Frequency importance functions in simulated bimodal cochlear-implant users with spectral holes.

Frequency importance functions (FIFs) for simulated bimodal hearing were derived using sentence perception scores measured in quiet and noise. Acoustic hearing was simulated using low-pass filtering. Electric hearing was simulated using a six-channel vocoder with three input frequency ranges, resulting in overlap, meet, and gap maps, relative to the acoustic cutoff frequency. Spectral holes present in the speech spectra were created within electric stimulation by setting amplitude(s) of channels to zero. FIFs were significantly different between frequency maps. In quiet, the three FIFs were similar with gradually increasing weights with channels 5 and 6 compared to the first three channels. However, the most and least weighted channels slightly varied depending on the maps. In noise, the patterns of the three FIFs were similar to those in quiet, with steeper increasing weights with channels 5 and 6 compared to the first four channels. Thus, channels 5 and 6 contributed to speech perception the most, while channels 1 and 2 contributed the least, regardless of frequency maps. Results suggest that the contribution of cochlear implant frequency bands for bimodal speech perception depends on the degree of frequency overlap between acoustic and electric stimulation and if noise is absent or present.

In-situ Audiometry Compared to Conventional Audiometry for Hearing Aid Fitting.

The use of in-situ audiometry for hearing aid fitting is appealing due to its reduced resource and equipment requirements compared to standard approaches employing conventional audiometry alongside real-ear measures. However, its validity has been a subject of debate, as previous studies noted differences between hearing thresholds measured using conventional and in-situ audiometry. The differences were particularly notable for open-fit hearing aids, attributed to low-frequency leakage caused by the vent. Here, in-situ audiometry was investigated for six receiver-in-canal hearing aids from different manufacturers through three experiments. In Experiment I, the hearing aid gain was measured to investigate whether corrections were implemented to the prescribed target gain. In Experiment II, the in-situ stimuli were recorded to investigate if corrections were directly incorporated to the delivered in-situ stimulus. Finally, in Experiment III, hearing thresholds using in-situ and conventional audiometry were measured with real patients wearing open-fit hearing aids. Results indicated that (1) the hearing aid gain remained unaffected when measured with in-situ or conventional audiometry for all open-fit measurements, (2) the in-situ stimuli were adjusted for up to 30 dB at frequencies below 1000 Hz for all open-fit hearing aids except one, which also recommends the use of closed domes for all in-situ measurements, and (3) the mean interparticipant threshold difference fell within 5 dB for frequencies between 250 and 6000 Hz. The results clearly indicated that modern measured in-situ thresholds align (within 5 dB) with conventional thresholds measured, indicating the potential of in-situ audiometry for remote hearing care.

Modeling the Intelligibility Benefit of Active Noise Cancelation in Hearing Devices That Improve Signal-to-Noise Ratio.

The extent to which active noise cancelation (ANC), when combined with hearing assistance, can improve speech intelligibility in noise is not well understood. One possible source of benefit is ANC's ability to reduce the sound level of the direct (i.e., vent-transmitted) path. This reduction lowers the "floor" imposed by the direct path, thereby allowing any increases to the signal-to-noise ratio (SNR) created in the amplified path to be "realized" at the eardrum. Here we used a modeling approach to estimate this benefit. We compared pairs of simulated hearing aids that differ only in terms of their ability to provide ANC and computed intelligibility metrics on their outputs. The difference in metric scores between simulated devices is termed the "ANC Benefit." These simulations show that ANC Benefit increases as (1) the environmental sound level increases, (2) the ability of the hearing aid to improve SNR increases, (3) the strength of the ANC increases, and (4) the hearing loss severity decreases. The predicted size of the ANC Benefit can be substantial. For a moderate hearing loss, the model predicts improvement in intelligibility metrics of >30% when environments are moderately loud (>70 dB SPL) and devices are moderately capable of increasing SNR (by >4 dB). It appears that ANC can be a critical ingredient in hearing devices that attempt to improve SNR in loud environments. ANC will become more and more important as advanced SNR-improving algorithms (e.g., artificial intelligence speech enhancement) are included in hearing devices.

Impact of Hearing Aids on Language Outcomes in Preschool Children With Mild Bilateral Hearing Loss.

This study aimed to investigate the role of hearing aid (HA) usage in language outcomes among preschool children aged 3-5 years with mild bilateral hearing loss (MBHL). The data were retrieved from a total of 52 children with MBHL and 30 children with normal hearing (NH). The association between demographical, audiological factors and language outcomes was examined. Analyses of variance were conducted to compare the language abilities of HA users, non-HA users, and their NH peers. Furthermore, regression analyses were performed to identify significant predictors of language outcomes. Aided better ear pure-tone average (BEPTA) was significantly correlated with language comprehension scores. Among children with MBHL, those who used HA outperformed the ones who did not use HA across all linguistic domains. The language skills of children with MBHL were comparable to those of their peers with NH. The degree of improvement in audibility in terms of aided BEPTA was a significant predictor of language comprehension. It is noteworthy that 50% of the parents expressed reluctance regarding HA use for their children with MBHL. The findings highlight the positive impact of HA usage on language development in this population. Professionals may therefore consider HAs as a viable treatment option for children with MBHL, especially when there is a potential risk of language delay due to hearing loss. It was observed that 25% of the children with MBHL had late-onset hearing loss. Consequently, the implementation of preschool screening or a listening performance checklist is recommended to facilitate early detection.

Changes in visually and auditory attended audiovisual speech processing in cochlear implant users: A longitudinal ERP study.

Limited auditory input, whether caused by hearing loss or by electrical stimulation through a cochlear implant (CI), can be compensated by the remaining senses. Specifically for CI users, previous studies reported not only improved visual skills, but also altered cortical processing of unisensory visual and auditory stimuli. However, in multisensory scenarios, it is still unclear how auditory deprivation (before implantation) and electrical hearing experience (after implantation) affect cortical audiovisual speech processing. Here, we present a prospective longitudinal electroencephalography (EEG) study which systematically examined the deprivation- and CI-induced alterations of cortical processing of audiovisual words by comparing event-related potentials (ERPs) in postlingually deafened CI users before and after implantation (five weeks and six months of CI use). A group of matched normal-hearing (NH) listeners served as controls. The participants performed a word-identification task with congruent and incongruent audiovisual words, focusing their attention on either the visual (lip movement) or the auditory speech signal. This allowed us to study the (top-down) attention effect on the (bottom-up) sensory cortical processing of audiovisual speech. When compared to the NH listeners, the CI candidates (before implantation) and the CI users (after implantation) exhibited enhanced lipreading abilities and an altered cortical response at the N1 latency range (90-150 ms) that was characterized by a decreased theta oscillation power (4-8 Hz) and a smaller amplitude in the auditory cortex. After implantation, however, the auditory-cortex response gradually increased and developed a stronger intra-modal connectivity. Nevertheless, task efficiency and activation in the visual cortex was significantly modulated in both groups by focusing attention on the visual as compared to the auditory speech signal, with the NH listeners additionally showing an attention-dependent decrease in beta oscillation power (13-30 Hz). In sum, these results suggest remarkable deprivation effects on audiovisual speech processing in the auditory cortex, which partially reverse after implantation. Although even experienced CI users still show distinct audiovisual speech processing compared to NH listeners, pronounced effects of (top-down) direction of attention on (bottom-up) audiovisual processing can be observed in both groups. However, NH listeners but not CI users appear to show enhanced allocation of cognitive resources in visually as compared to auditory attended audiovisual speech conditions, which supports our behavioural observations of poorer lipreading abilities and reduced visual influence on audition in NH listeners as compared to CI users.

An Exploration of the Memory Performance in Older Adult Hearing Aid Users on the Integrated Digit-in-Noise Test.

This study aimed to preliminarily investigate the associations between performance on the integrated Digit-in-Noise Test (iDIN) and performance on measures of general cognition and working memory (WM). The study recruited 81 older adult hearing aid users between 60 and 95 years of age with bilateral moderate to severe hearing loss. The Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) was used to screen older adults for mild cognitive impairment. Speech reception thresholds (SRTs) were measured using 2- to 5-digit sequences of the Mandarin iDIN. The differences in SRT between five-digit and two-digit sequences (SRT5-2), and between five-digit and three-digit sequences (SRT5-3), were used as indicators of memory performance. The results were compared to those from the Digit Span Test and Corsi Blocks Tapping Test, which evaluate WM and attention capacity. SRT5-2 and SRT5-3 demonstrated significant correlations with the three cognitive function tests (rs ranging from -.705 to -.528). Furthermore, SRT5-2 and SRT5-3 were significantly higher in participants who failed the MoCA-BC screening compared to those who passed. The findings show associations between performance on the iDIN and performance on memory tests. However, further validation and exploration are needed to fully establish its effectiveness and efficacy.

Intracochlear Recording of Electrocochleography During and After Cochlear Implant Insertion Dependent on the Location in the Cochlea.

To preserve residual hearing during cochlear implant (CI) surgery it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring). A promising method is electrocochleography (ECochG). Within this project the relations between intracochlear ECochG recordings, position of the recording contact in the cochlea with respect to anatomy and frequency and preservation of residual hearing were investigated. The aim was to better understand the changes in ECochG signals and whether these are due to the electrode position in the cochlea or to trauma generated during insertion. During and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed using the CI electrode (MED-EL). During insertion, the recordings were performed at discrete insertion steps on electrode contact 1. After insertion as well as postoperatively the recordings were performed at different electrode contacts. The electrode location in the cochlea during insertion was estimated by mathematical models using preoperative clinical imaging, the postoperative location was measured using postoperative clinical imaging. The recordings were analyzed from six adult CI recipients. In the four patients with good residual hearing in the low frequencies the signal amplitude rose with largest amplitudes being recorded closest to the generators of the stimulation frequency, while in both cases with severe pantonal hearing losses the amplitude initially rose and then dropped. This might be due to various reasons as discussed in the following. Our results indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.

Characterizing the relationship between modulation sensitivity and pitch resolution in cochlear implant users.

Cochlear implants are medical devices that have restored hearing to approximately one million people around the world. Outcomes are impressive and most recipients attain excellent speech comprehension in quiet without relying on lip-reading cues, but pitch resolution is poor compared to normal hearing. Amplitude modulation of electrical stimulation is a primary cue for pitch perception in cochlear implant users. The experiments described in this article focus on the relationship between sensitivity to amplitude modulations and pitch resolution based on changes in the frequency of amplitude modulations. In the first experiment, modulation sensitivity and pitch resolution were measured in adults with no known hearing loss and in cochlear implant users with sounds presented to and processed by their clinical devices. Stimuli were amplitude-modulated sinusoids and amplitude-modulated narrow-band noises. Modulation detection and modulation frequency discrimination were measured for modulation frequencies centered on 110, 220, and 440 Hz. Pitch resolution based on changes in modulation frequency was measured for modulation depths of 25 %, 50 %, 100 %, and for a half-waved rectified modulator. Results revealed a strong linear relationship between modulation sensitivity and pitch resolution for cochlear implant users and peers with no known hearing loss. In the second experiment, cochlear implant users took part in analogous procedures of modulation sensitivity and pitch resolution but bypassing clinical sound processing using single-electrode stimulation. Results indicated that modulation sensitivity and pitch resolution was better conveyed by single-electrode stimulation than by clinical processors. Results at 440 Hz were worse, but also not well conveyed by clinical sound processing, so it remains unclear whether the 300 Hz perceptual limit described in the literature is a technological or biological limitation. These results highlight modulation depth and sensitivity as critical factors for pitch resolution in cochlear implant users and characterize the relationship that should inform the design of modulation enhancement algorithms for cochlear implants.

Objective measure of binaural processing: Acoustic change complex in response to interaural phase differences.

Combining cochlear implants with binaural acoustic hearing via preserved hearing in the implanted ear(s) is commonly referred to as combined electric and acoustic stimulation (EAS). EAS fittings can provide patients with significant benefit for speech recognition in complex noise, perceived listening difficulty, and horizontal-plane localization as compared to traditional bimodal hearing conditions with contralateral and monaural acoustic hearing. However, EAS benefit varies across patients and the degree of benefit is not reliably related to the underlying audiogram. Previous research has indicated that EAS benefit for speech recognition in complex listening scenarios and localization is significantly correlated with the patients' binaural cue sensitivity, namely interaural time differences (ITD). In the context of pure tones, interaural phase differences (IPD) and ITD can be understood as two perspectives on the same phenomenon. Through simple mathematical conversion, one can be transformed into the other, illustrating their inherent interrelation for spatial hearing abilities. However, assessing binaural cue sensitivity is not part of a clinical assessment battery as psychophysical tasks are time consuming, require training to achieve performance asymptote, and specialized programming and software all of which render this clinically unfeasible. In this study, we investigated the possibility of using an objective measure of binaural cue sensitivity by the acoustic change complex (ACC) via imposition of an IPD of varying degrees at stimulus midpoint. Ten adult listeners with normal hearing were assessed on tasks of behavioral and objective binaural cue sensitivity for carrier frequencies of 250 and 1000 Hz. Results suggest that 1) ACC amplitude increases with IPD; 2) ACC-based IPD sensitivity for 250 Hz is significantly correlated with behavioral ITD sensitivity; 3) Participants were more sensitive to IPDs at 250 Hz as compared to 1000 Hz. Thus, this objective measure of IPD sensitivity may hold clinical application for pre- and post-operative assessment for individuals meeting candidacy indications for cochlear implantation with low-frequency acoustic hearing preservation as this relatively quick and objective measure may provide clinicians with information identifying patients most likely to derive benefit from EAS technology.

Two are better than one: Differences in cortical EEG patterns during auditory and visual verbal working memory processing between Unilateral and Bilateral Cochlear Implanted children.

Despite the proven effectiveness of cochlear implant (CI) in the hearing restoration of deaf or hard-of-hearing (DHH) children, to date, extreme variability in verbal working memory (VWM) abilities is observed in both unilateral and bilateral CI user children (CIs). Although clinical experience has long observed deficits in this fundamental executive function in CIs, the cause to date is still unknown. Here, we have set out to investigate differences in brain functioning regarding the impact of monaural and binaural listening in CIs compared with normal hearing (NH) peers during a three-level difficulty n-back task undertaken in two sensory modalities (auditory and visual). The objective of this pioneering study was to identify electroencephalographic (EEG) marker pattern differences in visual and auditory VWM performances in CIs compared to NH peers and possible differences between unilateral cochlear implant (UCI) and bilateral cochlear implant (BCI) users. The main results revealed differences in theta and gamma EEG bands. Compared with hearing controls and BCIs, UCIs showed hypoactivation of theta in the frontal area during the most complex condition of the auditory task and a correlation of the same activation with VWM performance. Hypoactivation in theta was also observed, again for UCIs, in the left hemisphere when compared to BCIs and in the gamma band in UCIs compared to both BCIs and NHs. For the latter two, a correlation was found between left hemispheric gamma oscillation and performance in the audio task. These findings, discussed in the light of recent research, suggest that unilateral CI is deficient in supporting auditory VWM in DHH. At the same time, bilateral CI would allow the DHH child to approach the VWM benchmark for NH children. The present study suggests the possible effectiveness of EEG in supporting, through a targeted approach, the diagnosis and rehabilitation of VWM in DHH children.

On the Feasibility of Using Behavioral Listening Effort Test Methods to Evaluate Auditory Performance in Cochlear Implant Users.

Realistic outcome measures that reflect everyday hearing challenges are needed to assess hearing aid and cochlear implant (CI) fitting. Literature suggests that listening effort measures may be more sensitive to differences between hearing-device settings than established speech intelligibility measures when speech intelligibility is near maximum. Which method provides the most effective measurement of listening effort for this purpose is currently unclear. This study aimed to investigate the feasibility of two tests for measuring changes in listening effort in CI users due to signal-to-noise ratio (SNR) differences, as would arise from different hearing-device settings. By comparing the effect size of SNR differences on listening effort measures with test-retest differences, the study evaluated the suitability of these tests for clinical use. Nineteen CI users underwent two listening effort tests at two SNRs (+4 and +8 dB relative to individuals' 50% speech perception threshold). We employed dual-task paradigms-a sentence-final word identification and recall test (SWIRT) and a sentence verification test (SVT)-to assess listening effort at these two SNRs. Our results show a significant difference in listening effort between the SNRs for both test methods, although the effect size was comparable to the test-retest difference, and the sensitivity was not superior to speech intelligibility measures. Thus, the implementations of SVT and SWIRT used in this study are not suitable for clinical use to measure listening effort differences of this magnitude in individual CI users. However, they can be used in research involving CI users to analyze group data.

Focusing on Positive Listening Experiences Improves Speech Intelligibility in Experienced Hearing Aid Users.

Negativity bias is a cognitive bias that results in negative events being perceptually more salient than positive ones. For hearing care, this means that hearing aid benefits can potentially be overshadowed by adverse experiences. Research has shown that sustaining focus on positive experiences has the potential to mitigate negativity bias. The purpose of the current study was to investigate whether a positive focus (PF) intervention can improve speech-in-noise abilities for experienced hearing aid users. Thirty participants were randomly allocated to a control or PF group (N = 2 × 15). Prior to hearing aid fitting, all participants filled out the short form of the Speech, Spatial and Qualities of Hearing scale (SSQ12) based on their own hearing aids. At the first visit, they were fitted with study hearing aids, and speech-in-noise testing was performed. Both groups then wore the study hearing aids for two weeks and sent daily text messages reporting hours of hearing aid use to an experimenter. In addition, the PF group was instructed to focus on positive listening experiences and to also report them in the daily text messages. After the 2-week trial, all participants filled out the SSQ12 questionnaire based on the study hearing aids and completed the speech-in-noise testing again. Speech-in-noise performance and SSQ12 Qualities score were improved for the PF group but not for the control group. This finding indicates that the PF intervention can improve subjective and objective hearing aid benefits.

An Analysis of Mental State Verb and Complex Syntax Use in Children Who Are Deaf and Hard of Hearing.

PURPOSE: Children who are deaf and hard of hearing (DHH) have documented deficits with complex syntax and vocabulary knowledge. Mental state verbs (MSVs) are necessary for some kinds of complex syntax use and communicate abstract concepts needed for academic language. The purpose of this study was to examine the frequency, diversity, and syntactic context of MSV use in children who are DHH compared to children with typical hearing (CTH). METHOD: Seventy-three preschool children (23 with cochlear implants, 22 with hearing aids, and 28 with typical hearing) completed a structured language sample as part of a larger assessment battery. Samples were analyzed and compared across groups for use of MSVs, diversity in MSV use, and syntactical context for MSVs. RESULTS: Children who are DHH used significantly fewer MSV in complex syntax, a smaller diversity of MSV, and significantly fewer MSV in obligatory contexts compared to CTH. Results for the cochlear implants and hearing aid groups were not significantly different from one another despite differing levels of hearing loss. CONCLUSION: Children who are DHH demonstrate significant differences in the rate, diversity, and complexity of MSV use compared to peers with typical hearing. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24091860.

[Improving Social Participation through Cochlear Implants for Hearing Impaired Persons? On the Ambivalence of Human-Machine-Interaction and the Importance of Psycho-Social Support]. / Mehr soziale Teilhabe für Hörgeschädigte durch Cochlea-Implantate? Zur Ambivalenz der Mensch-Maschine-Interaktion und zum Stellenwert psycho-sozialer Begleitung.

AIM OF THE STUDY: Cochlea implants help persons that suffer from deafness over time to regain hearing capacity. However, persons with CI implants experience year-long processes of adapting to technology-assisted hearing. The study highlights how people experience those processes and how they deal with changing expectations. METHODS: Within this qualitative study, 50 cochlear implant recipients were interviewed about their personal experiences with the supplying clinics. 30 persons were recruited through self-help groups; another 20 persons were recruited through a learning center for hearing-impaired persons. They were asked about their experiences in social, cultural and professional participation as well as hearing barriers they still face in everyday life after their CI fitting. Participants had been wearing CI devices for a maximum of three years. This is a timeframe when most subsequent therapies have ended. Also, the initial phase of learning to handle the CI is supposed to be over. RESULTS: The study shows that even with a cochlear implant communication barriers remain. People's expectations are not met when complete comprehension of listening during conversations is not achieved. Difficulties in dealing with a high-tech hearing prosthesis and experiencing a "foreign body" are obstacles that lower acceptance of CI. CONCLUSION: Counselling and support preparing the use of cochlea implants should be guided by realistic goals and expectations. Guided training and communication courses can help, including local care such as certified hearing aid acousticians. Those elements can increase quality and reduce uncertainty.

[Improving Social Participation through Cochlear Implants for Hearing Impaired Persons? On the Ambivalence of Human-Machine-Interaction and the Importance of Psycho-Social Support]. / Mehr soziale Teilhabe für Hörgeschädigte durch Cochlea-Implantate? Zur Ambivalenz der Mensch-Maschine-Interaktion und zum Stellenwert psycho-sozialer Begleitung.

AIM OF THE STUDY: Cochlea implants help persons that suffer from deafness over time to regain hearing capacity. However, persons with CI implants experience year-long processes of adapting to technology-assisted hearing. The study highlights how people experience those processes and how they deal with changing expectations. METHODS: Within this qualitative study, 50 cochlear implant recipients were interviewed about their personal experiences with the supplying clinics. 30 persons were recruited through self-help groups; another 20 persons were recruited through a learning center for hearing-impaired persons. They were asked about their experiences in social, cultural and professional participation as well as hearing barriers they still face in everyday life after their CI fitting. Participants had been wearing CI devices for a maximum of three years. This is a timeframe when most subsequent therapies have ended. Also, the initial phase of learning to handle the CI is supposed to be over. RESULTS: The study shows that even with a cochlear implant communication barriers remain. People's expectations are not met when complete comprehension of listening during conversations is not achieved. Difficulties in dealing with a high-tech hearing prosthesis and experiencing a "foreign body" are obstacles that lower acceptance of CI. CONCLUSION: Counselling and support preparing the use of cochlea implants should be guided by realistic goals and expectations. Guided training and communication courses can help, including local care such as certified hearing aid acousticians. Those elements can increase quality and reduce uncertainty.

Correspondência entre alvo e saída da prótese auditiva segundo as regras prescritivas NAL-NL1 e NAL-NL2 / Correspondência entre alvo e saída da prótese auditiva segundo as regras prescritivas NAL-NL1 e NAL-NL2

RESUMO Objetivo Analisar comparativamente os alvos prescritos pelas regras NAL (National Acoustic Laboratories) não lineares com a resposta da prótese auditiva obtida por meio das mensurações com microfone-sonda no ajuste de uso efetivo, de acordo com o grau da perda auditiva. Método Participaram do estudo 67 usuários experientes de próteses auditivas. Todos foram reavaliados quando compareceram às sessões de acompanhamento periódico. Nesse momento, realizou-se avaliação audiológica, registrando-se as horas de uso do dispositivo e realizando-se a resposta com prótese auditiva (REAR - Real Ear Aided Response). Resultados Observou-se que 80% das próteses auditivas de todos os grupos atingiram a faixa analisada, com exceção do grupo de perda moderada. Também foi realizada a análise da porcentagem de orelhas cuja resposta com prótese auditiva estivesse em ±5 dB para as frequências baixas e ±8 dB nas altas frequências e observou-se que menos de 80% dos ajustes atingiram esta faixa. Intervalos de confiança foram construídos para verificar a faixa de adaptação de preferência dos usuários experientes. Conclusão A faixa de ±10 dB demonstra ser a de preferência dos usuários. Porém, para usuários experientes, sugere-se que a faixa de adaptação encontre-se na faixa de ±3 nas frequências baixas e médias e ±7 na região de altas frequências.

ABSTRACT Purpose To compare the targets prescribed by the non-linear NAL with the real ear aided response - REAR obtained through probe microphone in the setting of effective use according to the degree of hearing loss. Methods 67 experienced hearing aid users participated in the study. All were reassessed when attending follow-up sessions. At that moment, they were asked whether they had any complaints with respect to the amplification. An audiological evaluation was performed, the hours of use of the device were recorded and the new probe microphone measurement was taken. Results The percentage of ears with REAR within ± 10dB of the prescriptive target was verified. It was observed that 80% of the hearing aids of all groups reached the analyzed range, with the exception of the moderate hearing loss group. We also performed the analysis of the percentage of ears whose hearing aid response was within ± 5 dB for the low frequencies and ± 8 dB for the high frequencies, and it was observed that less than 80% of the adjustments reached this range. Confidence intervals were constructed to verify the preference fit to target of experienced users. Conclusion The range of ±10dB proves to be the users' preference. For experienced users, it is suggested that the adaptation phase be found in the range of ±3 in the low and medium frequencies and ±7 in the high frequency region

Saúde auditiva nas Coordenadorias Regionais de Saúde do estado do Rio Grande do Sul: regulação de acesso, desafios e perspectivas / Hearing health care in the Regional Health Coordinating Bodies in Rio Grande do Sul: access regulation, challenges, and perspectives

RESUMO Objetivo compreender a dinâmica da regulação de acesso, os desafios e as perspectivas da atuação das Coordenadorias Regionais de Saúde do Rio Grande do Sul (CRS/RS) em saúde auditiva. Métodos estudo exploratório, transversal, de natureza censitária e análise descritiva. Envolveu os responsáveis pela regulação dos procedimentos de saúde auditiva nas CRS/RS, entrevistados quanto à formação profissional, identificação dos procedimentos disponíveis e respectiva oferta, sistemática da regulação de acesso e outras ações em saúde auditiva. Resultados participaram 15 profissionais, todas mulheres, de 16 das 18 CRS/RS existentes, entre 30 e 47 anos de idade: 13 fonoaudiólogas e duas fisioterapeutas, graduadas entre 1997 e 2012; 13 possuíam pós-graduação. Sobre a regulação nas CRS/RS, 13 utilizavam o Sistema Nacional de Regulação e três a realizavam manualmente; 12 utilizavam o protocolo disponibilizado pela Secretaria Estadual de Saúde/RS; dez CRS/RS regulavam procedimentos de Triagem Auditiva Neonatal e 16, de avaliação e diagnóstico, bem como de reabilitação. Verificou-se demanda reprimida para todos os procedimentos (maior para reabilitação auditiva) em 12 CRS/RS. Todas as CRS/RS realizavam uma ou mais ações promotoras da saúde auditiva, como vigilância, apoio matricial e atividades de educação em saúde. Conclusão a regulação de acesso em saúde auditiva é realizada de forma qualificada na maioria das CRS/RS. A oferta de procedimentos é insuficiente, sobretudo em reabilitação auditiva, que implica exclusiva atuação fonoaudiológica por meio de tecnologias leves e leve-duras.

ABSTRACT Purpose To understand the dynamics of access regulation, the challenges, and perspectives of the performance of the Regional Health Coordinating Bodies of Rio Grande do Sul (RHCB/RS) in hearing health care. Methods This is an exploratory, cross-sectional, census study and the analysis is descriptive. It involved those responsible for the regulation of hearing health care procedures in RHCB/RS, interviewed about professional training, identification of available procedures and their respective offer, access regulation systematics, and other actions in hearing health care. Results 15 professionals participated, all were women, from 16 of the 18 existing RHCB/RS, aged between 30 and 47; 13 speech-language pathologists and audiologists and two physiotherapists, who graduated between 1997 and 2012; and 13 had post -graduate degrees. Regarding regulation in RHCB/RS, 13 used the National Regulation System and three performed it manually; 12 used the protocol provided by the State Health Department/RS; ten RHCB/RS regulated procedures for Neonatal Hearing Screening and 16 for assessment and diagnosis, as well as auditory rehabilitation. There is a repressed demand for all procedures (greater for auditory rehabilitation) in 12 RHCB/RS. All RHCB/RS performed one or more actions to promote hearing health care such as surveillance, matrix support, and health education. Conclusion The access regulation in hearing health care is performed in a qualified way in most RHCB/RS; the offer of procedures is insufficient, especially in auditory rehabilitation, which includes exclusive speech-language pathologists and audiologists' performance through soft and soft-hard technologies.

Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US.

Importance: Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging. Objective: To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function. Design, Setting, and Participants: In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US. Exposures: Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment. Main Outcomes and Measures: Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time. Results: Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (ß, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test. Conclusions and Relevance: In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.