The latest medical research on Audiologist

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Cross-Sectional and Longitudinal Associations Between Quality of Parent-Child Interaction and Language Ability in Preschool-Age Children With Developmental Language Disorder.

Journal of Speech, Language, and

This study explores whether the quality of parent-child interaction is associated with language abilities cross-sectionally and longitudinally up to preschool-age among children with developmental language disorder (DLD).

Participants were 97 monolingual children with DLD and their parents from the Helsinki Longitudinal SLI study, HelSLI (baseline, age in years;months, M = 4;3, SD = 0;10), of which 71 pairs were followed longitudinally (age in years;months, M = 6;6, SD = 0;5). Video recordings from three play sessions were scored for child, parent, and dyadic behavior using Erickson's sensitivity scale protocol and mutually responsive orientation at baseline. Children's expressive and receptive language and language reasoning ability were assessed at baseline, and expressive and receptive language were assessed at follow-up.

At baseline, engaged child behavior, parent's supportive guidance, and fluent and attuned dyadic behavior were associated with better receptive language ability, and engaged child behavior and dyadic synchrony were positively associated with language reasoning ability in 3- to 6-year-olds. The child's positive engagement and fluent and attuned dyadic behavior at baseline were associated with better expressive and receptive language abilities at follow-up in 6- to 7-year-olds, respectively.

Fluent and attuned dyadic behavior is associated with better receptive language ability in preschool-age children. Parent behavior alone was not associated with language ability. A connected and mutually attuned parent-child relationship could be a protective factor for language development for children with DLD.

Low Frequency Air-Bone Gap in Meniere's Disease: Relationship With Magnetic Resonance Imaging Features of Endolymphatic Hydrops.

Ear and Hearing

The appearance of low-frequency air-bone gaps (LFABGs) in Meniere's disease (MD) is a recognized but relatively unexplored phenomenon. Two theories have been proposed to explain their etiology: increased perilymphatic pressure resulting in either reduced stapedial mobility or dampened transmission of acoustic energy, and direct contact between the dilated saccule and the stapes footplate. The aim of this study was to evaluate these two hypotheses by comparing delayed postgadolinium magnetic resonance imaging (MRI) features of two groups of patients with unilateral definite MD, those with and without LFABGs.

This retrospective case-control study was conducted at a tertiary otolaryngology unit in the United Kingdom. The study included 35 patients who satisfied the 2015 Barany criteria for unilateral definite MD. The cohort was divided into two groups, those with LFABGs (LFABG+ group) and those without (LFABG- group), according to the pure-tone audiometry performed within 6 months of MRI. Alternative potential causes for the LFABGs were excluded on the basis of otologic history, otoscopy, tympanometry, and/or imaging. Using a 4-hr delayed postgadolinium 3-dimensional fluid-attenuated inversion recovery sequence, two observers evaluated the severity of cochlear and vestibular endolymphatic hydrops (EH) and the presence of vestibular endolymphatic space contacting the oval window (VESCO). The air and bone conduction thresholds, ABGs and MRI features were compared between the LFABG+ and LFABG- groups. Where any of the variables were found to be significantly associated with the presence of ABGs, further analysis was performed to determine whether or not they were independent predictors. Continuous variables were compared using the independent t test if normally distributed, and the Mann-Whitney U test or Kruskall-Wallis test if not normally distributed. Categorical variables were compared with Pearson's Chi-squared test or Fishers/Fisher-Freeman-Halton exact tests.

There were 10 patients in the LFABG+ group (28.6%) and 25 patients in the LFABG- group (71.4%). The mean ABGs in the symptomatic ear at 500 Hz, 1 kHz, and 2 kHz were 15.1 dB ± 6.4, 10.5 dB ± 9.0, and 4.0 dB ± 7.7, respectively, in the LFABG+ group and 2.0 ± 5.8, 2.4 ± 4.4, and -0.8 ± 4.7 dB in the LFABG- group. The differences in ABGs between the two groups were statistically significant at all three test frequencies (p < 0.001 at 500 Hz, p = 0.007 at 1 kHz, and p = 0.041 at 2 kHz). The presence of ABGs was significantly associated with both the grade of vestibular EH (p = 0.049) and VESCO (p = 0.009). Further analysis showed a statistically significant association between the grade of vestibular EH and VESCO (p = 0.007), and only VESCO was an independent variable associated with the presence of LFABGs (p = 0.045).

The study findings add to the existing body of evidence that LFABGs are a true audiological finding in MD and allow us to propose a mechanism. Analysis of delayed gadolinium-enhanced MRI suggests that direct contact between the distended saccule and the inner surface of the stapes footplate is the more likely underlying pathophysiological mechanism for this audiometric phenomenon.

Effects of Sequential Bilateral Cochlear Implantation in Children: Evidence from Speech-Evoked Cortical Potentials and Tests of Speech Perception.

Audiology and Neuro-Otology

Benefits of bilateral cochlear implants (CI) may be compromised by delays to implantation of either ear. This study aimed to evaluate the effects of sequential bilateral CI use in children who received their first CI at young ages, using a clinical set-up.

One-channel cortical auditory evoked potentials and speech perception in quiet and noise were evoked at repeated times (0, 3, 6, 12 months of bilateral CI use) by unilateral and bilateral stimulation in 28 children with early-onset deafness. These children were unilaterally implanted before 3.69 years of age (mean ± SD of 1.98 ± 0.73 years) and received a second CI after 5.13 ± 2.37 years of unilateral CI use. Comparisons between unilaterally evoked responses were used to measure asymmetric function between the ears and comparisons between bilateral responses and each unilateral response were used to measure the bilateral benefit.

Chronic bilateral CI promoted changes in cortical auditory responses and speech perception performance; however, large asymmetries were present between the two unilateral responses despite ongoing bilateral CI use. Persistent cortical differences between the two sides at 1 year of bilateral stimulation were predicted by increasing age at the first surgery and inter-implant delay. Larger asymmetries in speech perception occurred with longer inter-implant delays. Bilateral responses were more similar to the unilateral responses from the first rather than the second CI.

These findings are consistent with the development of the aural preference syndrome and reinforce the importance of providing bilateral CIs simultaneously or sequentially with very short delays.

Achondroplasia and severe sensorineural hearing loss: The role of active bone conduction implants.

Cochlear Implants International

The BONEBRIDGE is a partially implantable, transcutaneous bone conduction device that can be used to treat conductive or mixed mild-to-moderate hea...

A Scoping Review of Technology and Infrastructure Needs in the Delivery of Virtual Hearing Aid Services.

Am J Audiology

The digital health revolution has brought forward integral technological advancements enabling virtual care as a readily accessible delivery model. Despite this forward momentum, the field of audiology still faces barriers that impede the uptake of virtual services into routine clinical practice. The aim of this study was to gather, synthesize, and summarize the literature around virtual hearing aid intervention studies and the related technology and infrastructure requirements.

A scoping review was conducted using MEDLINE, CINAHL, Scopus, Nursing and Allied Health, and Web of Science databases. Objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol.

The 11 studies identified through this review related to virtual hearing aid services delivered by a licensed health care provider and/or facilitator(s) specific to hearing aid management, programming, verification, and validation services. Service delivery models varied according to patient population, technology experience, type(s) and time course of care, type of remote location, and technology/support requirements. Barriers and facilitators to implementation-related themes including technology access and function, client sociotechnical, convenience, education and training, interaction quality, service delivery, and technology innovation.

This scoping review provides evidence around the technology and infrastructure required for full integration of virtual hearing aid services into practice and according to care type. Low-tech versus high-tech requirements may be used to guide virtual service delivery triaging efforts. Research and development efforts in the areas of pediatrics, clinical support tools, and hearing aid/app-based solutions will support further uptake of virtual service delivery in audiology.

Evaluation of health service outcomes for an audiology first point of contact retrocochlear clinic: a 6-year retrospective cohort study.

International Journal of Epidemiology

Although existing studies of audiology first point of contact clinics which screen for retrocochlear pathology have demonstrated positive clinical outcomes, they have provided limited information regarding service impacts. Thus, this study aimed to evaluate both the clinical and health service outcomes of an audiology first point of contact (FPOC) clinic for adults referred to ENT services with suspected retrocochlear pathology.

Retrospective cohort study.

All 1123 patients referred to the clinic over a 6-year period (2013-2019).

Most (73.7%) of the 1123 patients referred to the Retrocochlear Clinic were managed and discharged by the audiologist and did not require ENT appointment. Almost half (43.1%) were directly referred for MRI imaging, of which 4 (1.1%) were diagnosed with Vestibular Schwannoma. Waiting times for first appointments significantly (p < 0.001) reduced from a median of 748 days to 63.5 days over the 6-year period. Attendance rates also significantly (p < 0.001) improved over this time (from 52.2% to 90%). There were no adverse events reported. Of those discharged without attending an ENT appointment, 1.8% were rereferred to ENT within 12 months of discharge.

This audiology FPOC Retrocochlear Clinic was shown to be a safe and effective alternative service model.

Long-Term Impedance Trend in Cochlear Implant Users with Genetically Determined Congenital Profound Hearing Loss.

Am Academy Audiology

 Impedance is a basic parameter registered at any cochlear implant (CI) fitting section. It is useful in monitoring electrode functioning and the status of the surrounding anatomical structures.

 The main aim of this study is to evaluate the 5-year impedance-value trend in patients affected by congenital genetically determined profound hearing loss implanted with Cochlear Nucleus devices.

 Impedance values were measured over time (activation, 6, 12, 24, and 60 months after cochlear implantation), for each of the 22 electrodes, in common ground, monopolar 1, monopolar 2, and monopolar 1 + 2 stimulation modes.

 A significant variation was found between CI activation and 6-month follow-up. This difference was found for each of the 22 electrodes. Electrodes 1 to 4 showed higher impedance values compared with all other electrodes in each time interval. Repeated-measures analysis of variance ruled out significant variations in impedance values from 6-month to 5-year follow-up.

 Impedance values were extremely stable after activation, at least for the first 5 years. In these cases, even minimal impedance variations should be carefully evaluated for their possible implications on hearing performance.

The Impact of Transducer Selection on the Acceptable Noise Level.

Am Academy Audiology

 The aim of this study was to assess the impact of transducer (loudspeaker, supra-aural headphones, and insert earphones) selection on the acceptable noise level (ANL).

 Most comfortable listening level (MCL) and background noise level (BNL) were measured for all participants using three transducers (loudspeaker, supra-aural headphones, and insert earphones). ANL was computed as the difference between the mean MCL and the mean BNL.

 Analytical statistics revealed that ANL did not differ due to the transducer used. However, there were statistically significant differences found for MCL and BNL across transducers.

 Results of this study indicate that ANL is not vulnerable to the selection of transducer and that ANLs can be compared across transducer types. Researchers should cautiously interpret findings across studies when discussing the base measures of MCL and BNL as these may be influenced slightly by transducer selection.

A Systematic Review and Meta-Analysis Exploring Effects of Third-Wave Psychological Therapies on Hearing-Related Distress, Depression, Anxiety, and Quality of Life in People With Audiological Problems.

Am J Audiology

There is growing evidence supporting the use of third-wave psychological therapies, such as mindfulness-based interventions (MBIs) and acceptance and commitment therapy (ACT), for people with long-term or chronic physical health conditions. We conducted a systematic review and meta-analysis to critically evaluate the effectiveness of third-wave interventions for improving hearing-related distress and psychological well-being in people with audiological problems.

We searched online bibliographic databases and assessed study quality. We conducted random-effects meta-analyses if at least two randomized controlled trials (RCTs) examined hearing-related distress, depression, anxiety, or quality of life in people with audiological problems. Findings of pre-post studies were summarized narratively.

We identified 15 studies: six RCTs and nine pre-post studies. The methodological quality of studies was mostly poor to moderate, and sample sizes were typically small (overall n = 750). Most studies focused on tinnitus (n = 12), MBIs (n = 8), and ACT (n = 6). Statistically significant improvements in hearing-related distress were found with ACT and MBIs versus controls and other treatments at post-intervention in people with tinnitus, while improvements in depression and anxiety were only found for ACT versus controls at post-intervention. However, gains were either not maintained or not examined at follow-up, and there was no evidence for improvements in quality of life.

At present, there is insufficient evidence to recommend the use of third-wave interventions for improving hearing-related distress or psychological well-being in people with audiological problems. There is some evidence that ACT and MBIs may be useful in addressing hearing-related distress in people with tinnitus, but only in the short term. However, findings should be interpreted with caution given the small number of studies with generally small sample sizes and mostly poor-to-moderate methodological quality. More high-quality, adequately powered, double-blind RCTs, particularly in audiological problems other than tinnitus, are needed to draw firm conclusions and meaningful clinical recommendations.

Changes in Acoustic Absorbance Pre- and Post-Cochlear Implantation.

Am J Audiology

Until recently, there has been little investigation on the effects of cochlear implantation on the transmission of acoustic stimuli through the middle-ear system. Recent studies have shown that cochlear implantation decreases low-frequency acoustic absorbance, consistent with a stiffer middle-ear system postsurgery. The objectives of this study are (a) to investigate the time course of changes in acoustic absorbance post-cochlear implantation in the implanted ear and (b) to compare changes in acoustic absorbance between implanted and nonimplanted ears over time.

Seventeen adult cochlear implant (CI) recipients within 6 months of device activation participated in this study. Wideband acoustic absorbance was measured in both ears at one to six different time points from pre-implantation up to 6-month postactivation. Analyses examined (a) changes in acoustic absorbance as compared to pre-implantation and (b) differences in acoustic absorbance between implanted and nonimplanted ears over time.

Acoustic absorbance in the implanted ear decreased postsurgery for frequencies lower than 1.5 kHz and persisted through at least 6-month postactivation. We also observed that the spectral range of decreased acoustic absorbance in the implanted ear decreased with longer time postsurgery. Differences in acoustic absorbance between implanted and nonimplanted ears occurred over a broad spectral range at the activation time point and persisted through at least 3-month postactivation, though for a narrower spectral range at the later time point.

Cochlear implantation increased middle-ear stiffness as indicated by decreased acoustic absorbance of low-frequency acoustic power. The findings of this study are consistent with those of previous studies and may have important implications toward understanding spatial hearing and programming of acoustic components for CI-combined electric and binaural acoustic stimulation patients.

The electrophysiological markers of hyperacusis: a scoping review.

International Journal of Epidemiology

Hyperacusis is known as a reduced tolerance to sounds perceived as normal to the majority of the population. There is currently no agreed definition, diagnostic tool, or objective measure of its occurrence. The purpose of this review is to catalogue the research to date on the use of auditory evoked potentials (AEP) to assess hyperacusis.

A step-by-step methodology was conducted following guidelines. Four databases were searched. A total of 3343 papers were identified. A final yield of 35 articles were retained for analysis.

The analysis identified four types of aetiologies to describe the hyperacusic population in AEP studies; developmental disorders (n = 19), neurological disorders (n = 3), induced hearing damage (n = 8) and idiopathic aetiology (n = 5). Electrophysiological measures were of short (n = 16), middle (n = 13) and long (n = 19) latencies, believed to reflect the activity of the ascending and descending pathways of the auditory system from periphery to cortex.

The results of this review revealed the potential use of electrophysiological measures for further understanding the mechanisms of hyperacusis. However, according to the disparity of concepts to define hyperacusis, definitions and populations need to be clarified before biomarkers specific to hyperacusis can be identified.

Philosophy for Adolescents: Using Fables to Support Critical Thinking and Advanced Language Skills.

Language, Speech, and Hearing Services

In this clinical focus article, we discuss the nature of critical thinking, its importance for adolescents, and its interaction with later language development. We also introduce a language arts program, Philosophy for Adolescents. The program aims to support critical thinking, narrative and expository discourse, and the use of complex syntax and literate vocabulary.

In designing Philosophy for Adolescents, we examined research from education, psychology, philosophy, and speech-language pathology in the areas of critical thinking and narrative discourse. The resulting program encourages students to think independently, listen to others, offer reasons and evidence to support their views, and express themselves with accuracy, clarity, and efficiency. Implementation is illustrated with a case study of a 12-year-old girl.

Although critical thinking improves during adolescence, many students struggle in this area, particularly in the ability to offer reasons and evidence to support their views. This suggests that these adolescents could benefit from instruction in critical thinking. Research also indicates that competence in critical thinking is associated with narrative and expository discourse, and with the use of complex syntax and literate words such as metacognitive verbs. Instruction using Philosophy for Adolescents may be carried out in small groups or individually by a speech-language pathologist working collaboratively with a teacher, teaching assistant, or other professional. Designed for flexible application, the program may be used with adolescents who have language disorders and those who have typical language development.

Research is necessary to evaluate the program with students from diverse backgrounds, having differing levels of language competence and academic achievement.