An Evaluation of Simulation Techniques in Audiology and Allied Health Professions.

Purpose This study aims to investigate the experiences and opinions of clinical educators from various allied health care fields, including audiology, related to the use of simulation as a teaching technique and determine the status of clinical simulation techniques in training audiology graduate students nationwide. Method An interview was conducted with nine faculty members in the College of Health Professions at Towson University to discuss advantages and challenges of incorporating clinical simulation techniques into student learning. A thematic analysis was used to analyze the interview responses. Additionally, a web-based questionnaire was sent to all audiology graduate program directors nationwide, yielding a response rate of 63%. These data were analyzed using descriptive statistics. Results Interview responses revealed a number of benefits and barriers related to simulation use at the graduate level. Benefits included its use as a learning tool, a quality control measure, and an aid in professional development. It also increases students' confidence levels in clinical procedures and counseling skills and exposes them to a variety of clinical pathologies not routinely seen. Barriers included lack of training with simulators, lack of funding to purchase simulator technology, and lack of resources, such as time and space. At present, only 50% of audiology program directors reported using clinical simulation to train their students. Conclusions The field of audiology is embracing simulation techniques in training its preprofessional work force. To date, there has been limited guidance from professional organizations regarding the role of simulation in audiology. Additional assistance focusing on best practices for these techniques is warranted.

Effectiveness of Simulation Training on Graduate Audiology Students' Auditory Brainstem Response Testing Skills.

Purpose Simulation is a tool commonly used in the clinical training of students within the health professions fields, such as medicine and nursing. The effectiveness of simulation as a teaching technique has been extensively documented in numerous health care professions; however, little is known about the effectiveness of simulation techniques in audiology education. This study assesses the effectiveness of a simulation activity focused on auditory brainstem response (ABR) testing conducted with students of an applied doctoral program in audiology. Method Twelve 2nd year audiology graduate students enrolled in the auditory electrophysiology course at Towson University in Fall 2018 participated in this pre-post study. Over a 3-week period, each student (a) received didactic instruction in ABR testing, (b) underwent a presimulation exercise skills assessment, (c) participated in a simulation exercise, and (d) underwent a postsimulation exercise skills assessment. Results Significant improvements were observed in clinical skill level for the ABR tasks evaluated in terms of both accuracy and efficiency (time in seconds needed to complete the task). The tasks evaluated included skin preparation, identification of scalp electrode placement sites, and scalp electrode placement in a variety of configurations (single- and two-channel arrays, horizontal and vertical electrode montages). Benefits associated with simulation-based instruction varied by clinical skill as well as by student. Conclusions The data described in this study reinforce the need to incorporate simulation in audiology training programs, especially for complex clinical skills. It also emphasizes the need for additional research that can be useful in the design and implementation of simulation-based exercises.

Pilot Comparison of Adjustment Protocols of Personal Sound Amplification Products.

The Over-the-Counter Hearing Aid Act of 2017 was signed into law in August 2017 and facilitates the introduction of direct-to-consumer sales of hearing aids for adults with mild-to-moderate hearing loss. Among many questions surrounding over-the-counter sales is the ability of users to self-fit amplification. Many studies have conducted self-fitting procedures using guidance materials provided by audiologists. In this pilot, we explore the ability of users to self-adjust personal sound amplification devices using only materials provided by the manufacturer and contrast this with models that involve a hearing professional. Outcomes to assess adjustments included clinic-based speech-in-noise measures and ability to approximate NAL-NL2 prescriptive targets. We found that an audiologist-driven model provided the best outcomes. However, it is unknown if the difference is clinically meaningful.

Relations among Auditory Brainstem and Middle Latency Response Measures, Categorical Loudness Judgments, and Their Associated Physical Intensities.

This study characterizes changes in response properties of toneburst-evoked auditory brainstem responses (ABRs) and/or middle latency responses (MLRs) as a function of perceived loudness and physical intensity of these stimuli and delineates the range of levels corresponding to categorical loudness judgments for these stimuli. ABRs/MLRs were recorded simultaneously to 500- and 2,000-Hz tonebursts in 10 normal-hearing adults at levels corresponding to each listener's loudness judgments for four categories on Contour Test of Loudness. Group mean ABR wave V and MLR wave Pa latency values increased significantly as loudness judgments decreased. Group mean amplitude values for ABR wave V-V' and MLR wave Na-Pa increased as the listeners' categorical judgments increased. Listeners assigned a broad range (30 to 40 dB) of stimulus intensities when judging loudness of these stimuli within a specific loudness category. This was true for all four loudness categories and both frequencies. Thus, it appears that tone-evoked ABR/MLR response measures reflect, in part, the listener's perception of loudness. Response latencies are a more sensitive indicator of listener's loudness percept than corresponding response amplitudes. An appreciable range of signal levels was judged to be categorically equivalent across listeners. Thus, limiting how loudness judgments can be applied to prescriptive hearing aid fittings in individuals who cannot provide accurate loudness judgments.

Auditory Brainstem and Middle Latency Responses Measured Pre- and Posttreatment for Hyperacusic Hearing-Impaired Persons Successfully Treated to Improve Sound Tolerance and to Expand the Dynamic Range for Loudness: Case Evidence.

In this report of three cases, we consider electrophysiologic measures from three hyperacusic hearing-impaired individuals who, prior to treatment to expand their dynamic ranges for loudness, were problematic hearing aid candidates because of their diminished sound tolerance and reduced dynamic ranges. Two of these individuals were treated with structured counseling combined with low-level broadband sound therapy from bilateral sound generators and the third case received structured counseling in combination with a short-acting placebo sound therapy. Each individual was highly responsive to his or her assigned treatment as revealed by expansion of the dynamic range by at least 20 dB at one or more frequencies posttreatment. Of specific interest in this report are their latency and amplitude measures taken from tone burst-evoked auditory brainstem response (ABR) and cortically derived middle latency response (MLR) recordings, measured as a function of increasing loudness at 500 and 2,000 Hz pre- and posttreatment. The resulting ABR and MLR latency and amplitude measures for each case are considered here in terms of pre- and posttreatment predictions. The respective pre- and posttreatment predictions anticipated larger pretreatment response amplitudes and shorter pretreatment response latencies relative to typical normal control values and smaller normative-like posttreatment response amplitudes and longer posttreatment response latencies relative to the corresponding pretreatment values for each individual. From these results and predictions, we conjecture about the neural origins of the hyperacusis conditions (i.e., brainstem versus cortical) and the neuronal sites responsive to treatment. The only consistent finding in support of the pre- and posttreatment predictions and, thus, the strongest index of hyperacusis and positive treatment-related effects was measured for MLR latency responses for wave Pa at 2,000 Hz. Other response indices, including ABR wave V latency and wave V-V' amplitude and MLR wave Na-Pa amplitude for 500 and 2,000 Hz, appear either ambiguous across and/or within these individuals. Notwithstanding significant challenges for interpreting these findings, including associated confounding effects of their sensorineural hearing losses and differences in the presentation levels of the toneburst stimuli used to collect these measures for each individual, our limited analyses of three cases suggest measures of MLR wave Pa latency at 2,000 Hz (reflecting cortical contributions) may be a promising objective indicator of hyperacusis and dynamic range expansion treatment effects.

Development of a formative and summative assessment system for AuD education.

PURPOSE: This article provides an overview of a comprehensive assessment system that documents that students have obtained the skills and knowledge necessary to obtain a Doctor of Audiology (AuD) degree. METHOD: The individual components of the assessment system; rationale for development of each assessment; and grading criteria, outcomes measures, faculty commentary, missteps, and successes of the system are discussed. CONCLUSION: Carefully planned and dynamic assessments can be integrated successfully into the AuD students' program of study with generally reasonable expectations for faculty workload. It is crucial for program directors to continually assess the system used to document student learning and to make modifications based on formal and informal feedback from students, faculty, alumni, evidence based clinical practice, and clinical preceptors.

Auditory steady-state responses.

BACKGROUND: The auditory steady state response (ASSR) is an auditory evoked potential (AEP) that can be used to objectively estimate hearing sensitivity in individuals with normal hearing sensitivity and with various degrees and configurations of sensorineural hearing loss (SNHL). For this reason, many audiologists want to learn more about the stimulus and recording parameters used to successfully acquire this response, as well as information regarding how accurately this response predicts behavioral thresholds across various clinical populations. PURPOSE: The scientific goal is to create a tutorial on the ASSR for doctor of audiology (Au.D.) students and audiologists with limited (1-5 yr) clinical experience with AEPs. This tutorial is needed because the ASSR is unique when compared to other AEPs with regard to the type of terminology used to describe this response, the types of stimuli used to record this response, how these stimuli are delivered, the methods of objectively analyzing the response, and techniques used to calibrate the stimuli. A second goal is to provide audiologists with an understanding of the accuracy with which the ASSR is able to estimate pure tone thresholds in a variety of adult and pediatric clinical populations. DESIGN: This tutorial has been organized into various sections including the history of the ASSR, unique terminology associated with this response, the types of stimuli used to elicit the response, two common stimulation methods, methods of objectively analyzing the response, technical parameters for recording the ASSR, and the accuracy of ASSR threshold prediction in the adult and pediatric populations. In each section of the manuscript, key terminology/concepts associated with the ASSR are bolded in the text and are also briefly defined in a glossary found in the appendix. The tutorial contains numerous figures that are designed to walk the reader through the key concepts associated with this response. In addition, several summary tables have been included that discuss various topics such as the effects of single versus multifrequency stimulation techniques on the accuracy of estimating behavioral thresholds via the ASSR; differences, if any, in monaural versus binaural ASSR thresholds; the influence of degree and configuration of SNHL on ASSR thresholds; test-retest reliability of the ASSR; the influence of neuro-maturation on ASSR thresholds; and the influence of various technical factors (i.e., oscillator placement, coupling force, and the number of recording channels) that affect bone conducted ASSRs. CONCLUSION: Most researchers agree that, in the future, ASSR testing will play an important role in clinical audiology. Therefore, it is important for clinical audiologists and Au.D. students to have a good basic understanding of the technical concepts associated with the ASSR, a knowledge of optimal stimulus and recording parameters used to accurately record this response, and an appreciation of the current role and/or limitations of using the ASSR to estimate behavioral thresholds in infants with various degrees and configurations of hearing loss.

Survey of the diagnosis and management of auditory processing disorder.

PURPOSE: A survey of audiologists' diagnosis and intervention protocols for auditory processing disorder (APD) was conducted to determine current protocols and compare results with published recommendations. METHOD: A survey was distributed by mail to 515 American Speech-Language-Hearing Association audiology members who listed APD as an area of expertise and via e-mail to Educational Audiology Association members. The survey was completed by 195 audiologists. RESULTS: The majority of respondents reported using auditory processing (AP) test batteries selected based on clinical experience, review of the literature, and attendance at professional conferences. The most popular tests were dichotic, monaural low-redundancy speech, and temporal processing tests. Treatment and management recommendations were usually customized for each patient based on deficits found in behavioral AP testing. The majority of respondents indicated that audiologists are responsible for APD diagnosis (97%) and recommendation of treatment/management (81%); in contrast, only 40% of respondents indicated audiologists were responsible for providing treatment/management. CONCLUSIONS: Audiologists are selecting AP test batteries based on the age and case history of the patient, which is in accordance with recent national guidelines. Audiologists are primarily responsible for APD diagnosis and recommending treatment/management. APD treatment is provided by speech-language pathologists, educators, and audiologists.

Effects of various articulatory features of speech on cortical event-related potentials and behavioral measures of speech-sound processing.

OBJECTIVE: To investigate the effects of three articulatory features of speech (i.e., vowel-space contrast, place of articulation of stop consonants, and voiced/voiceless distinctions) on cortical event-related potentials (ERPs) (waves N1, mismatch negativity, N2b, and P3b) and their related behavioral measures of discrimination (d-prime sensitivity and reaction time [RT]) in normal-hearing adults to increase our knowledge regarding how the brain responds to acoustical differences that occur within an articulatory speech feature and across articulatory features of speech. DESIGN: Cortical ERPs were recorded to three sets of consonant-vowel speech stimuli (/bi versus /bu/, /ba/ versus /da/, /da/ versus /ta/) presented at 65 and 80 dB peak-to-peak equivalent SPL from 20 normal-hearing adults. All speech stimuli were presented in an oddball paradigm. Cortical ERPs were recorded from 10 individuals in the active-listening condition and another 10 individuals in the passive-listening condition. All listeners were tested at both stimulus intensities. RESULTS: Mean amplitudes for all ERP components were considerably larger for the responses to the vowel contrast in comparison with the responses to the two consonant contrasts. Similarly, the mean mismatch negativity, P3b, and RT latencies were significantly shorter for the responses to the vowel versus consonant contrasts. For the majority of ERP components, only small nonsignificant differences occurred in either the ERP amplitude or the latency response measurements for stimuli within a particular articulatory feature of speech. CONCLUSIONS: The larger response amplitudes and earlier latencies for the cortical ERPs to the vowel versus consonant stimuli are likely related, in part, to the large spectral differences present in these speech contrasts. The measurements of response strength (amplitudes and d-prime scores) and response timing (ERP and RT latencies) for the various cortical ERPs suggest that the brain may have an easier task processing the steady state information present in the vowel stimuli in comparison with the rapidly changing formant transitions in the consonant stimuli.

Speech evoked potentials: from the laboratory to the clinic.

Speech-evoked auditory event-related potentials (ERPs) provide insight into the neural mechanisms underlying speech processing. For this reason, ERPs are of great value to hearing scientists and audiologists. This article will provide an overview of ERPs frequently used to examine the processing of speech and other sound stimuli. These ERPs include the P1-N1-P2 complex, acoustic change complex, mismatch negativity, and P3 responses. In addition, we focus on the application of these speech-evoked potentials for the assessment of (1) the effects of hearing loss on the neural encoding of speech allowing for behavioral detection and discrimination; (2) improvements in the neural processing of speech with amplification (hearing aids, cochlear implants); and (3) the impact of auditory training on the neural processing of speech. Studies in these three areas are reviewed and implications for audiologists are discussed.

Effects of sensorineural hearing loss and personal hearing AIDS on cortical event-related potential and behavioral measures of speech-sound processing.

OBJECTIVE: To systematically investigate the combined effects of sensorineural hearing loss and prescribed personal hearing aid(s) on cortical event-related potentials (ERPs) (waves N1, MMN, N2b, and P3b) and their related behavioral measures of discrimination (d-prime sensitivity and reaction time) to the speech sounds /ba/ and /da/ presented at 65 and 80 dB peak-to-peak equivalent SPL. DESIGN: Cortical ERPs were recorded to /ba/ and /da/ speech stimuli presented at 65 and 80 dB peak-to-peak equivalent SPL from 20 normal-hearing adults and 14 adults with sensorineural hearing losses. The degree of sensorineural impairment at 1000 to 2000 Hz ranged from moderate losses (50 to 74 dB HL) to severe-profound losses (75 to 120 dB HL). The speech stimuli were presented in an oddball paradigm and cortical ERPs were recorded in both active and passive listening conditions at both stimulus intensities. The adults with hearing impairments were tested in the unaided and aided conditions at each stimulus intensity. Electroacoustic and real-ear testing was performed on each subject's hearing aid(s) before electrophysiology testing to ensure that the hearing aids were functioning at the time of testing. RESULTS: The use of personal hearing aids substantially improved the detectability of all the cortical ERPs and behavioral d-prime performance scores at both stimulus intensities. This was especially true for individuals with severe-profound hearing losses. At 65 dB SPL, mean ERP amplitudes and d-prime sensitivity scores were all significantly higher or better in the aided versus unaided condition. At 80 dB SPL, only the N1 amplitudes and d-prime sensitivity scores were significantly better in the aided condition. Even though the majority of the hearing-impaired subjects showed increased amplitudes, decreased latencies, and better waveform morphology in the aided condition, the amount of response change (improvements) seen in these measures showed considerable variability across subjects. When compared with the responses obtained from the normal-hearing subjects, both hearing-impaired groups had significantly prolonged aided RT latencies at both stimulus intensities and N2b latencies at the higher stimulus intensities. CONCLUSIONS: These results suggest that hearing-impaired individuals' brains process speech stimuli with greater accuracy and in a more effective manner when these individuals use their personal hearing aids. This is especially true at the lower stimulus intensity. The effects of sensorineural hearing loss and personal hearing aids on cortical ERPs and behavioral measures of discrimination are dependent on the degree of sensorineural loss, the intensity of the stimuli, and the level of cortical auditory processing that the response measure is assessing. The possible clinical significance of these cortical ERP and behavioral findings is discussed.