Automated Audiometry in Quiet and Simulated Exam Room Noise for Listeners with Normal Hearing and Impaired Hearing.

BACKGROUND: Up to 80% of audiograms could be automated which would allow more time for provision of specialty services. Ideally, automated audiometers would provide accurate results for listeners with impaired hearing as well as normal hearing. Additionally, accurate results should be provided both in controlled environments like a sound-attenuating room but also in test environments that may support greater application when sound-attenuating rooms are unavailable. Otokiosk is an iOS-based system that has been available for clinical use, but there are not yet any published validation studies using this product. PURPOSE: The purpose of this project was to complete a validation study on the OtoKiosk automated audiometry system in quiet and in low-level noise, for listeners with normal hearing and for listeners with impaired hearing. RESEARCH DESIGN: Pure tone air conduction thresholds were obtained for each participant for three randomized conditions: standard audiometry, automated testing in quiet, and automated testing in noise. Noise, when present, was 35 dBA overall and was designed to emulate an empty medical exam room. STUDY SAMPLE: Participants consisted of 11 adults with hearing loss and 15 adults with normal hearing recruited from the local area. DATA COLLECTION AND ANALYSIS: Thresholds were measured at 500, 1,000, 2,000, and 4,000 Hz using the Otokiosk system that incorporates a modified Hughson-Westlake method. Results were analyzed using descriptive statistics and also by a linear mixed-effects model to compare thresholds obtained in each condition. RESULTS: Across condition and participant group 73.6% of thresholds measured with OtoKiosk were within ± 5 dB of the conventionally measured thresholds; 92.8% were within ± 10 dB. On average, differences between tests were small. Pairwise comparisons revealed thresholds were ∼3.5-4 dB better with conventional audiometry than with the mobile application in quiet and in noise. Noise did not affect thresholds measured with OtoKiosk. CONCLUSIONS: The OtoKiosk automated hearing test measured pure tone air conduction thresholds from 500 to 4,000 Hz at slightly higher thresholds than conventional audiometry, but less than the smallest typical 5 dB clinical step-size. Our results suggest OtoKiosk is a reasonable solution for sound booths and exam rooms with low-level background noise.

Remote Microphone System Use in the Homes of Children With Hearing Loss: Impact on Caregiver Communication and Child Vocalizations.

Purpose This study examined the impact of home use of remote microphone systems (RMSs) on caregiver communication and child vocalizations in families of children with hearing loss. Method We drew on data from a prior study in which Language ENvironmental Analysis recorders were used with 9 families during 2 consecutive weekends-1 that involved using an RMS and 1 that did not. Audio samples from Language ENvironmental Analysis recorders were (a) manually coded to quantify the frequency of verbal repetitions and alert phrases caregivers utilized in communicating to children with hearing loss and (b) automatically analyzed to quantify children's vocalization rate, duration, complexity, and reciprocity when using and not using an RMS. Results When using an RMS at home, caregivers did not repeat or clarify their statements as often as when not using an RMS while communicating with their children with hearing loss. However, no between-condition differences were observed in children's vocal characteristics. Conclusions Results provide further support for home RMS use for children with hearing loss. Specifically, findings lend empirical support to prior parental reports suggesting that RMS use eases caregiver communication in the home setting. Studies exploring RMS use over a longer duration of time might provide further insight into potential long-term effects on children's vocal production.

Remote Microphone System Use at Home: Impact on Child-Directed Speech.

Purpose The impact of home use of a remote microphone system (RMS) on the caregiver production of, and child access to, child-directed speech (CDS) in families with a young child with hearing loss was investigated. Method We drew upon extant data that were collected via Language ENvironment Analysis (LENA) recorders used with 9 families during 2 consecutive weekends (RMS weekend and no-RMS weekend). Audio recordings of primary caregivers and their children with hearing loss obtained while wearing and not wearing an RMS were manually coded to estimate the amount of CDS produced. The proportion of CDS that was likely accessible to children with hearing loss under both conditions was determined. Results Caregivers produced the same amount of CDS when using and when not using the RMS. However, it was concluded that children with hearing loss, on average, could potentially access 12% more CDS if caregivers used an RMS because of their distance from their children when talking to them. Conclusion Given our understanding of typical child language development, findings from this investigation suggest that children with hearing loss could receive auditory, speech, and language benefits from the use of an RMS in the home environment.

Remote Microphone System Use at Home: Impact on Caregiver Talk.

Purpose: The purpose of this study was to investigate the effects of home use of a remote microphone system (RMS) on the spoken language production of caregivers with young children who have hearing loss. Method: Language Environment Analysis recorders were used with 10 families during 2 consecutive weekends (RMS weekend and No-RMS weekend). The amount of talk from a single caregiver that could be made accessible to children with hearing loss when using an RMS was estimated using Language Environment Analysis software. The total amount of caregiver talk (close and far talk) was also compared across both weekends. In addition, caregivers' perceptions of RMS use were gathered. Results: Children, with the use of RMSs, could potentially have access to approximately 42% more words per day. In addition, although caregivers produced an equivalent number of words on both weekends, they tended to talk more from a distance when using the RMS than when not. Finally, caregivers reported positive perceived communication benefits of RMS use. Conclusions: Findings from this investigation suggest that children with hearing loss have increased access to caregiver talk when using an RMS in the home environment. Clinical implications and future directions for research are discussed.

Remote Hearing Aid Support: The Next Frontier.

BACKGROUND: In an effort to reduce health-care disparities, there has been a recent surge of interest in the remote provision of care. Audiologists have begun to provide screening, diagnostic, and rehabilitative services via telehealth technologies. PURPOSE: To evaluate the feasibility and perceived benefits of providing remote hearing aid follow-up appointments in a controlled clinical environment and in participants' homes. RESEARCH DESIGN: A descriptive quasi-experimental study was completed. STUDY SAMPLE: The study consisted of two phases. The in-clinic phase included 50 adults with hearing loss who participated in remote hearing aid follow-up appointments at Vanderbilt University Medical Center. A subgroup of 21 adults from the original in-clinic phase plus one additional participant completed the in-home appointments. DATA COLLECTION AND ANALYSIS: All participants completed the Montreal Cognitive Assessment and study-designed questionnaires. All participants were asked to install proprietary distance support (DS) client software on a laptop or desktop computer and participate in hearing aid follow-up appointments. RESULTS: The majority of participants in both groups installed the DS client software with no assistance other than written instructions, and indicated a preference for DS appointments over face-to-face appointments. CONCLUSION: On average, participants and the study audiologist were satisfied with remote hearing aid follow-up visits. Additional support might be needed for older patients with little confidence in their ability to interact with technology.