The latest medical research on Audiology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about audiology gathered by our medical AI research bot.

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Migration and other electrode complications following cochlear implantation.

Cochlear Implants International

To investigate migration and other electrode-related complications in cochlear implant surgery.

Retrospective review of all patients (adult and paediatric) undergoing cochlear implantation at a tertiary referral centre in England, between April 2019 and December 2021. Split arrays and patients who did not have post-op imaging were excluded.

Two hundred and ninety-nine cochlear implants were performed including 90% primary and 10% revision surgeries. Two hundred and forty-eight (86%) of electrodes implanted were straight arrays.Twenty-seven (9%) demonstrated suboptimal position on post-operative imaging. Three (11%) were true migration, 4 (15%) possible migration, 15 (56%) had two or less extra-cochlear electrodes, 3 (11%) expected partial insertion and 2 (7%) demonstrated tip fold-overs. Twenty (74%) of arrays within the suboptimal insertion group were in primary surgeries. Six patients required re-implantation. The most common reason for re-implantation was migration.

Electrode migration after cochlear implantation may be more common than previously thought. We demonstrate rates of migration congruous with current literature; this is despite robust and varied fixation techniques. Notable in our series is that all true captured migrations were seen exclusively in straight arrays. The majority of patients in the possible and confirmed migration group had normal inner ear anatomy.

Suboptimal electrode position following cochlear implant surgery is a recognized complication and can affect implant performance. Reporting may increase with more widespread use of sophisticated post-operative imaging. Use of a pre-curved electrode and routine use of appropriate fixation techniques may reduce migration rates.

The Narrowband CE-Chirp Stimulus Does Not Necessarily Produce More Robust Cervical Vestibular Evoked Myogenic Potential.

Ear and Hearing

Various studies have been conducted to search for the most optimal stimulus for eliciting cervical vestibular evoked myogenic potential (cVEMP). More recently, there is a growing interest to study the usefulness of chirp stimuli in cVEMP recording. Nevertheless, contradictory outcomes have been reported across the studies, and further research with larger samples would be beneficial to provide better insight into this matter. As such, the present study was carried out to compare cVEMP results between narrowband (NB) CE-Chirp (centered at 500 Hz) and 500 Hz tone burst stimuli.

In this study that employed a comparative study design, 98 normally hearing adults aged between 19 and 24 years were enrolled. All of them underwent the cVEMP testing based on the recommended test protocol. The stimuli were a 500 Hz tone burst and a NB CE-Chirp (360-720 Hz) presented through insert earphones at an intensity level of 120.5 dB peSPL.

For each stimulus, cVEMP results did not differ significantly between the ears (p > 0.05). Relative to the 500 Hz tone burst, the NB CE-Chirp stimulus produced statistically shorter P1 and N1 latencies (p < 0.001). On the other hand, P1-N1 amplitude was found to be comparable between the two stimuli (p > 0.05).

The present study did not find any supporting evidence that the NB CE-Chirp stimulus (centered at 500 Hz) outperformed the conventional 500 Hz tone burst in the cVEMP testing. Both stimuli are considered equally appropriate to record cVEMP responses in clinical settings.

Dysphagia management in community/home settings: A scoping review investigating practices in Africa.

International Journal of Epidemiology

Little is known about how people living with dysphagia in rural, socioeconomically impoverished contexts in Africa are supported and manage their disability. This scoping review sought to map and synthesise evidence relating to the management of dysphagia in adults in community/home settings in Africa as a starting point for a broader study on this topic.

A multifaceted search strategy involved searches of electronic databases and grey literature, hand searches, ancestry searches, and consultation with expert advisors. Records were screened by two blinded researchers. Characteristics of included studies were summarised, and their findings synthesised using the Framework approach.

Six studies were included, relating to services for people with dysphagia secondary to various aetiologies. No grey literature was identified that provided service delivery descriptions or practice guidance. This limited evidence suggests little professional support is available to people living with dysphagia in the community. Individuals and carers use a range of strategies, including choosing different food and drink items and modifying how food is chewed and swallowed.

Further research is required to understand current practice in managing dysphagia in the community in Africa, and the needs and priorities of community members who experience dysphagia and their carers.

Do Caregiver Perceptions of the Virtual More Than Words® Program Differ Based on Autistic Children's Attributes?

Speech Language Path

More Than Words® (MTW) is a caregiver-mediated intervention program led by a speech-language pathologist (SLP) who teaches caregivers strategies to support their autistic child's early social communication and play development. The program includes group sessions composed of multiple families with children of varying profiles. We explored whether caregiver experiences and perceived outcomes of the virtual MTW program differed depending on the child's age and social communication stage.

As part of a program evaluation of virtual MTW delivered to over 2,000 families in Ontario, Canada, between 2020 and 2021, we randomly selected 31 families across four social communication stages and two age groups using stratified sampling (n = 4, in all but one subgroup). The Final Reflection and Evaluation form was analyzed both qualitatively and quantitatively, and a modified RE-AIM framework guided our analyses, including theme development.

Child attributes did not appear to impact caregivers' experiences, but perceived child skill improvements varied by children's social communication stage. The majority of caregivers reported changes in how they interact with their child. Four themes emerged: (a) perceived child skill improvements differed by social communication stage, (b) caregivers gained new knowledge and strategies regardless of child attributes, (c) SLPs effectively managed families' individual needs, and (d) program components were appropriate for a variety of families.

Findings suggest that the content taught in the MTW program was relevant for a variety of children, including those beyond the program's intended age of 5 years and under. Grouping families of children with varying profiles does not appear to negatively influence caregivers' experiences or perceived outcomes.

Bone Conduction Implants: Comparative of Audiometric Results and Quality of Life Bonebridge® vs Osia®.

Audiology and Neuro-Otology

Bone conduction implants have been indicated for patients with conductive hearing loss, mixed hearing loss, and even profound unilateral sensorineural hearing loss. With the introduction of Bonebridge®, new transcutaneous implant options emerged. The latest is Osia®, a direct-drive variant or active systems where the implant directly generates and applies vibration to the bone.

Retrospective study of two cohorts of patients treated with active bone conduction implants at a single center, one with the Bonebridge® device and the other with Osia®.

Fourteen patients were included, seven in each group (n=14). The Bonebridge® group showed an average hearing gain in tonal intelligibility thresholds of 32.43±21.39 dB and a gain in the average intelligibility threshold (with 50% discrimination) of 26.29±19.10 dB. In the Osia® group, there was a gain in average tonal thresholds of 41.49±14.16 dB and 23.72±6.98 dB in average intelligibility thresholds. Both devices contributed to improvements in patients' quality of life, as assessed with APHAB in all the variables studied in the test. Both devices offer rehabilitation for hearing loss as an alternative to hearing aids. The Osia® system shows statistically significant(p<0.05) improvements in mid and high frequencies, but Bonebridge® slightly outperforms in speech understanding at 50%. Differences in average tonal thresholds and quality of life are not statistically significant.

While auditory improvement is observed post-implantation, other aspects, such as intelligibility thresholds and quality of life, lack statistical significance. Given the limited experience with Osia® and the small sample size, the choice of the device should be personalized. Although the literature is inconsistent due to small sample sizes and variable approaches, some studies suggest potential advantages of the Osia® system, especially in speech comprehension in different environments and greater hearing gain compared to Bonebridge®.

Listening-Related Fatigue in New and Experienced Adult Cochlear Implant Users.

Ear and Hearing

Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue.

Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined.

Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue).

Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap.

Hearing Loss and Dementia: Where to From Here?

Ear and Hearing

Victorian era psychologists were the first to comment on associations between sensory and cognitive function. More recently, hearing loss has been ...

The Effect of Time-Restricted Feeding on Postural Balance: From Vestibular Perspective.

Audiology and Neuro-Otology

The aims of the present study were to evaluate postural balance performance of the subjects on the time-restricted feeding (TRF) and reveal the effect of TRF on the vestibular system by comparing the results to those of traditional daily dietary (DD) condition.

Sixteen adults (3 males, 13 females; mean age 25.4 ± 4) who had experienced at least one month of TRF were included in the study. Sensory Organization Test (SOT) and Head-Shake Sensory Organization Test (HS-SOT) -which evaluate proprioceptive, visual and vestibular systems- were performed on TRF and DD conditions via the Computerized Dynamic Posturography System.

Significant differences were obtained between TRF and DD situations in SOT-5 (p=.008), SOT-6 (p=.01), and HS-SOT5 (p =.007) conditions in which the vestibular system dominated.

We revealed that time-restricted feeding has an effect on postural balance in the absence of proprioceptive and visual systems. This feeding model is a negative stressor that has a substantial effect on the vestibular system, but this impact is minimal once the proprioceptive and visual systems are intact. To best of our knowledge, it is the first study to evaluate postural balance utilizing vestibular parameters in time-restricted feeding.

The impact of PD Check-In on self-management skills for maintenance of speech after intensive treatment.

Int J Lang

Maintenance of speech outcomes following speech-language therapy (SLT) in Parkinson's disease (PD) is an unmet expectation of people with PD (PWPD) and poorly defined in SLT practice. PD Check-In, a model for supported self-managed maintenance of speech following Lee Silverman Voice Treatment (LSVT) LOUD was investigated.

To investigate the impact of the semi-structured component of PD Check-In on the adoption of self-management concepts and behaviours and the identification of facilitators, barriers and strategies for speech maintenance by PWPD over 24 months post-treatment.

Following LSVT LOUD, 16 PWPD participated in individual PD Check-In semi-structured discussions with a SLT at 6 and 12 weeks, and 6, 12 and 24 months post treatment. A two-stage qualitative content analysis was applied: directed content analysis using categories from the theoretical framework of PD Check-In followed by inductive content analysis to identify subcategories.

Statements from PWPD indicated adoption of seven concepts of self-management across participants and across time. Six concepts from the theoretical framework of PD Check-In (partnerships, self-reflection, maintenance barriers and facilitators, revision of LSVT LOUD skill, goal setting and maintenance strategies), and one new category, participation, emerged from the analysis. Self-reflection, maintenance facilitators and barriers and participation were most prevalent in discussions. PWPD identified facilitators, barriers and strategies for maintenance across time points.

What is already known on this subject People with Parkinson's disease (PWPD) have expressed their need for speech-language therapy (SLT) services that are accessible for the duration of the condition and responsive to their expectation of maintaining speech following treatment. Outcomes for maintenance of the treatment effect following Lee Silverman Voice Treatment (LSVT) LOUD are variable. What this paper adds to existing knowledge This study presents the outcomes of five PD Check-In interventions delivered in semi-structured discussions between PWPD and a SLT over 24 months following LSVT LOUD for the development of self-management skills and behaviours. PWPD adopted self-management positively using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs. What are the potential or actual clinical implications of this work? PWPD responded positively to the individual development of self-management skills and behaviours over time. Individuality and flexible responsivity are features of PD Check-In which resonate with PWPD and speak to SLT supported self-managed maintenance of speech as a long-term model for PD.

Using Conversation Analysis to explore assessments of decision-making capacity in a hospital setting.

Int J Lang

Healthcare professionals (HCPs) have a responsibility to conduct assessments of decision-making capacity that comply with the Mental Capacity Act 2005 (MCA). Current best-practice guidance, such as the Mental Capacity Code of Practice and National Institute for Health and Care Excellence decision-making and mental capacity guidance, does not stipulate how to accomplish this in practice, for example, what questions should be asked, how options and information should be provided. In addition, HCPs struggle to assess the capacity of individuals with communication difficulties.

This study was a service evaluation that aimed to objectively analyse, using Conversation Analysis (CA), how real-life capacity assessments were conducted in a hospital setting with patients with acquired brain injury (ABI)-related communication difficulties. A second aim was to establish the feasibility of using CA to advance knowledge of the conduct of capacity assessment.

Four naturally occurring capacity assessments were video-recorded. Recordings involved speech and language therapists, occupational therapists, neuropsychologists and patients with communication difficulties as a result of ABI. The methods and findings of CA were used to investigate the interactional behaviours of HCPs and patients during assessments of decision-making capacity. The analysis was informed by our knowledge of the MCA best practice guidance.

An overall structure of capacity assessment that enacted some of the best-practice MCA guidance was identified in one recording, consisting of six phases: (i) opening, (ii) preparation, (iii) option-listing, (iv) test, (v) decision, and (vi) close. The preparation phase consisted of two sub-components: information gathering and information giving. Variation from this structure was observed across the dataset, notably in the way in which options were (or were not) presented.

What is already known on this subject The Mental Capacity Act (MCA) is poorly implemented in practice. Healthcare professionals (HCPs) find it challenging to assess the decision-making capacity of individuals with communication difficulties, and people with communication difficulties are often excluded from or insufficiently supported during capacity assessment. Research is limited to self-report methods. Observational studies of capacity assessment are required. What this study adds This is the first study to use Conversation Analysis (CA) to explore how capacity assessments are conducted in a hospital setting by HCPs with people with communication difficulties as a result of acquired brain injury. One video-recorded capacity assessment was structured in six phases that aligned with best practice MCA guidance. However, other capacity assessments deviated from this structure. One phase, option listing, varied in practice and options were not always presented. What are the clinical implications of this work? CA revealed interactional behaviours that align with and diverge from best-practice MCA guidance. Future CA studies are warranted to inform training for health and social care professionals who conduct capacity assessments.

Phonemic and pitch variability in bilingual preschoolers: A comparison of Jamaican Creole and English.

International Journal of Epidemiology

The purpose of this study was to investigate the cross-linguistic influences of Jamaican Creole (JC) and English on phonemic and vocal development in bilingual JC-English-speaking preschoolers.

Sixteen typically developing children (12 females, M = 4 years; 4 months) completed the Diagnostic Evaluation of Articulation in Phonology Word Inconsistency Assessment subtest in JC and in English. Acoustic measures of voice onset time (VOT), VOT variability (VOT SD), mean fundamental frequency (fo), and fo variability (fo SD) were extracted from each target word. Prevoicing was noted. Mixed models and regression models were analysed to understand the patterns of acoustic measures in each language, and the relationship between phonemic and vocal variability, respectively.

Analyses showed a significant effect of language on fo SD, wherein SD was greater in English than JC. JC spoken (percentage) was a significant positive predictor of VOT SD for voiced (short lag) productions. There was no relationship between phonemic and vocal variability measures.

Greater fo SD in English may be due to linguistic fo differences and speaking environment. Variability for voiced VOT is likely due to the continued maturation of vocal and articulatory control when children are developing adult-like productions, though longitudinal studies are needed.

Cochlear-facial dehiscence - the most common cause of facial nerve stimulation from a cochlear implant? A case-control study.

Cochlear Implants International

To investigate the prevalence of cochlear-facial dehiscence (CFD) and other radiographical pathologies in ears with facial nerve stimulation (FNS) from a cochlear implant (CI).

Retrospective case-control study of 27 patients with CI and FNS on either ear (study group) and 27 patients without FNS, matched for age, sex and type of electrode array (control group). Preoperative CT scans of all 108 ears were re-evaluated. Subanalyses included comparisons between the study and control groups and associations between FNS and radiographic pathologies.

CFDs were detected in 20 of 54 ears (37%) in the study group and in 3 of 54 ears (6%) in the control group (P < 0.001). The corresponding numbers of otosclerosis were 10 (18%) and 0 (P = 0.011) and of developmental anomalies 16 (30%) and 8 (15%) (not significant). FNS was present in 33 ears in the study group, of which 14 (42%) had a CFD. FNS was absent in six ears with CFD and CI, four of which contralateral to an ear with FNS. Eight of 14 ears with FNS and CFD had a lateral electrode array and six had a perimodiolar electrode array. We found no association between the presence of CFD and stimulation thresholds for FNS. The adjusted odds ratio for developing FNS in the presence of a CFD was 9.9 (95% CI 2.7-36.0).

CFD was the most common radiographic pathology in ears with FNS, with a 10-fold increased risk of FNS. To avoid CI-related FNS, preoperative CT scan and awareness of typical dehiscence symptoms are strongly recommended.