The latest medical research on Audiologist

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A Tutorial Review on Clinical Acoustic Markers in Speech Science.

Journal of Speech, Language, and

The human voice changes with the progression of neurological disease and the onset of diseases that affect articulators, often decreasing the effectiveness of communication. These changes can be objectively measured using signal processing techniques that extract acoustic features. When measuring acoustic features, there are often several steps and assumptions that might be known to experts in acoustics and phonetics, but are less transparent for other disciplines (e.g., clinical medicine, speech pathology, engineering, and data science). This tutorial describes these signal processing techniques, explicitly outlines the underlying steps for accurate measurement, and discusses the implications of clinical acoustic markers.

We establish a vocabulary using straightforward terms, provide visualizations to achieve common ground, and guide understanding for those outside the domains of acoustics and auditory signal processing. Where possible, we highlight the best practices for measuring clinical acoustic markers and suggest resources for obtaining and further understanding these measures.

Age-Related Differences of Mandarin Tone and Consonant Aspiration Perception in Babble Noise.

Journal of Speech, Language, and

This study investigated the categorical perception of Mandarin tones and consonant aspiration contrasts in babble noise among adults and adolescents aged 12-14 years, and explored the association between working memory and categorical perception.

Twenty-four adults and 20 adolescents with Mandarin as their native language were recruited. Their performances of phonemic identification and discrimination in babble noise and quiet conditions, digit span tasks, and nonword repetition were assessed.

Results indicated that, firstly, in the noise condition, both adults and adolescents showed wider boundary widths and lower between-category accuracies when perceiving aspiration of consonants than in the quiet condition, and the categorical boundary of tone perception in adolescents showed a transitional tendency toward Tone 1. Secondly, discrimination of consonant aspiration in adolescents needed to be further developed. Lastly, the accuracy of nonword repetition in adolescents was lower than that in adults, and adults with better auditory verbal working memory had better performance on tone perception.

Our results provided evidence that tone perception is acquired easier than consonant aspiration perception, and tone perception is more robust and less susceptible to noise interference. Categorical perception performance relates to the capacity and utilization of auditory verbal working memory in some ways.

Glottal Stop Production in Controls and Patients With Unilateral Vocal Fold Paresis/Paralysis.

Journal of Speech, Language, and

The purposes of this study were to determine whether the acoustic measures from glottal stops distinguished between controls and patients with unilateral vocal fold paresis/paralysis (UVFP) at initial evaluation and posttreatment/observation, to explore the types of false vocal fold (FVF) movement during glottal stop production in UVFP, and to assess the agreement between normalization of various measures and reported voice normalization.

Patients with UVFP and controls were recorded acoustically and laryngoscopically speaking two sets of five repeated /i/s, controls once and patients with UVFP initially and posttreatment/observation. Averaged intensity differences and slopes for offsets (maximum voicing intensity to minimum glottal stop intensity) and onsets (minimum glottal stop intensity to maximum voicing intensity) were measured. FVF movements were rated separately for paretic and nonparetic sides. Patients were asked to report voice normalization posttreatment/observation. Cohen's kappas were calculated for agreements between patient-reported voice normalization and normalization of Voice-Related Quality of Life (V-RQOL), translaryngeal flow, four acoustic measures of glottal stop production, and FVF movement.

Significant differences (analysis of variance [ANOVA]; p < .014) were found for all acoustic measures between controls and patients with UVFP and between patients with UVFP initially and posttreatment/observation (paired t tests; p < .05). In addition, 78% of UVFP patients had no FVF movement on the paretic side initially, and 42% had bilateral dynamic FVF movement posttreatment/observation. Cohen's kappa showed moderate agreement between voice normalization and V-RQOL, slight agreement with offset measures, and fair agreement with onset measures.

This study provided proof of concept for using acoustic measures of glottal stops to distinguish between controls and patients with UVFP, both initially and posttreatment/observation.

Language-Fair Fast Mapping and Mutual Exclusivity Tasks for Mono- and Bilingual Preschoolers.

Journal of Speech, Language, and

Both monolingual and bilingual children use learning constraints and heuristics to acquire new words from their environment. Overall, fast mapping abilities seem to be similar in both populations, but monolinguals rely more than bilinguals on the mutual exclusivity strategy. Our study probes the robustness of these results in a large group of children learning different language combinations, with a newly devised language-fair task that relies as little as possible on previous linguistic knowledge, in order to avoid disadvantaging bilingual children.

We tested 138 3- to 5-year-old mono- and bilingual children in their dominant language (German, French, Italian, or Turkish) in a computerized task starting with a fast mapping phase, followed by a mutual exclusivity phase, using only invented nonobjects and nonwords.

As hypothesized, monolingual and bilingual children showed similar results during the initial fast mapping stage, but monolinguals relied significantly more on the mutual exclusivity strategy than their bilingual peers.

The language-fair design of our task supports the idea that differences in mutual exclusivity strategy use between mono- and bilingual children really stem from their specific linguistic background, and not from potential familiarity differences with respect to the test words. We discuss the implications of our results for bilingual language assessment in clinical or educational contexts.

Development and Utility of an International Classification of Functioning, Disability and Health Code Set for Younger-Old Adults With Fall Risk: Implications for Audiologists.

Am J Audiology

Falling is a multifactorial condition that can cause severe injury and even death in older adults. Early identification of fall risk factors, as the first step of preventive health care, can assist in reducing the negative and often debilitating effects of falls in older adults. By using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to develop an ICF code set to identify fall risk factors in older adults, health care practitioners could obtain health information in a multidimensional way.

This study describes the final phase of a comprehensive, three-phase, mixed-methods sequential study. For this third phase, a pre-post group design that focused on the audiologist's perceptions of the clinical utility of a newly developed ICF code set was employed. The questionnaire that was used for this purpose consisted of two distinct sections: clinical application and clinical utility (viz., appropriateness, accessibility, practicability, acceptability, and professional utility). Thirty practicing audiologists participated in the study. Data were analyzed for each of the two sections of the questionnaire.

Results related to clinical application indicated that regardless of the audiologists' experience in routine fall risk assessment or fall risk factor identification, the use of the developed ICF code set increased their ability to correctly identify relevant clinical aspects. Results related to clinical utility showed high scores across all five measure components, with the highest clinical utility component being acceptability, closely followed by appropriateness and professional utility, and the lowest being accessibility.

Several clinical implications have emerged from this study, including the usefulness of the ICF code set to identify and document fall risk factors in older adults, the code set's ability to guide audiologists to determine individualized assessment needs either by themselves or by other health care disciplines, and that the code set could be used by audiologists regardless of their experience in vestibular assessments.

An Investigation of Developmental Coordination Disorder Characteristics in Children With Childhood Apraxia of Speech.

Language, Speech, and Hearing Services

Children with childhood apraxia of speech (CAS) evidence a high rate of co-occurring fine and gross motor deficits. This clinical focus article reports a preliminary investigation of characteristics of developmental coordination disorder (DCD), a neurodevelopmental disorder categorized by poor motor proficiency and functional limitations, in this population.

Children with CAS underwent a comprehensive motor evaluation using the Movement Assessment Battery for Children-Second Edition, the Developmental Coordination Disorder Questionnaire, and a developmental history questionnaire to determine if they met criteria for a DCD diagnosis as specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Six out of seven participants met DCD criteria based on the DSM-5 criteria. Four of these children had a co-occurring diagnosis of developmental language disorder, and all met criteria for DCD.

Consistent with previous research, the majority of participants demonstrated motor deficits and 85% met criteria for DCD. Despite this high rate of motor deficits, only 57% had previously undergone a physical/occupational therapy evaluation and intervention and only one had a previous diagnosis of DCD. These findings suggest that formal movement assessments are essential for children with a CAS diagnosis.

Intervention Research to Increase Pediatric Hearing Device Use: A Scoping Review.

Am J Audiology

This study is a scoping review examining interventions to increase hearing device use for children.

Online databases were used to identify peer-reviewed journal articles published prior to November 1, 2021, yielding 1,288 after duplications were removed. Four articles met the inclusion criteria after articles were screened by title name and abstract and subsequent full-text screening of six articles. A qualitative analysis was conducted to identify features of the intervention studies related to the participants, design, intervention, key findings, and limitations.

The included studies were published between 1982 and 2021, and in all four studies, the children used hearing aids. All four of the studies used a longitudinal design to address hearing aid use problems, with the timeframe ranging from approximately 1 month to 6 months and had variable success in increasing use time. None of the studies included a protocol, such as counseling skills, for addressing internal challenges that interfere with hearing aid use.

Review of the limited research in this area found variable effectiveness for the interventions studied. There is an urgent need for research in this area to inform clinical practice and provide evidence-based interventions to address malleable factors that interfere with audibility for children who use hearing devices.

Factors Predicting Mental Effort Associated With Verbal Fluency: Cue Types, Switching, and Fear of Negative Evaluation.

Journal of Speech, Language, and

Verbal fluency, a task frequently employed in neuropsychological assessment, provides important word productivity data but little information about subjective effort associated with demand monitoring and resource allocation. In two experiments, this study investigated the effects of task variables (semantic vs. phonemic cues; alternating vs. nonalternating conditions) and personal factors (fear of negative evaluation and trait anxiety) on subjective effort for a wide variety of verbal fluency tasks in neurotypical individuals.

Twenty-one adults completed eight verbal fluency tasks in Experiment 1. The tasks were selected to examine effort reported for verbal fluency that differed in (a) cue types and (b) the disruptions of clustering strategies. In Experiment 2, a separate group of 50 adults completed two verbal fluency tasks twice in separate sessions. Participants also completed social-emotional measures including fear of negative evaluation and trait anxiety. Working memory was assessed as a control variable.

Experiment 1 showed greater effort for completing semantic than phonemic cue tasks and greater effort for alternating than nonalternating conditions. Alternating semantic verbal fluency yielded the greatest effort among all tasks. Differences in effort could not be accounted for by performance alone. Experiment 2 showed that greater fear toward negative evaluation was associated with greater effort. The relationship between fear and effort was not related to trait anxiety or moderated by performance levels or repeated testing.

Knowledge about factors that impact subjective effort in neurotypical individuals is fundamental to accurate interpretation of effort reported by clinical populations. This study demonstrated the multifaceted nature of subjective effort that could not be accounted for by performance alone. In addition to task variables, effort assessment needs to consider the impact of social-emotional factors such as fear toward negative evaluation.

The Impact of Self-Disclosure and Strategies for Communication Competence on Professors' Perceptions and Evaluations of Students Who Do and Do Not Stutter.

Journal of Speech, Language, and

The purpose of this study was to examine the impact of self-disclosure and strategies for communication competence on perceptual ratings and performance evaluations of undergraduate students who do and do not stutter by professors who require oral presentations.

Two hundred thirty-eight college instructors who require oral presentations in their classes participated in this study. Each participant viewed one video of six possible randomized conditions varying according to the presence and disclosure of stuttering (i.e., fluent, stuttering, stuttering + disclosure) and level of communication competence (i.e., high vs. low). Participants evaluated public speaking performance against a standardized rubric and rated the student along 16 personality traits.

Results of separate 2 × 3 analyses of variance revealed that professors perceived a student who disclosed stuttering, compared to the identical video without disclosure, more positively overall. Significant interactions between fluency (i.e., presence vs. absence of stuttering vs. disclosure of stuttering) and communication competence (i.e., high vs. low) were found for overall performance evaluation scores. The video during which the student disclosed stuttering and presented with low communication competence was given a higher score than the identical video without disclosure.

Professors respond positively to both strategies for high communication competence and self-disclosure. High communication competence behaviors mitigate positive feedback bias. Disclosure results in improved positive perceptions across levels of communication competence. For students presenting with low communication competence, disclosure may improve evaluation of performance in oral presentations. The greatest perceptual and evaluative benefits were achieved with the combination of the two strategies.

Signal Alteration of the Inner Ear on High-Resolution Three-Dimensional Constructive Interference in Steady State Sequence in Patients with Ménière's Disease and Labyrinthitis.

Audiology and Neuro-Otology

The aim of this study is to evaluate signal alteration in the inner ear using three-dimensional (3D)-constructive interference in steady state (CISS) sequence in patients with Ménière's disease and labyrinthitis and its correlation with clinical and audiological parameters.

The medical records of the department of otorhinolaryngology were searched for patients with Ménière's disease or labyrinthitis who underwent MRI with 3D-CISS sequence. Blinded analysis of these patients and of MRI from control subjects without middle or inner ear symptoms was performed to detect any signal asymmetry of the inner ear structures. The results were correlated with clinical symptoms and results of audiological and vestibular tests.

Fifty-eight patients with definite Ménière's disease and 5 patients with labyrinthitis as well as 41 control exams were included. A separate analysis was performed for patients with probable Ménière's disease (n = 68). A total of 172 3D-CISS sequences were analyzed by 2 blinded independent neuroradiologists. A CISS-hypointense signal of the inner ear structures was found in 3 patients with definite Ménière's disease (5.2%), in 4 patients with probable Ménière's disease (5.9%), and 2 patients with labyrinthitis (40%). No CISS hypointensity was found in the control group. Although no significant difference in symptoms or audiological test results was found between patients with and without this signal change, the side of hypointensity was frequently correlated with the symptomatic side and with hearing impairment.

CISS hypointensity of the inner ear structures was evident in patients with clinical conditions other than vestibular schwannoma - more frequently in labyrinthitis than in Ménière's disease. This signal alteration was frequently encountered on the same symptomatic side as that of the pathological audiology tests, but it is not a predictor for hearing or vestibular impairment.

Hearing Health Care Digital Therapeutics: Patient Satisfaction Evidence.

Am J Audiology

A digital therapeutic is a software-based intervention for a disease and/or disorder and often includes a daily, interactive curriculum and exercises; online support from a professional versed in the treatment base; and an online support community, typically active as a social chat group. Recently, the Consumer Technology Association published revised standards for digital therapeutics (DTx) that stipulate that a DTx must be evidence based and founded in scientific evidence showing effectiveness and must be supported by evidence showing improved patient satisfaction and adherence to an intervention. The purpose of this study was to investigate whether a DTx could help older adults better adjust to their hearing loss and acclimate to new hearing aids.

Thirty older adults with mild or moderate hearing loss who had never used hearing aids participated. All hearing aids were fitted remotely. Participants used a hearing health care DTx (Amptify) for 4 weeks, either immediately following receipt of the hearing aids or 4 weeks after the fitting. A control condition was watching closed caption television. Participants completed a satisfaction questionnaire that queried about their impressions of the DTx, which had items that included both a rating scale of 1-7 and open-ended questions.

Ninety-six percent of the participants reported positive benefits, and one-half reported that the DTx helped them to adjust to their new hearing aids. They assigned a score of 5.8 to one of the questionnaire items that is similar to a Net Promoter Score Benefits, which included an enhanced ability to engage in conversation and increased listening confidence.

This investigation provides scientific evidence to support the use of a hearing health care DTx, paving the way for audiologists to be able to more easily and efficiently incorporate follow-up aural rehabilitation into their routine clinical services and to be able to provide services remotely.

Real-Ear-to-Coupler Difference: Physical and Perceptual Differences.

Am J Audiology

The real-ear-to-coupler difference (RECD) is a recommended measure for accurate hearing aid fittings, especially for pediatric populations. However, for adults, many clinicians question whether it is necessary.

Hearing aids were fit on two groups of 85 older adults seen at a Veterans Administration audiology clinic. One group was fit using RECD measurements, whereas the second group was fit with population-based average RECD values. The two groups had similar pure-tone hearing thresholds.

Like previous studies, there was little difference between the measured RECD for the right and left ears among the participants. Although the majority of the measured RECDs were within 1 SD of the mean, approximately 20% of those measured were outside of the normal range. It also was found that all participants produced lower (improved) Hearing Handicap Inventory for Elderly-Screening (HHIE-S) scores from pre- to postfitting, thus suggesting a reduction in self-perceived hearing handicap.

Despite having similar prefitting HHIE-S scores, those participants who had their hearing aids fit using measured RECD values had lower postfitting scores than the group that was fit with average RECD values. Furthermore, there was a significant difference between the groups on several questions of the International Outcome Inventory-Hearing Aids, suggesting that there was higher satisfaction with the fittings based on the custom RECD rather than the fittings based on the average RECD. This study demonstrated that, in addition to performing verification using real-ear measurements, accurate conversion of dB HL to dB SPL using personalized RECD likely improved hearing aid satisfaction.