Self-reported hearing loss in urban Aboriginal and Torres Strait Islander adults: unmeasured, unknown and unmanaged.

Background Effective management of hearing loss in adults is fundamental for communication, relationships, employment, and learning. This study examined the rates and management of self-reported hearing loss in urban Aboriginal and Torres Strait Islander adults. Methods A retrospective, observational study of Aboriginal and Torres Strait Islander people aged ≥15years who had annual health checks at an urban Aboriginal and Torres Strait Islander primary healthcare clinic in Inala, Queensland, was conducted to determine self-reported hearing loss rates by age and ethnic groups stratified by sex. A medical record audit of patients who self-reported hearing loss from January to June 2021 was performed to identify current management approaches, and the proportion of patients that were appropriately managed. Results Of the 1735 patients (average age 40.7years, range 15.0-88.5years, 900 [52.0%] women) who completed 3090 health checks between July 2018 and September 2021, 18.8% self-reported hearing loss. Rates did not differ between men and women. However, significant effects were noted for age, with rates increasing from 10.7% for patients aged 15-24years to 38.7% for those aged ≥65years. An audit of 73 patient medical records revealed that 39.7% of patients with self-reported hearing loss were referred to Ear, Nose and Throat/audiology or received other management. A total of 17.8% of patients owned hearing aids. Conclusions Only 40% of Aboriginal and Torres Strait Islander adults who self-reported hearing loss were referred for management. Significant changes to clinical management and government-funded referral options for hearing services are required to improve the management of self-reported hearing loss in this population.

A comment on the order of report in two-pair dichotic digit testing in children assessed for auditory processing.

OBJECTIVE: This clinical note aimed to 1) describe the order-of-report (OoR) strategies used by a large sample of children who completed 2pDD testing in the free-recall condition as part of an audiological assessment of auditory processing (AP), and 2) determine if use of OoR correlated with 2pDD test performance. DESIGN: A retrospective (case-review), single observation design. STUDY SAMPLE: A convenient sample of 77 children (50 males and 27 females aged 7.0 to 17.4 years [median = 8.8 years]) referred to audiology for an AP assessment. RESULTS: The participating children used temporal more than ear or sequential OoR and showed decreased test scores with increased use of ear OoR. CONCLUSIONS: These findings suggest children referred for an AP assessment could favour a temporal OoR when completing 2pDD testing for its opportunity to rehearse the first digit pair (possibly strengthening its memory trace) prior to processing the second digit pair, while their use of an ear OoR could come at the cost detrimental ear dominance effects that reduce their test performance. Future research could consider if similar results are observed in other child populations and if preferred dichotic processing strategy could inform auditory training for children with dichotic listening deficits.

Audiological ototoxicity monitoring guidelines: a review of current evidence and appraisal of quality using the AGREE II tool.

OBJECTIVE: The effectiveness of audiological monitoring for detecting early hearing changes in patients receiving ototoxic medication could be limited by the lack of adequate audiological ototoxicity monitoring (OtoM) guidelines. This study aimed to evaluate existing OtoM guidelines using the AGREE II tool for guideline evaluation. DESIGN: Guideline Review. STUDY SAMPLE: Three audiological OtoM guidelines. RESULTS: An online search identified three audiological OtoM guidelines published by the American Speech-Language and Hearing Association (ASHA), the American Academy of Audiology (AAA) and the Health Professionals Council of South Africa (HPCSA). Evaluation using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool found the HPCSA audiological OtoM guideline scored higher than the ASHA and AAA guidelines in five of the six tool domains. All guidelines received average domain ratings of less than 50% with each reviewer recommending all three guidelines for use following modification. CONCLUSION: The findings of this study could partly explain the poor uptake of audiological OtoM practices internationally, further investigation is needed to identify the specific factors limiting the implementation of audiological OtoM in clinical practice.

Barriers to Adoption of Digital Therapeutics (DTx) into Audiology Clinical Practice: Acknowledging the Challenges, Adapting to the Future.

The continuous advancements in technologies supporting digital health and digital therapeutics (DTx) bring new possibilities to the field of audiology. This study considers a new DTx for tinnitus called Tinnibot and the willingness of a group of Australian university audiology students to consider this new DTx in their future careers as practicing audiologists. A single-group case-series design (pretest/posttest) was used to examine the opinions of 10 university audiology students before and after participating in a 2-hour information workshop on the topics of tinnitus, DTx, cognitive behavioral therapy, and a new digital therapy tool for tinnitus called Tinnibot. Student knowledge levels of the main topic areas increased from poor (before the workshop) to moderate to high after the workshop, with 40% of participants reporting they would very likely use digital therapies for future patients. A common barrier to improving this rating was the need for direct hands-on training on the DTx before the students would be confident to recommend the DTx to patients. Incorporating direct training on DTx into university audiology programs would allow greater uptake of DTx by students as they begin their careers as practicing audiologists.

Modulations of right hemisphere connectivity in young children relates to the perception of spoken words.

The early school years shape a young brain's capability to comprehend and contextualize words within milliseconds of exposure. Parsing word sounds (phonological interpretation) and word recognition (enabling semantic interpretation) are integral to this process. Yet little is known about the causal mechanisms of cortical activity during these early developmental stages. In this study, we aimed to explore these causal mechanisms via dynamic causal modelling of event-related potentials (ERPs) acquired from 30 typically developing children (ages 6-8 years) as they completed a spoken word-picture matching task. Source reconstruction of high-density electroencephalography (128 channels) was used to ascertain differences in whole-brain cortical activity during semantically "congruent" and "incongruent" conditions. Source activations analyzed during the N400 ERP window identified significant regions-of-interest (pFWE<.05) localized primarily in the right hemisphere when contrasting congruent and incongruent word-picture stimuli. Dynamic causal models (DCMs) were tested on source activations in the fusiform gyrus (rFusi), inferior parietal lobule (rIPL), inferior temporal gyrus (rITG) and superior frontal gyrus (rSFG). DCM results indicated that a fully connected bidirectional model with self-(inhibiting) connections over rFusi, rIPL and rSFG provided the highest model evidence, based on exceedance probabilities derived from Bayesian statistical inferences. Connectivity parameters of rITG and rSFG regions from the winning DCM were negatively correlated with behavioural measures of receptive vocabulary and phonological memory (pFDR<.05), such that lower scores on these assessments corresponded with increased connectivity between temporal pole and anterior frontal regions. The findings suggest that children with lower language processing skills required increased recruitment of right hemisphere frontal/temporal areas during task performance.

A Systematic Review of the Effect of Hearing Aids on Static and Dynamic Balance in Adults with Hearing Impairment.

This preregistered systematic review examined the peer-reviewed scientific literature to determine the effect of hearing aids (HAs) on static and dynamic balance in adults with Hearing Impairment (HI). A search of the English language literature in seven academic databases identified 909 relevant articles published prior to July 2021. Ten articles contained studies that met the inclusion criteria for this review. Seven studies had measured static balance with five reporting improvements and one reporting no changes in balance with HA use. Two studies had measured dynamic balance with both reporting no changes with HA use. One study had measured both dynamic and static balance and reported no changes with HA use. For adults with HI, the evidence was equivocal that amplification from HAs improves balance. High quality studies investigating the effect of HAs on balance in adults with HI are needed given this field is likely to develop in response to the growing population of adults with hearing and balance impairment worldwide.

Diagnostic and management plan concordance across advanced audiologists, paediatric audiologists and non-specialist ENT doctors.

OBJECTIVE: To compare the concordance of advanced audiologists (AA), junior doctors (JD) and paediatric audiologists (PA) with an Ear, Nose and Throat (ENT) specialist on the diagnosis and management of children with middle ear or hearing concerns. DESIGN: A clinical equivalence (concordance) study. STUDY SAMPLE: Three AAs, five JDs, three PAs and one ENT specialist asynchronously reported diagnoses and management plans for ten, online paediatric cases consisting of video-otoscopic images and clinical findings. RESULTS: For medical diagnosis, significant agreement with the ENT specialist was observed at moderate and near-perfect levels for two AAs (k = 0.561 and 0.815), moderate levels for four JDs (k = 0.5 to 0.603) and near-perfect level for one PA (k = 0.815). For management decisions, significant agreement with the ENT specialist was observed at substantial (k = 0.636) and near-perfect (k = 0.818) levels for two AAs, and at a moderate level (k = 0.538) for one PA. Within group inter-rater agreement for management plans was substantial for AAs and JDs, and moderate for PAs. CONCLUSIONS: For children with middle ear disease or hearing concerns, AAs, JDs and PAs showed similar levels of agreement with an ENT specialist on diagnosis, but AAs were more likely than JDs or PAs to agree with an ENT specialist on management.

Extended High Frequency Hearing, but Not Tinnitus, Is Associated With Every-Day Cognitive Performance.

Research into the potential associations between tinnitus and cognition has investigated specific cognitive domains in laboratory settings despite adults with tinnitus reporting broad cognitive difficulties in every-day life. To address this limitation, the present study compared performance and perceived exertion on a visual office-like task in 38 adults with tinnitus (19 with normal hearing and 19 with hearing loss) and 38 adults without tinnitus (19 with normal hearing and 19 with hearing loss) matched for age, sex and educational background. All participants were also assessed for hearing, anxiety and depression, and participants with tinnitus were also assessed for tinnitus handicap. No associations were found between presence of tinnitus and cognitive performance (mean total rate correct score on the visual office-like task being 2.9 for the tinnitus group, 2.8 for the control group, p = 0.612) and perceived exertion (mean ratings of perceived exertion on the Borg CR10-scale being 5.8 for the tinnitus group, 6.5 for the control group, p = 0.063) on the visual office-like task when corrected for standard (0.125 to 8 kHz) and extended high frequency (10 to 16 kHz) hearing thresholds, anxiety, and depression. The correction for extended high frequency average (10, 12.5, 14, and 16 kHz) hearing threshold was significant for performance (p = 0.009) but not perceived exertion on the visual office-like task. Overall, the results showed extended high frequency hearing, but not tinnitus, was associated with every-day cognitive performance. This indicates clinical testing of hearing thresholds above 8 kHz could support clinicians' identification and management of cognitive difficulties. One management method suggested by the current findings would include provision of auditory stimulation at frequencies exceeding the frequency response of many current hearing aids.

Auditory training for adults with cochlear implants: a systematic review.

OBJECTIVE: To systematically review the peer-reviewed literature on the efficacy of auditory training (AT) on auditory outcomes in post lingually deafened adults with cochlear implants (CIs). DESIGN: A systematic review. STUDY SAMPLE: Searches of five electronic databases yielded 10 studies published after 2010 that met the inclusion criteria. RESULTS: For post lingually deafened adults with CIs, the evidence is suggestive that some AT can improve some auditory outcomes compared to no training. More specifically, the evidence suggests that phonemic training can improve identification of trained phonemes, and nonsense word training can improve sentence recognition in noise in this population. CONCLUSIONS: While many AT interventions are currently being used with post lingually deafened adults with CIs, the evidence for AT improving auditory outcomes is suggestive with the best evidence being for nonsense word training improving sentence recognition in noise by an average of 10% with these improvements retained at 26 weeks post-training in this population. There remains a need for high quality studies that have the capacity to demonstrate, clearly and unequivocally, which AT is most effective for improving which auditory outcomes in this population.

Parental satisfaction with an advanced audiology-led triage service in paediatric ENT outpatient clinics.

OBJECTIVE: The advanced audiology-led service is designed to triage and manage children who are referred to Ear Nose and Throat (ENT) outpatient services with middle ear or hearing concerns. This service has resulted in shorter waiting times for children to receive ENT treatment, and improved ENT capacity. The aim of this study was to explore parental satisfaction with the advanced audiology-led ENT service and to determine if there were cultural or process factors affecting satisfaction. DESIGN: Prospective cross-sectional study using a modified Visit-Specific Satisfaction Questionnaire (VSQ-9) survey. STUDY SAMPLE: One hundred and thirteen parents of children consecutively attending a first appointment in the advanced audiology-led service recruited between October 2016 and October 2017. RESULTS: There were a total of 100 valid responses (rate of 88.5%). The survey showed high levels of satisfaction. Satisfaction scores were significantly higher for items related to interactions with the audiologist compared to items related to waiting times. There were no differences in satisfaction across cultural groups. Parents were equally satisfied with the service whether their child was managed independently by the audiologist or required another appointment for medical input. CONCLUSIONS: The advanced audiology-led service had high levels of satisfaction from parents attending with their children.

The suitability and readability of cochlear implant information brochures for potential adult recipients.

OBJECTIVE: Adult cochlear implant (CI) candidates seeking to make an informed decision about cochlear implantation can find themselves needing to quickly understand large volumes of complex information provided by different professionals in different formats. This study investigates the suitability, within a health literacy context, of one of those sources of information: the CI brochure. DESIGN: A single-observation design. STUDY SAMPLE: Thirty English passages of approximately 100-words each were sampled from 15 sections of seven CI brochures. All brochures were readily available to the general public on the Australian websites of four CI manufacturers at the time of the analysis (June 2019). RESULTS: Analyses by two examiners using the Suitability Assessment of Materials (SAM) classified all 15 sections from all seven CI brochures as being "not suitable" for general, adult readers. Analyses by the same examiners using four readability formulae (Flesch Reading Ease Scale, Fry Readability Graph, Flesch-Kincaid Readability Formula, and the Fog index) showed sampled passages from the 15 sections were written at a level best suited for persons with 10 to 14 years of schooling. CONCLUSIONS: Brochures intended for adult CI candidates should be revised to improve their suitability and readability for adult CI candidates. Specific recommendations are suggested.

A preliminary investigation of sound-field amplification as an inclusive classroom adjustment for children with and without Autism Spectrum Disorder.

PURPOSE: This study aimed to determine if sound-field amplification (SFA) could be used as an inclusive classroom adjustment to support primary school students with and without Autism Spectrum Disorder (ASD). METHODS: A two-group, randomised controlled trial (RCT) with crossover was conducted involving 13 students with ASD (9 males, aged 7.6 to 8.4 years) and 17 typically progressing students without ASD (7 males, aged 7.6 to 9.3 years) from 10 primary schools in and near to Brisbane, Australia. Eighteen of these children had an SFA system in their classrooms in semester one and 12 in semester two of their fourth year of formal schooling (Year 3). Potential proximate benefits were assessed using teacher questionnaire and video analysis of student listening behaviours. Potential distant benefits were assessed using measures of phonological processing in quiet and in noise, attention, memory, and educational achievement. RESULTS: Potential proximate benefits were observed for all students with teachers rating student listening behaviours higher with SFA versus without SFA. Potential distant benefits were observed for students with ASD who showed greater improvements in one area of phonological processing (blending nonsense words in noise) following SFA versus no SFA. No other potential proximate or distant benefits following SFA were observed. CONCLUSIONS: SFA could be used as an inclusive classroom adjustment to support some primary school students with and without ASD by potentially putting those students in a better position to learn, but their learning must still take place over time and realistic expectations of what can reasonably be achieved by SFA alone are needed.

Can an advanced audiology-led service reduce waiting times for paediatric ear nose and throat outpatient services?

AIM: Children with middle ear disease often experience lengthy delays waiting for outpatient paediatric ear nose and throat (ENT) services. This study aimed to investigate whether an alternative service delivery model using audiologists working in an expanded scope of practice reduced waiting times for children to access such services. METHODS: A total of 131 children consecutively referred to a large ENT outpatient service in Queensland, Australia, for middle ear and hearing concerns were prospectively allocated to either a standard ENT service or an advanced audiology (AA)-led service. Waiting times and attendance rates were collected and compared between the two patient groups. RESULTS: The median waiting time from referral to first offered appointment was 96 days for children in the AA-led service versus 417.5 days for children in the standard ENT service. Seventy-nine percent of children in the AA-led service attended their first offered appointment versus 61% in the standard ENT service. For children receiving grommets, the median waiting time from initial referral to grommet insertion was 226 days for children in the AA-led service versus 627 days for children in the standard ENT service. CONCLUSION: The AA-led service was an effective alternative pathway to reduce waiting times for children referred to ENT services with middle ear and hearing concerns.

The impact of tinnitus on working memory capacity.

OBJECTIVE: To determine if tinnitus was related to working memory (WM) in adults and if tinnitus handicap was related to WM in adults with tinnitus. DESIGN: Two groups, cross-sectional design. STUDY SAMPLES: 76 adults forming a tinnitus group (n = 38) and a control group (n = 38). Each group included 19 adults with normal hearing and 19 adults with hearing loss matched for age, sex and educational backgrounds. All participants completed the visual n-back test; pure tone audiometry (0.125-16 kHz); and the Hospital Anxiety and Depression Scale (HADS). Tinnitus sufferers also completed the Tinnitus Handicap Inventory (THI). RESULTS: For all participants, tinnitus was not related to WM scores when corrected for hearing thresholds, anxiety, and depression. The corrections for best ear high-frequency pure-tone average hearing threshold (BEHFPTA: 10, 12.5, 14 and 16 kHz) were significant. For tinnitus sufferers, THI was related to WM scores in the easiest n-back condition, and BEHFPTA was related to WM scores in the easiest and the hardest n-back condition. CONCLUSION: Tinnitus was not related to WM scores. Tinnitus handicap was related to some WM scores in tinnitus sufferers. Further investigation of the possible relationship between high-frequency hearing and WM is warranted.

The validity of an isiZulu speech reception threshold test for use with adult isiZulu speakers.

BACKGROUND: This study continued the development of an isiZulu speech reception threshold (zSRT) test for use with first language, adult speakers of isiZulu. OBJECTIVES: The objective of this study was to determine the convergent and concurrent validity of the zSRT test. METHODS: One hundred adult isiZulu first-language speakers with normal hearing and 76 first-language, adult isiZulu speakers with conductive or sensorineural hearing losses ranging from mild to severe were assessed on pure tone audiometry and a newly developed isiZulu SRT test. Convergent validity was established through agreement of the zSRT scores with pure tone average (PTA) scores. Concurrent validity was assessed by examining the steepness of the psychometric curve for each word in the zSRT test for each type and degree of hearing loss. RESULTS: Intraclass correlation coefficient analyses showed zSRT scores were in substantial to very high agreement with PTA scores for the normal hearing and hearing loss groups (NH - right ear ICC consistency = 0.78, left ear ICC = 0.67; HL - right ear ICC consistency = 0.97, left ear ICC consistency = 0.95). The mean psychometric slope (%/dB) at 50% correct perception for all words in the zSRT test was 4.92%/dB for the mild conductive hearing loss group, 5.26%/dB for the moderate conductive hearing loss group, 2.85%/dB for the moderately severe sensorineural hearing loss group and 2.47%/dB for the severe sensorineural hearing loss group. These slopes were appropriate for the degree of hearing loss observed in each group. CONCLUSION: The zSRT test showed convergent and concurrent validity for assessing SRT in first language, adult speakers of isiZulu.

Systematic review protocol for assessing central auditory functions of Alzheimer's disease and its preclinical stages.

INTRODUCTION: A number of studies have reported an association between peripheral hearing impairment, central auditory processing and Alzheimer's disease (AD) and its preclinical stages. Both peripheral hearing impairment and central auditory processing disorders are observed many years prior to the clinical manifestation of AD symptoms, hence, providing a long window of opportunity to investigate potential interventions against neurodegenerative processes. This paper outlines the protocol for a systematic review of studies examining the central auditory processing functions in AD and its preclinical stages, investigated through behavioural (clinical assessments that require active participation) central auditory processing tests. METHODS AND ANALYSIS: We will use the keywords and Medical Subject Heading terms to search the following electronic databases: MEDLINE, PsychINFO, PubMed, Scopus, EMBASE and CINAHL Plus. Studies including assessments of central auditory function in adults diagnosed with dementia, AD and its preclinical stages that were published before 8 May 2019 will be reviewed. This review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Data analysis and search results will be reported in the full review. This manuscript has designed the protocols for a systematic review that will identify the behavioural clinical central auditory processing measures that are sensitive to the changes in auditory function in adults with AD and its preclinical stages. Such assessments may subsequently help to design studies to examine the potential impact of hearing and communication rehabilitation of individuals at risk of AD. ETHICS AND DISSEMINATION: Ethical approval is not required as this manuscript only reports the protocols for conducting a systematic review as primary data will only be reviewed and not be collected. The results of this systematic review will be disseminated through publication and in scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42017078272.

Learning difficulties and auditory processing deficits in a clinical sample of primary school-aged children.

Objective: The current study examined the relationship between learning and auditory processing (AP) ability in a clinical sample of children with and without learning difficulties (LD).Design: A non-randomised, cross-sectional, single measure research design was used.Study sample: The participants consisted of 50 children (7.7-10.8 years) who had been referred for a clinical AP assessment based on having been referred from a school-based AP screening. These children had previously been identified as having (n = 14) or not having (n = 36) LD.Results: Children with LD performed significantly worse than children without LD on frequency patterns with linguistic reports (FPlinR and FPlinL), dichotic digits (DD) and Auditory Word Memory - Forward (ANMF) tests, with significant correlations being observed between these variables and the learning score. The multiple linear regression showed that FPlinR, DDR and ANMF scores explained 50% of the variance in the learning score.Conclusion: The present study's results are most consistent with risk factor models linking AP to learning abilities in children where reduced AP abilities could put children at greater risk for LD. Further investigations into the potential relationships between AP, cognition, speech and language development, and learning ability in children are warranted.

Effectiveness and Safety of Advanced Audiology-Led Triage in Pediatric Otolaryngology Services.

OBJECTIVES: Expansion of the scopes of practice of allied health practitioners has the potential to improve the efficiency and cost-effectiveness of healthcare, given the identified shortages in medical personnel. Despite numerous examples in other allied health disciplines, this has yet to be applied to pediatric Audiology. This study aimed to investigate the effectiveness and safety of using audiologists with advanced training to independently triage children referred to otolaryngology (ORL) services, and compare the subsequent use of specialist resources, and postoperative grommet care to a standard medical ORL service. DESIGN: One hundred twenty children consecutively referred to a large ORL outpatient service in Queensland, Australia, for middle ear and hearing concerns were prospectively allocated to either the ORL service or Advanced Audiology-led service. Demographic and clinical data were extracted from electronic medical records and compared between the two services. Clinical incidents and adverse events were recorded for the Advanced Audiology-led service. RESULTS: Approximately half of all children referred to ORL for middle ear or hearing concerns were discharged without requiring any treatment, with the remaining half offered surgical treatment. The Advanced Audiology-led model increased the proportion of children assessed by ORL that proceeded to surgery from 57% to 82% compared with the standard medical ORL model. Children followed up by the audiologists after grommet insertion were more likely to be discharged independently and at the first postoperative review appointment compared with the standard medical ORL service. There were no reports of adverse events or long-term bilateral hearing loss after discharge by the Advanced Audiology-led service. CONCLUSIONS: These findings indicate that an Advanced Audiology-led service provides a safe and effective triaging model for the independent management of children not requiring treatment, and children requiring routine postoperative grommet review, and improves the effective use of specialist resource compared with the standard medical ORL service.

White noise facilitates new-word learning from context.

Listening to white noise may facilitate cognitive performance, including new word learning, for some individuals. This study investigated whether auditory white noise facilitates the learning of novel written words from context in healthy young adults. Sixty-nine participants were required to determine the meaning of novel words placed within sentence contexts during a silent reading task. Learning was performed either with or without white noise, and recognition of novel word meanings was tested immediately after learning and after a short delay. Immediate recognition accuracy for learned novel word meanings was higher in the noise group relative to the no noise group, however this effect was no longer evident at the delayed recognition test. These findings suggest that white noise has the capacity to facilitate meaning acquisition from context, however further research is needed to clarify its capacity to improve longer-term retention of meaning.

On the definition of APD and the need for a conceptual model of terminology.

Objective: To consider the definition of auditory processing disorder (APD). Design: Narrative review and opinion piece. Study sample: Considerations of definition drawn primarily from the fields of philosophy, audition, learning and language. Results: The problem of defining APD appears genuine. Current and previous definitions of APD are nominal in nature, being both stipulative (offering explicit and arbitrary adoptions of meaning relation between words) and operational (creating rules that stipulate how the terms might apply to particular cases). Such definitions survive by consensus and perceived heuristic value in a manner that fails to achieve closure as arguments about their validity remain relative. Conclusion: A conceptual model of APD terminology is needed that considers nominal, conceptual and real definitions as well as different purposes for defining APD within professional and public domains. A framework for such a conceptual model of APD terminology is offered.