dB and the bandwidths used were 3 to 10 Hz, 3 to 20 Hz, 3 to 30 Hz, and 3 to 60 Hz. RESULTS: Speech identification scores improved when the envelope of the speech was enhanced. The improvement was greater for the broader bandwidth (3 to 30 Hz) conditions when compared with the smaller bandwidth (3 to 10 Hz and 3 to 20 Hz) conditions. In the unprocessed condition, manner of articulation was transmitted better than voicing and place of articulation. In the envelope-enhanced conditions, cues for manner and place of articulation were transmitted better than voicing. CONCLUSIONS: Envelope enhancement using digital techniques improves speech perception by individuals with auditory neuropathy, and it may be a viable option for the rehabilitation of these individuals. However, the magnitude of envelope enhancement of speech required for maximal improvement of speech perception is yet to be determined.

Functioning of olivocochlear bundle and speech perception in noise.

OBJECTIVES: To evaluate the effect of contralateral acoustic stimuli on speech identification scores and to correlate this effect to contralateral suppression of evoked otoacoustic emission. DESIGN: Ten normal-hearing children with good academic performance participated in the study. Speech identification scores were measured in quiet and with different ipsilateral signal to noise ratios in two conditions, with and without contralateral acoustic stimuli. Transient evoked otoacoustic emissions were recorded for 70 dB SPL clicks with and without contralateral acoustic stimuli. RESULTS: Findings revealed that contralateral acoustic stimuli enhanced speech perception when ipsilateral signal to noise ratios was +10 dB and +15 dB. This enhancement had significant positive correlation with contralateral suppression of OAE. CONCLUSIONS: The results of the present study support the hypothesis that medial olivocochlear bundle might aid in speech perception in noise, thereby suggesting a possible role of cochlear efferent fibers in hearing. The psychoacoustic measures can be used to evaluate the efferent auditory pathways, where it is not possible to record otoacoustic emissions.