dissertation topics in audiology

Research Topics in Audiology

The focus of our work is on the perception of speech signals, taking into account audiological, technical, linguistic and neurological aspects. Based on these findings the aim is to create clinical approaches for the improvement of diagnostics and rehabilitation of hearing disorders.

New: Moritz Wächtler wins poster prize at annual DGA-meeting

New: Khaled Abdellatif obtains Colin-Cherry-Award

New: DFG funds project on speech perception and cognitive load in cochlear implant recipients

New: DFG funds project on attention and speech recognition in the framework of aging

Read our latest publicatons:

Wächtler M, Sandmann P, Meister H. The Right-Ear Advantage in Static and Dynamic Cocktail-Party Situations. Trends in Hearing. 2024;28:1-13.

Abdellatif KHA, Müller V, Walger M, Meister H . Music sound quality assessment in bimodal cochlera implant users. MedRxiv 2022, preprint.

Meister H, Winter IS, Wächtler M, Sandmann P, Abdellatif KHA . A virtual-reality based method for examining audiovisual prosody. ArXiv 2022, preprint.

Wächtler M, Kessler J, Walger M, Meister H . Revealing Perceptional and Cognitive Mechanisms in Static and Dynamic Cocktail Party Listening by Means of Error Analyses. Trends in Hearing. 2022;26:1-11.

Abdellatif, KH, and Meister H. Speech recognition and listening effort in cochlear implant recipients and normal-hearing listeners. Frontiers in Neuroscience, 2021

Wächtler M, Kessler J, Walger M, Meister H. Costs of dynamic cocktail party listening: Investigating the effects of cognitive abilities and hearing impairment. JASA Express Letters 1, 075201, 2021

Meister H, et al. Letter to the Editor concerning Skuk et al.: Parameter-Specific Morphing Reveals Contributions of Timbre and Fundamental Frequency Cues to the Perception of Voice Gender and Age in Cochlear Implant Users. JSLHR, Vol. 63, Dec. 20220, 4325-4326

Meister H, Wenzel F, Gehlen AK, Kessler J, Walger M. Static and dynamic cocktail party listening in younger and older adults [published online ahead of print, 2020 Jul 13]. Hear Res. 2020;395:108020

Speech perception with cochlear implants

The cochlear implant (CI) – an auditory neuroprosthesis- allows electrical stimulation of the auditory nerve. By means of a speech processor the sound signals are converted into electrical signals and transmitted transcutaneously to the implant. A CI is typically indicated for severe to profound hearing loss.

  Due to the limited transmission of natural acoustic features, the verbal communication of persons provided with cochlear implants is subject to certain restrictions. However, cochlear implantation often results in reasonable speech intelligibility and may even allow for communication using the telephone. Crucially, this is due to an adequate neuronal processing in the auditory cortex, which allows perception and use of speech features despite the reduced input signal.

  Our work relates to several aspects of speech perception with CIs. For instance, it focuses on the perception of suprasegmental features of speech that have a distinct function for verbal communication. These include prosody, namely word and sentence accent (stress patterns) or intonation patterns (e.g., questions vs. statements). Adequate processing of prosodic features is particularly important, for example, in language acquisition in early childhood.

  We also focus on speech recognition with competing talkers. These are especially demanding communication situations since information from different sound sources has to be processed. We are particularly interested in the questions of whether CI recipients are able to segregate different talkers based on voice cues (such as fundamental frequency) or the spatial distribution of the sound sources. The research projects are typically conducted in cooperation with industry partners in order to directly address clinically relevant issues.

  Selected publications:

Meister H, Walger M, Lang-Roth R, Müller V. Voice fundamental frequency differences and speech recognition with noise and speech maskers in cochlear implant recipients. J Acoustic Society America. 2020 Jan;147(1):EL19. doi: 10.1121/10.0000499. PMID: 32007021

Pyschny V, Landwehr M, Hahn M, Lang-Roth R, Walger M, Meister H. Head shadow, squelch, and summation effects with an energetic or informational masker in bilateral and bimodal CI users. J Speech Lang Hear Res. 2014, Oct;57(5):1942-60.

Landwehr M, Fürstenberg D, Walger M, von Wedel H, Meister H. Effects of various electrode configurations on music perception, intonation and speaker gender identification. Cochlear Implants Int. 2014 Jan;15(1):27-35.

Meister H, Landwehr M, Pyschny V, Grugel L, Walger M. Use of intonation contours for speech recognition in noise by cochlear implant recipients. J Acoust Soc Am. 2011 May;129(5):EL204-9.Meister H, Landwehr M, Pyschny V, Walger M, von Wedel H. The perception of prosody and speaker gender in normal-hearing listeners and cochlear implant recipients. Int J Audiol. 2009 Jan;48(1):38-48.

Cognitive load and listening effort

Cognitive load during speech recognition.

In acoustically challenging communication situations, not only hearing ability, but also cognitive functions such as attention or working memory are of importance. Various studies have shown relationships between cognitive capacity and speech recognition. Older adults frequently do not only suffer from hearing impairment, but cognitive performance is also subject to decline. This causes extra problems for older people to communicate in demanding situations – for instance, when several persons speak simultaneously.

Our research in this area attempts to identify cognitive functions that are important for different communication situations. This includes, for example, the investigation of different forms of attention using speech audiometric as well as neuro-physiological methods (EEG, Pupillometry, Eye-Tracking). We are also interested in how technical rehabilitation of hearing (hearing aids and cochlear implants) interacts with the cognitive capacity of users.

Selected publications:

Meister H, Schreitmüller S, Ortmann M, Rählmann S, Walger M. Effects of Hearing Loss and Cognitive Load on Speech Recognition with Competing Talkers. Front Psychol. 2016 Mar 4;7:301. doi: 10.3389/fpsyg.2016.00301.  

Carroll R, Meis M, Schulte M, Vormann M, Kießling J, Meister H. Development of a German reading span test with dual task design for application in cognitive hearing research. Int J Audiol. 2015 Feb; 54(2):136-41. doi:10.3109/14992027.2014.952458.

Meister H, Schreitmüller S, Grugel L, Beutner D, Walger M, Meister I. Examining speech perception in noise and cognitive functions in the elderly. Am J Audiol. 2013 Dec;22(2):310-2

Meister H, Schreitmüller S, Grugel L, Ortmann M, Beutner D, Walger M, Meister IG. Cognitive resources related to speech recognition with a competing talker in young and older listeners. Neuroscience. 2013 Mar 1;232:74-82.

Assessment of cognitive load and listening effort

Listening effort can be defined as the expenditure necessary to understand speech. Even if speech intelligibility is near perfect, under adverse acoustic situations, it may be difficult to follow a conversation. The idea is that increased cognitive resources for otherwise largely automated and effortless speech perception are then needed.   In principle, this gives the potential to further measures, for example, to the purpose of the evaluation of hearing aid or cochlear implant provision. However, a generally useful measure of listening effort has not yet been established.

  Our investigations focus on various subjective and objective measures: we examine simple rating scales, but also more complex dual task methods or neuro-physiological measures, such as pupillometry or electrodermal activity in terms of its potential to determine listening effort. Moreover, we assess the use of event-related potentials in the framework of EEG-recordings. 

Abdellatif K, Schreitmüller S, Walger M, Meister H. Listening effort and cognitive functions in cochlear implant users. 22. DGA-Jahrestagung 2019, Heidelberg, Z. Audiol. Suppl.

Ortmann M, Rählmann S,Walger M, Meister H: EDA (Hautleitwert) als Maß für Höranstrengung? DGMP-Jahrestagung Köln, 18.9.-21.9.2013

Igelmund P, Meister H, Brockhaus-Dumke A, Fürstenberg D, von Wedel H, Walger M (2009) P300 and reaction time as measures of hearing effort of CI users during sound discrimination in noise DGA Jahrestagung 2009, Innsbruck, Z. Audiol.

Audiovisual speech perception

Speech information is not only perceived via the auditory system, but also visually. Especially in noisy environments there is often the need to use additional visual speech information. In particular persons with hearing impairment require visual speech information in order to compensate for a lack of auditory features. This is based on the ability to integrate different modalities at the cortical level.

We focus on the questions for which audiological testing it might be useful to include visual speech information and how audiovisual speech perception might be measured reliably within a clinical setting. Our hypothesis is that, in particular for combining acoustic and electric hearing (as with bimodal or hybrid fitting), the benefit of adding spectro-temporal fine structure might be better represented through audiovisual speech tests compared to conventional speech audiometry. This holds at least as long as the different cues (envelope information, fine structure, visual speech) provide complementary information. Here, we use the opportunities of virtual reality enabling to visualize arbitrary speech material via computer-animated avatars. This gives the option to parametrize visual and auditory cues important for multi-modal speech perception.

Other important aspects we are interested in are cross-modal cortical plasticity with cochlear implantation and the high ecological validity of audiovisual compared to auditory-only speech.

Schreitmüller S, Frenken M, Bentz L, Ortmann M, Walger M, Meister H. Validating a Method to Assess Lipreading, Audiovisual Gain, and Integration During Speech Reception With Cochlear-Implanted and Normal-Hearing Subjects Using a Talking Head. Ear Hear. 2017 Oct 24. doi:10.1097/AUD.0000000000000502. [Epub ahead of print]

Meister H, Fürsen K, Schreitmüller S, Walger M. Effect of acoustic fine structure cues on the recognition of auditory-only and audiovisual speech. J Acoust Soc Am. 2016 Jun;139(6):3116. doi: 10.1121/1.4953022.

Meister H, Schreitmüller S, Pyschny V, Lang-Roth R, Walger M, Fagel S (2011) Untersuchungen audio-visuellen Sprachwahrnehmung Personen mit Hörstörungen mittels virtuellem Kopfmodell. DGA Jahrestagung 2011, Jena, Z. Audiol. Suppl 

Hearing aid provision in adults

In Germany, about 14 million people suffer from hearing problems. Especially older persons frequently exhibit hearing loss and communication problems as a consequence. Despite the large progress in hearing technology within the last decade, hearing aid provision is quantitatively insufficient, since many who might benefit from hearing instruments do not use these.

The focus of our research is the identification of key factors relevant to hearing aid provision. We aim at determining mechanisms that either support or hamper hearing aid uptake as well as at describing models that allow for a prediction of hearing aid use. It is assumed that a deeper understanding of the effects relevant to hearing aid usage will help to improve hearing aid provision and rehabilitation services in general.

With respect to the latter, not only technological issues, but also educational aspects, are relevant. For example, counselling and auditory training might help to support hearing aid use. Another approach is cognitive training, since we know that cognitive capacity, speech understanding and hearing technology are linked a specific training of working memory or attention might be beneficial.

Meister H, Grugel L, Meis M. Intention to use hearing aids: a survey based on the theory of planned behavior. Patient Prefer Adherence. 2014 Sep 17;8:1265-75.

Ortmann M, Kessler J, Kaul T, Arehart KH, Meister H. Cognitive training to improve speech understanding in complex communication environments - a framework and methodological aspects. HEAL Conference 6/2014

Meister H, Grugel L, Walger M, von Wedel H, Meis M. Utility and importance of hearing-aid features assessed by hearing-aid acousticians. Trends Amplif. 2010 Sep;14(3):155-63.

Meister H, Walger M, Brehmer D, von Wedel UC, von Wedel H. The relationship between pre-fitting expectations and willingness to use hearing aids. Int J Audiol. 2008 Apr;47(4):153-9.

Meister H, von Wedel H. Demands on hearing aid features--special signal processing for elderly users? Int J Audiol. 2003 Jul;42 Suppl 2:2S58-62.

Meister H, Lausberg I, Kiessling J, von Wedel H, Walger M. Modeling relationships between various domains of hearing aid provision. Audiol Neurootol.2003 May-Jun;8(3):153-65.

Communication development in children with cochlear implants

The acquisition of language by children is the basis for an adequate emotional, social and intellectual development. It is subject to a variety of factors. Important aspects are hearing and speech processing in critical stages of language acquisition. Speech production is closely related to speech perception and processing.

Our research interests focus on children who exhibit hearing loss in sensitive stages of development. This may relate to auditory processing disorders as well as impairment of the middle ear, the inner ear or the auditory nerve.

A current research project is the examination of language and hearing development in children provided with hearing devices (especially cochlear implants, CI), including children with multiple disabilities. This research is based on a recently developed parents proxy questionnaire and supplemented with further testing. The FAPCI ("Functioning after Pediatric Cochlear Implantation"), which has been validated and translated to a German version (Grugel et al. 2009, 2011), is used as a main inventory.

With respect to real-world verbal communication (initially without distinction of language and auditory development), the score of FAPCI seems to be sensitive to the point in time at which intervention takes place. Further studies should be included to test the hypothesis of early rehabilitation with respect to sensitive phases of language acquisition.

Meister H, Keilmann A, Leonhard K, Streicher B,Lang-Roth R. Real-world verbal communication performance of children provided with cochlear implants or hearing aids. Otol Neurotol. 2015 Jul;36(6):1023-8.Grugel L, Streicher B, Lang-Roth R, Walger M, Meister H. Measuring communicative performance with the German version of the FAPCI-instrument: normative data and longitudinal results. Int J Pediatr Otorhinolaryngol. 2011 Apr;75(4):543-8.

• “The AuD/PhD pathway is not something that is reserved for the elite… Anyone can do a PhD with the proper organization.”
• “Don’t be shy to approach researchers whose work interests you!”
• “Research can seem like a scary endeavor, and it pushes you out of your comfort zone. There will be times where you feel like you can’t do it but I promise you that you can! With that being said, it has been the most rewarding experience of my life. I can’t imagine doing anything else!”
• “Write a grant. ASHA and AAA both offer small student grants that are ideal opportunities to learn about the process of writing a grant. Grantsmanship is a critical skill to develop as a Principal Investigator (PI), and early exposure to grant writing is a good way to figure out if a PI role is the right path for you. If you really dislike grant writing, but still want to be involved in research, there are ways to do that without having to get a PhD. You can save yourself a lot of time and energy by figuring that out early in your education.”
• “Diversify your academic portfolio. The profession does best when we reach out to other disciplines, learn more, and bring that knowledge back to our research for the benefit of our patients.”

If all of this has convinced you to pursue your interest in hearing-related research, the next step is to find out specifics from the programs that you’re interested in. A list of AuD/PhD programs is available from the Academy, but always check with any university you are interested in as they may have an unadvertised PhD option. As you get in contact with universities to discuss their programs, consider asking these questions suggested by current and graduated AuD/PhDs: 

• Is there support to help me through the dissertation process? What about afterwards when I’m finishing my AuD?
• What is a typical distribution of work for a PI? How much time is spent writing grants and manuscripts vs. designing studies and collecting data? How much time is spent on teaching and institutional service? How does this distribution change in different work settings (e.g., university, research center, industry)?
• How much opportunity is there for research collaboration between labs?
• What protections are in place to assure timely completion of both degrees? 

You can read more perspectives from AuD/PhD professionals through PhD Spotlight interviews . Additionally, take a look at this post from the SAA regarding how to select PhD programs and advisors. 

Whether you go on to work clinically, run your own research lab, or a combination of the two, we all have a role in translating clinical questions into research questions, and research results into practice. 

Hall III, J. W. (2014). Introduction to audiology today . Pearson.  

National Institute of Health (2019). Ruth L. Kirschstein National Research Service Award (NRSA) Individual Fellowship for Students at Institutions Without NIH-Funded Institutional Predoctoral Dual-Degree Training Programs (Parent F30). Retrieved November 2, 2019 from https://researchtraining.nih.gov/programs/fellowships/F30 .

Author Bios

Sarah Camera is a fifth-year AuD/PhD student at the University of Connecticut. She is currently the chair of the SAA Education Committee’s Research Sub-Committee. Her research and clinical interests include hearing conservation and interventions for individuals who perceive hearing difficulties despite “normal” hearing sensitivity.

Jin Hyung Park is a third-year AuD student at the University of Oklahoma Health Sciences Center. He is currently a member of the SAA Education Committee. His clinical interests are in implantable technologies, outcome measures, and access to hearing healthcare. 

Stephanie Berry is a third-year AuD student at the University of North Carolina. She is currently the chair of the SAA Education Committee. Her clinical interests include early hearing detection and intervention and interprofessional services for children with developmental disabilities. 

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Effects of Aided Language Input Intensity on AAC Use 

Alternative Receptive Language Assessment Modalities and Stimuli for Children with ASD who are Minimally Verbal 

Evaluating Person-Centered Factors Associated with Brain-Computer Interface Access to a Commercial Augmentative and Alternative Communication Device 

The Feasibility of Language-Literacy Instruction Facilitated by Preschool Classroom Volunteers 

The test-retest reliability of the Western Aphasia Battery-Revised 

Does the Timing of Feedback Given to New Coders of the Communication Complexity Scale Affect Coding Reliability Scores? 

Noise Exposure, Self-Reported Speech-in-Noise Percpetion, and the Auditory Brainstem Response in Normal-Hearing Human Ears 

Intervention Planning for Children who use Augmentative and Alternative Communication: Exploring the Expert-Novice Gap in Speech-Language Pathologists’ Clinical Reasoning 

Contributions of Phonology and Orthography to Spelling in Children with Dyslexia 

A Feasibility Study of Shared Storybook Reading in a Sibling Dyad 

Childhood Apraxia of Speech and Augmentative and Alternative Communication: Family Perspectives 

Perspectives of Families and School-Based Speech-Language Pathologists on the Augmentative Alternative Communication (AAC) Experience 

Augmentative and Alternative Communication Continuing Education in the Schools: A National Survey 

Preservice Education in Augmentative and Alternative Communication: An Update 

The Effect of Activating the Medial Olivocochlear Fibers on Cochlear Distortions in Humans 

Communication Disorders Among Persons Experiencing Homelessness 

Mapping Chromosomal Loci in Specific Language Impairment: A Pedigree-Focused Approach 

A national survey: Teacher identification of specific language impairment 

Impact of Alternative & Augmentative Communication on the Utterance Length of Children with Limited Oral Language 

Identifying the Cellular Sources of the Low-Frequency Cochlear Response 

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Ear Infections and Balance Concerns

Children often experience ear infections. An overlooked problem with ear infections is the impact on a child’s ability to maintain balance. Children usually can’t tell you when they have balance problems and most children aren’t screened for balance disturbances. 

Dr. Rehagen and colleagues presented a pilot study to show the results of a balance screening test for children. They found that children with hearing loss due to middle-ear infection are more likely to demonstrate difficulty with tracking objects with their eyes than their counterparts with normal hearing or permanent (sensorineural) hearing loss. The authors suggest that children with ear infections are screened for balance problems.  

Rehagen, Sonia Kim, et al. “Vestibular Screening in Pediatric Patients with Otitis Media.” Journal of the American Academy of Audiology, 2019, doi:10.3766/jaaa18101.

Balance Management Is a Team Approach

Balance problems can be from many different causes. We maintain our balance through the integration of multiple organs and systems. Since balance problems can be complicated, diagnosis and management should involve different professions that specialized in each of those organs and systems. These specialists include otologists, audiologists, ophthalmologists, neurologists, physical therapists, and pharmacists. Unfortunately, most patients don’t receive this thorough evaluation.

Dr. Rodriguez and colleagues found that patients with balance problems who received care from a team of professionals report improved symptoms as compared to those who didn’t. This study suggests that since those who received care by an interprofessional team reported improved symptoms, patients should expect to see multiple professionals to better manage balance problems. 

Rodriguez, Amanda I., et al. “Importance of an Interprofessional Team Approach in Achieving Improved Management of the Dizzy Patient.” Journal of the American Academy of Audiology, vol. 28, no. 3, Jan. 2017, pp. 177–186., doi:10.3766/jaaa.15054.

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Dissertations / Theses on the topic 'Health Sciences, Audiology'

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Shahnaz, Navid. "Distinguishing otosclerotic ears from healthy ears using multifrequency and multicomponent tympanometry." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=37837.

Nicholls, Gaye H. "Discourse comprehension by hearing-impaired children who use cued speech." Thesis, McGill University, 1985. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=72784.

Shahnaz, Navid. "Multifrequenzy, multicomponent tympanometry in normal and otosclerotic ears." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23934.

Makhoul, Georges. "Nano-encapsulated curcumin in a chinchilla ear model." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=95197.

Valentine, Deanna Susanne. "The influence of audibility on asynchronous double-vowel identification." [Bloomington, Ind.] : Indiana University, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3378384.

Tooley, Carolyn Jean 1965. "Contralateral stimulation does not influence the suppression tuning curves of spontaneous otoacoustic emissions." Thesis, The University of Arizona, 1993. http://hdl.handle.net/10150/278340.

Lim, Stacey R. "Evaluating speech-in-noise performance of bilateral cochlear implant recipients." Thesis, Kent State University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3618872.

The goal of this study was to determine whether sequentially acquired bilateral implants provide improved speech understanding relative to performance with unilateral implants in varying sound source configurations that may more closely represent daily listening environments. Participants were divided into higher and lower performance groups based upon their best unilateral performance on monosyllabic words in quiet and asked to repeat Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) sentences in unilateral and bilateral listening conditions. The sentences were always presented from directly in front, while competing noise was presented from varying locations. Results indicated that the bilateral listening condition yielded significantly better scores compared to the unilateral listening condition across all participants, with the higher performance group's scores significantly better than for the lower performance group. Both groups had similar gains in performance. No significant differences were observed amongst sound sources, contrary to the original hypothesis. Among demographic variables, only unilateral performance on words in quiet and onset of deafness were highly correlated with bilateral performance. As the initial grouping variable addressed performance in quiet, a second analysis regrouped participants by onset of deafness (pre- vs. postlingual) This regrouping yielded even greater group differences overall, and some noise configurations were now significantly different for the postlingually deafened participants. Taken together, these results suggest that postlingually deafened participants may be able to use higher level binaural processes established prior to deafness and not available to prelingually deafened listeners.

Wang, Xin. "The effects of glimpsing and lexical difficulty on word recognition in young normal-hearing listeners." [Bloomington, Ind.] : Indiana University, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3358984.

Mujica, Mota Mario. "Otoprotection of metformin in radiation-induced sensorineural hearing loss." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=117200.

Pitaro, Jacob. "Wideband measurements in newborns: relationship to otoscopic findings." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=119646.

GREGOR, SARAH MARGARET. "INVESTIGATION OF HEARING LOSS IN NEONATES OF MOTHERS WITH DIABETES MELLITUS (TYPE I, TYPE II, AND GESTATIONAL DIABETES MELLITUS)." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1022180186.

Plourde, Gilles. "Human auditory steady-state response, electroencephalogram, and late auditory evoked potentials during general anesthesia." Thesis, University of Ottawa (Canada), 1990. http://hdl.handle.net/10393/5787.

Maiste, Anita. "Human auditory event-related potentials to frequency changes in speech and non-speech sounds." Thesis, University of Ottawa (Canada), 1989. http://hdl.handle.net/10393/5899.

Neuss, Deirdre. "The ecological transition to auditory-verbal therapy: Mothers' and fathers' experiences with children who wear cochlear implants." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/29242.

Sobol, Steven E. "Th2 cytokine expression in atopic children with otitis media with effusion." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33031.

Nguyen, Ha-Nam Phan 1975. "Evidence linking allergic otitis media with effusion to the United airways concept." Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=80341.

Daugherty, Julie A. "The Relationship Between Hearing Status and Cognitive Performance and the Influence of Depressive Symptoms in Older Adults." Thesis, University of South Florida, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3687585.

Hearing loss and cognitive impairment are significant health problems, threatening the independent function of older adults. While there appears to be a strong relationship between the two conditions, the mechanisms underlying this association are complex and are not fully elucidated.

The purpose of this secondary analysis was to explore the relationship between hearing ability and cognitive performance in older adults. In addition, this study attempted to examine the role of depressive symptoms in the relationship between hearing loss and cognitive performance. Comprehensive measures of peripheral hearing, central auditory processing and cognitive performance were utilized to examine these relationships in a sample (N = 30) of adults aged 60 years and older. The Geriatric Depression Scale (GDS) was used to assess depressive symptoms.

Correlational analyses revealed a statistically significant relationship between central auditory processing and executive function. Statistically significant relationships were also observed between speed of processing and peripheral hearing as well as central auditory processing. No significant relationships were noted between depressive symptoms, hearing acuity and cognitive performance. While the correlation coefficients (r) for several of the hearing and cognitive performance measures were not statistically significant, medium effect sizes were detected, suggesting a moderate association may exist between these variables.

Salinas, Alexander A. "Effects of subconcussive head impacts on cerebral acoustic response, oculomotor function, and balance in high school athletes." Thesis, University of Delaware, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1562420.

There is an increasing amount of evidence indicating potentially devastating long-term effects of subconcussive impacts in the absence of clinical symptoms of concussion in high school football players.

Purpose: To determine whether subconcussive head impacts produce any immediate cognitive, postural, and physiological changes after athletic participation.

Methods: Fifty-nine interscholastic football (FB), soccer (SOC), and track (RUN) athletes provided baseline and post-participation data. Four cerebral acoustic response variables were examined using the Brain Acoustic Monitor (BAM) (Active Signal Technologies, Linthicum Heights, MD). Oculomotor function was assessed via the King-Devick (K-D) test. Balance was evaluated using a computerized version of the Balance Error Scoring System (BESS).

Results: Significant changes in left-brain ratio were observed in football players postgame (p = 0.023). Between-group analysis of baseline data for left- and right-brain divergence noted differences as well (FB vs. SOC, p = 0.012, p = 0.008, respectively; FB vs. RUN, p < 0.001, p < 0.001, respectively). There were no significant differences with either oculomotor or balance variables.

Conclusions: One game may not provide enough head impact exposure to elicit detectable changes with the utilized instrumentation. Unexpectedly, there were differences observed in football players' baseline BAM scores in the absence of significant differences in baseline and post-participation K-D test and BESS scores across all groups, possibly indicating that prior exposures to subconcussive impacts in this cohort of football players may be present.

Riffle, Travis Lee. "Variability in Auditory Distraction." Ohio University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1565870603158009.

Sislian, Nicole Christine. "Effects of matched and mismatched stimulation rates on speech perception in bilateral cochlear implant users." Thesis, City University of New York, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3561639.

Does matching stimulation rates in bilateral cochlear implants (CI) really matter? When bilateral CI recipients are implanted sequentially, the first implant is likely to be mapped at a relatively slow stimulation rate, while the second may be capable of faster stimulation rates, due to the technology available at implantation. Ten sequential bilateral CI recipients were used to investigate this question. Prior to the experiment, all participants used slow rates in the first CI, ranging from 720-1856 Hz. Five used slow rates (900Hz) (matched) on the second CI, and five used high rates (2400-3867Hz) (mismatched). The stimulation rate in the first implanted CI was never changed (non-modified), but all participants were given at least four weeks experience with both low and high rates on the newer implant.

Speech perception in quiet (CNC) and in noise (CRISP) with the first CI alone (non-modified), the second CI alone (modified), and bilaterally was evaluated four times during the experiment. Phase 1) Baseline testing was conducted prior to any re-programming. The second implant was re-mapped with either a slow or high rate. Phase 2) Participants were tested and re-mapped with the alternative rate after four weeks experience with the new map. Phase 3) After four weeks experience with the alternative map, participants were retested then re-mapped with the original rates. Phase 4) Participants were given one week of additional experience before final testing. Participants were asked which mapping configuration they preferred and would like to continue using. Most (8/10) participants choose to leave with the mismatched configuration.

With bilateral stimulation, speech perception was better listening in quiet when they used a higher stimulation rate in one ear and a slow rate in the other ear than when they used slow rates in both ears, regardless of the program used before entering the study. There was no significant improvement in the CRISP (independent of noise source location) when participants were using both rate configurations with the modified CI alone, non-modified CI alone, or bilateral CIs. Clinicians programming bilateral CI patients who have internal equipment with different capabilities may find this information helpful when mapping this population.

Zheng, Yun. "Development of new "Detectsound": A computerized model for adjusting the level of acoustic warning signalization in the workplace." Thesis, University of Ottawa (Canada), 2003. http://hdl.handle.net/10393/26415.

SUTHERLAND, BILLIE BROOKE. "MATERNAL DIABETES MELLITUS AND POTENTIALLY OTOTOXIC MEDICATIONS ON THE NEONATE: A RETROSPECTIVE STUDY." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1061236026.

Lee, Jae Hee. "Speech-identification performance of older adults in a competing-talker background effect of fundamental frequency and sentence onset differences /." [Bloomington, Ind.] : Indiana University, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3380097.

Ladak, Hanif M. "Finite-element and experimental analyses of the response of the cat eardrum to large static pressures." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0003/NQ44481.pdf.

Cetas, Justin Schultz. "Neuronal architecture and functional organization of the rabbit auditory thalamus." Diss., The University of Arizona, 2000. http://hdl.handle.net/10150/284260.

LUTZ, MANDY J. "LISTENING THERAPY IN PATIENTS WITH TINNITUS: EFFICACY WITH MILD VERSUS SEVERE CASES." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1054224482.

SISTRUNK, ROSALIND SMITH. "THE DEVELOPMENT OF SIMULATED CASE STUDIES ON CD-ROM FOR AUDIOLOGY STUDENTS." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1021548464.

Hazelbaker, Julie L. "Effect of bone conduction transducer placement on distortion product otoacoustic emissions." Connect to this title online, 2004. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1092677782.

Lizerbram, Jeffrey Kane 1969. "Recording active basilar membrane tuning characteristics using distortion-product otoacoustic emissions." Thesis, The University of Arizona, 1993. http://hdl.handle.net/10150/278354.

Warner, John Richard. "THE EFFICACY AND REPEATABILITY IN OTOACOUSTIC EMISSIONS SCREENING BY NON-AUDIOLOGY PROFESSIONALS." Miami University / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=miami1051146726.

Jardine, David Alvin. "Biodesensitization: Biofeedback-controlled systematic desensitization of the distress response to chronic tinnitus." Scholarly Commons, 1999. https://scholarlycommons.pacific.edu/uop_etds/2731.

Ghosh, Sudeshna S. "On the effects of incudostapedial joint flexibility in a finite-element model of the cat middle ear." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=27485.

Siah, Tiong Heng. "Finite-element modelling of the mechanics of the coupling between the incus and stapes in the middle ear." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33993.

Velenovsky, David Scott 1955. "The effect of noise bandwidth on the contralateral suppression of transient evoked otoacoustic emissions." Diss., The University of Arizona, 1998. http://hdl.handle.net/10150/282808.

Schmisseur, Brooke E. B. "An Evaluation of Noise Reduction Effectiveness in Four Digital Hearing Aids." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1022253793.

Laroche, Marilyn. "A Study of Auditory Speech Processing using Brainstem Evoked Responses under Quiet and Noisy Conditions." Thesis, University of Ottawa (Canada), 2011. http://hdl.handle.net/10393/28877.

Resavage, Allison Lynne. "CURRENT MEDICAL PRACTICES FOR TREATMENT OF VESTIBULAR DYSFUNCTION." Miami University / OhioLINK, 2004. http://rave.ohiolink.edu/etdc/view?acc_num=miami1082599683.

Joly, Yvan. "A digital speech transformation system for developing aids for the hearing impaired /." Thesis, McGill University, 1991. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=60047.

Burkholder, Rose A. "Perceptual learning of speech processed through an acoustic simulation of a cochlear implant." [Bloomington, Ind.] : Indiana University, 2005. http://wwwlib.umi.com/dissertations/fullcit/3200642.

HOUSTON, LISA MICHELLE. "A STANDARDIZATION STUDY OF THE TIME COMPRESSED SENTENCE TEST." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1022179121.

BELAND, MICHELLE LYNNE. "AN INVESTIGATION OF CLASSROOM ACOUSTICS IN BUILDINGS CONSTRUCTED IN DIFFERENT ERAS OF THE 20TH CENTURY." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1054296040.

JAHNKE, MARGARET L. "QUALITATIVE ANALYSIS OF THE BENEFITS OF COCHLEAR IMPLANTS FOR CHILDREN WITH MULTIPLE HANDICAPS." University of Cincinnati / OhioLINK, 2004. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1084200167.

Williams, A. Lynn, Lori J. Marks, R. Barnhart, and Susan Epps. "ICF-CY: Basis for a Conceptual Model for Interprofessional Education." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/2067.

RYERSON, ELIZABETH SUZANNE. "MATERNAL DIABETES MELLITUS AND NEONATAL HEARING: A RETROSPECTIVE STUDY OF HYPERBILIRUBINEMIC RELATED RISK FACTOR." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1054303348.

Arnold, Michelle L. "Factors Related to Hearing Aid Use among Older Adults from Hispanic/Latino Backgrounds: Findings from the Hispanic Community Health Study/Study of Latinos." Scholar Commons, 2018. https://scholarcommons.usf.edu/etd/7665.

DiSalvo, Maribeth. "Effects of Cardiovascular Health on Hearing Levels Among Musicians." Miami University / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=miami1051043965.

Davis, Lindsey Brooke. "Efficacy of Audiologic and Otologic Outcome Measures to Predict Middle Ear Status." Miami University / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=miami1050962431.

SUMME, LORI ANN. "Noise Reduction in Digital Hearing Aids Using Environmental Sounds." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1052327314.

THOMPSON, KIERSTEN LYN. "PRIOR COMBINED SOLVENT AND NOISE EXPOSURE AND ITS IMPACT ON HEARING." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1054223886.

Marks, Lori J., R. Barnhart, A. Lynn Williams, Susan Bramlett Epps, and E. Skelly. "Full Participation in Appalachia for People with Disabilities: Model for Professional Development." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/2068.

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• Current Issues in Pediatric Audiology - Vanderbilt Audiology's Journal Club

Anne Marie Tharpe, PhD

• Hearing Aids - Children
• Vanderbilt Audiology Journal Club

Editor’s Note: This text course is an edited transcript of a live seminar. Download supplemental course materials .

Dr. Gus Mueller:  Our presenter today is Dr. Anne Marie Tharpe.  She is Professor and Chair at the Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine.  You may know Dr. Tharpe not only from Vanderbilt, but also for the work that she has done in the area of pediatric audiology over the years.  Perhaps you have the Comprehensive Handbook of Pediatric Audiology textbook , which she completed a few years ago with Richard Seewald (2010).  It has become one of the main texts for teaching pediatric audiology and is an excellent resource. 

This year marks the 30 th anniversary of the seminal publication that Dr. Tharpe authored along with Dr. Fred Bess (1984) entitled, Unilateral Hearing Impairment in Children .  The publication of that article was the first bit of evidence showing that unilateral hearing loss can have quite an impact on many aspects of a child’s life.

In addition to her academic and research accomplishments, Dr. Tharpe is the Chair of the Department of and Hearing and Speech Sciences.  There are 9 different clinics at Vandy, 5 of which are on the main campus, and 2 preschools – one for children with hearing loss and one for children with autism.  We have about 20 research labs.  There are 41 full-time faculty in the department, 16 or 17 of which are audiologists.  There are about 130 staff people, of which 32 are clinical audiologists.  We see about 84,000 patient visits a year.  Dr. Tharpe is in charge of all that, and she does an excellent job.  With that, I will turn it over to our speaker today, Dr. Anne Marie Tharpe.

Dr. Anne Marie Tharpe:   Thank you, Gus.  It’s a pleasure to be here today.   As you’ve mentioned, my passion has always been in pediatric audiology, and my research has focused on applied clinical issues.  Today I’m going to review three interesting articles from the past year that have a direct clinical application to pediatric audiology, although there are many more that were worthy of consideration.

Article 1: Subjective Fatigue in Children with Hearing Loss: Some Preliminary Findings

The first article I’ll review is by Ben Hornsby and colleagues (2013), here at Vanderbilt.  Fatigue has become a hot topic in audiology today.  We have finally gotten beyond simple speech perception advantages with hearing aids, and now we are starting to look at functional health advantages and implications.  I would like to also point out that Fred Bess began looking at functional health measures in the elderly including fatigue and stress when he was conducting the Charge Project in the 1980s.  That was the first time I became aware of this issue.  Dr. Bess later looked at the impact of minimal hearing loss on stress and other functional health status. 

I want to provide you with some background information before getting into the Hornsby (2013) study.  Bess, Dodd-Murphy and Parker (1998) did some work on minimal, permanent hearing loss in children.  The takeaway was that children with minimal losses reported less energy than children with normal hearing.  That was of great interest to those of us who had an interest in minimal bilateral loss as well as unilateral loss. 

I want to explain the concept of effort and how it contributes to fatigue.  We assume a commonly held hypothesis of limited effort capacity, which means that we have only so much effort available to us.  Think about effort being contained in a bucket.  There is a limited capacity.  If we have two tasks to perform, one of which is a difficult listening task, we are going to use most of that effort in the bucket for the listening task, which only leaves a little effort for a secondary task.  Many people have used a paradigm of dual-task performance that is based on this concept of limited effort capacity. 

In a prior study (Hicks & Tharpe, 2002), we looked at listening in the presence of background noise as a primary task.  As a secondary task, we asked children to push a button when they saw a light come on.  The light would come on randomly in front of them.  The children’s primary task was to repeat a word that they heard and the secondary task was pushing a button when the light came on.  The premise here was that if the majority of effort was being used to listen, then children with hearing loss would have a longer reaction time in pushing the button when the light came on than children with normal hearing, because most of their effort was already being allocated towards listening.  This is what we found to be true. 

Subjects & Methods

Hornsby and colleagues asked, “What is the effect of hearing loss on subjective reports of fatigue in school-aged children?”  They had 10 children with hearing loss and 10 age-matched peers with normal hearing (Hornsby, et al., 2013).  They used subjective ratings quantified by the PedsQL Multidimensional Fatigue Scale.  This is a well-standardized, widely- used scale.  All children had normal nonverbal intelligence, and the children with hearing loss had poorer language abilities than those with normal hearing, as would be expected.  They were age-matched within plus-or-minus six months.  The children with hearing loss varied widely in terms of their hearing losses.  There were five who used hearing aids, four with cochlear implants, and one who had a unilateral hearing loss. 

As I mentioned, they used the PedsQL Fatigue Scale.  It queried areas of general fatigue (e.g., “I feel tired”), sleep and rest fatigue (e.g., “I rest a lot”), cognitive fatigue, and then there is a composite score. 

They found that children with hearing loss demonstrated or reported more fatigue than their normal-hearing counterparts on all portions of that scale.  It is interesting to note that the fatigue scores reported in this study indicated more fatigue experienced by children with hearing loss than children with other chronic conditions, such as cancer, rheumatoid arthritis, diabetes, and obesity (Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002; Varni, Burwinkle, & Szer, 2004; Varni, Limbers, Bryant, & Wilson, 2009; Varni, Limbers, Bryant, & Wilson, 2010).  In fact, the study might have even underestimated the impact of hearing loss on fatigue because the PedsQL does not include items for speech processing and listening effort.  I think it is important to consider that more work needs to be done. 

We also know that fatigue can be caused by additional mental effort, and that can lead to increased stress and tension.  In adults, this fatigue has resulted in an increased rate of sick leave (Kramer, Kapteyn, & Houtgast, 2006) and is also associated with attentional and concentration issues, slow mental processing, and impaired decision-making (van der Linden, Frese, & Meijman, 2003).  Certainly, those of us who are interested in pediatric audiology would all be concerned about fatigue being a mitigating factor in poor academic performance of children with hearing loss. 

I also want to mention that Hornsby (2013) had another study that I did not include in this review.  He examined speech-processing-related fatigue and was specifically looking at whether or not hearing aids would mitigate the impact of fatigue.  We have not seen this work done in children, but in adults, he found that the use of hearing aids decreased listening effort.  I think that is a very exciting finding.  Again, it takes us away from only thinking about the impact of hearing loss on speech perception and focuses more globally on what might be going beyond the ears of children with hearing loss. 

Article 2: Predictors of Hearing Aid Use Time in Children with Mild-to-Severe Hearing Loss

The next study that I would like review is by Walker and colleagues (2013); I was intrigued by the title right away.  As a pediatric audiologist, one of our primary goals for children with hearing loss is to ensure full-time hearing aid use.  We typically define full-time use in children as wearing hearing aids during all waking hours, with the exception of bathing or swimming.  I was interested in what kind of documentation might be used in this particular study.  The researchers asked, “What are the predictors of hearing aid use time in children with hearing loss, and what are the challenges?”  As most of you know, we are now screening more than 95% of babies at birth (Russ, Hanna, DesGeorges, & Forsman, 2010).  That is good news but we hope that the process does not stop there.  Identification is not helpful unless it leads to early intervention. 

Although we have a significant loss-to-follow-up rate (Russ, et al., 2010), we do expect that early diagnosis of hearing loss will lead to early intervention, likely hearing aid fitting in most cases.  It is also assumed that children who can achieve consistent full-time use of hearing aids will have better outcomes than children who do not.  Although we accept this on faith, we have not seen this topic specifically addressed in the literature, in terms of the wear time of hearing aids with children. 

There is some evidence that Mary Pat Moeller and colleagues brought forth in 2009 showing that hearing aid use is inconsistent early in life and becomes more consistent with age.  It is also likely that some situations for wearing hearing aids are more challenging than others; these can also vary by age. 

I should point out that the Walker et al. study (2013) was part of the larger Outcomes of Children with Hearing Loss (OCHL) study, which is a multi-site study that has been going on for a number of years; the data are now starting to come out.  They took parents of 272 children with permanent bilateral mild- to- severe hearing loss and presented a hearing aid use questionnaire, which was completed on their regular study visits over time.  Parents, using this questionnaire, would estimate the average amount of time their child used hearing aids per day during the week and also on the weekend, with the assumption that children might vary usage between weekdays when they are in school and on the weekend.  Parents also rated how often their child wore hearing aids in eight different listening environments (car, school, daycare, meal time, playing alone, book sharing, playground, and public).

On average, parents reported children wore hearing aids about 10-and-a-half hours a day during the week and about 10 hours on weekends.  The longer hearing aid use time was associated with older age, poorer hearing, and higher maternal education level.  I want to stop here to say that, for most pediatric audiologists, these results are likely somewhat surprising and disappointing.  Ten hours a day seems relatively short for children, especially school-aged children. 

I also want to mention some interesting results that came out at the Sound Foundation conference in December 2013, as reported by Christine Jones.  She was using data logging to confirm wear time in hearing aids.  She reported that children, on average, were using their hearing aids six hours a day.  That is obviously even more concerning than 10-and-a-half hours a day.  I speculate that the children enrolled in this current study (Walker et al., 2013) are optimal cases.  These are families who have chosen to participate in a longitudinal study that requires some effort on their part to go in on a regular basis to have testing.  I would consider these families to probably be more motivated than average. 

Going back to Christine Jones’ (2013) study, the range of wear time was considerable, with the data logging showing that some children wear their hearing aids less than 30 minutes a day.  There were only 33% of the children in that study who wore their hearing aids greater than or equal to eight hours a day.  That is quite alarming. 

Here are the predictors that Walker (2013) found in this current study.  For every 10 dB increase in the pure-tone average (PTA) of the better hearing ear, the average hearing aid use time increased by half an hour.  This means that the greater the hearing loss, the more the children wore their hearing aids.  For every 10-month increase in age, there was also an increase in hearing aid use time by 0.71 hours.  Mothers who obtained a college degree had children with the most hearing aid use time compared to mothers with less education. 

Furthermore, only 35% of parents of infants responded that they used hearing aids in the car, compared to 78% of parents of preschoolers and school-aged children who use hearing aids in the car.  I think that is understandable and not surprising to most of us who have worked with infants and young toddlers.  We know that infants are in car seats placed in the back seat, and there is often concern about children getting their hearing aids out, throwing them out the window, swallowing them, et cetera.  It is not too surprising that infants would not be wearing their hearing aids in the car as much as older children.  I think it is also interesting to note that 58% of parents of infants reported that they always wear hearing aids at daycare, compared to 79% of preschoolers and 76% of school-aged children who wear hearing aids at daycare.  Again, this is likely a concern about damage to or loss of the hearing aids, and now we have some concrete evidence to support some of the suspicions that many of us have had over the years. 

In terms of the relationship between hearing levels and the use of hearing aids in public and at school, children who had greater hearing loss showed more consistent hearing aid use in public and at school.  It is speculated that this is likely because children (or the parents of those children) who have hearing losses better than 50 dB feel that they can get along without hearing aids, and that it is not as important as for those children with more significant losses. 

The authors presented an open-ended question about the challenges of consistent hearing aid use in relation to age.  The child’s state was considered one of the most important and significant challenges to hearing aid use.  In other words, if a child was fussy, crying, and tearing off the hearing aid, that was an important factor related to keeping a hearing aid on a child.  That was more important for those children who were very young, in the birth to two-year age range. 

Parental Estimates of Average Hearing Aid Use

A second study was also completed (Walker et al., 2013).  For this study, the researchers examined the accuracy of parental estimates of average hearing aid use time for their children.  They compared these reports to objective data logging measures.  It is important to note that the parents were unaware that the data logging feature of the hearing aid was being used.  They found 84% of parents overestimated their child’s hearing aid use time.  This might relate back to what I was saying about the report from Christine Jones (2013) who, through data logging, found less hearing aid use than in this current parental report.  They found that only 16% either underestimated or were accurate in their estimations of hearing aid use.  The parents reported about 10-and-a-half hours a day of use, and the data logging indicated about 8 hours a day of use.  The older the child was, the smaller the expected difference would be between the parents’ estimates and data logging.

Applications

Why is this important?  I think most of us can come up with many reasons why this would be important for an audiologist to know.  One reason could be for counseling parents about hearing aid use.  We can tell them that we know there are certain challenges for keeping aids on and one of them is that their very young children get fussy -- and they are not alone.  All parents find that it is difficult keeping the hearing aids on a young child, but the important thing is that things get better.  As children get older, their state is better controlled, they are not as fussy, and it will be easier to keep the hearing aids in.  I think that that is an important message for counseling purposes. 

For me, this raises another interesting issue, and that is the use of data logging to monitor how much hearing aids are used.  I have been in several discussions with pediatric audiologists at meetings talking about whether or not we should notify parents that we can look at how many hours their child is using hearing aids or not.  Is that going to put pressure on parents?  Will it make them feel that big brother is watching?  Is it going to, for some parents, make them turn on the hearing aids and set them on the dresser to fool their audiologists? Or is it better for us to have that information and knowledge, and then use the knowledge of how much a child is using his or her hearing aids to help us in counseling that family?  It would be an indication to us that perhaps we need to spend more time with the family when we see data logging that suggests the family is having a difficult time keeping the hearing aids in. 

The other point I would like to make is on counseling for parents of children with milder losses.  This study (Walker et al., 2013) verified that less hearing loss resulted in less hearing aid use time.  This is something that also came up in Mary Pat Moeller’s 2009 study as well.  Parents of children with milder losses do not see the benefits as dramatically as parents of children with more severe hearing losses.  This is where I think providing families with simulations of mild hearing loss can be particularly useful, because it is hard for them to see the benefits of hearing aid use with their own eyes.

Article 3: The Future Role of Genetic Screening to Detect Newborns at Risk of Childhood-Onset Hearing Loss

The next study that I would like to cover discusses the role of genetic screening for hearing loss in infancy (Phillips, Bitner-Glindzicz, Lench, Steel, Langford et al., 2013).  I would like to start by first saying that I am not a geneticist, nor do I conduct genetic research, but as a pediatric audiologist, I am very interested in this concept, as I am sure you are as well.  Interest has been growing in genetic screening for hearing loss over the last decade, and as we learn more and more about genetics and genetic hearing loss, more and more interest in screening is expressed.   I am going to describe an expert consensus statement out of England.  Let me provide a bit of background before we get into the details of what this paper discussed. 

We know that hearing loss is the most common birth defect in developed countries.  Permanent hearing loss of greater than moderate degree occurs in about 1.6 per 1,000 live births.  These are data out of England, but are similar in the United States.  At least two-thirds of these losses have a genetic cause, and about 70% of those genetically- caused losses are non-syndromic. 

This group of experts asked, “What is the future potential of genetic screening to detect newborns at risk of childhood hearing loss?”  I see this as very similar to the way that we approached newborn hearing screening back in the early 1990s.  We had a group of experts come together as the National Institutes of Health (NIH) Consensus Group in March of 1993 to discuss the future of newborn hearing screening in this country.  That is a very similar approach to what was taken here.  In England, as I mentioned, they have a rate of about 1.6 per 1,000 births with permanent hearing loss, and about 3.5 per 1,000 children at school-age.  That is a big increase between the newborn period and entry into school.  It is not clear if these children were those with very mild losses who were passed on a newborn hearing screening, whether or not they were true false negatives, or whether they had acquired late-onset, progressive losses because of genetic predisposition for hearing loss.  That is what set the stage for these individuals to start considering genetic screening for hearing loss. 

This was an expert-led discussion of current and future developments in genetic technology to understand what the knowledge base is of genetic hearing loss and the viability of genetic screening.  They concluded that technology would yield it possible to have an entire genome sequenced within 10 years.  It is interesting though that there is little commercial interest in developing genetic assays for hearing loss compared to other conditions.  This is likely because there are no commercially produced therapeutic interventions that could be linked.  We end up with “what now?” and “where do we go from here?”  There is also a great need to standardize the interpretation of genetic tests across geneticists.  There is large variance in terms of interpretation, how geneticists approach such information, and how they use it.  There is a need for algorithms that can guide the counseling and the interpretation of these genetic tests before they are widely used. 

They also concluded that genetics cannot be reliably used in a screening capacity for hearing loss until we know more about the genes involved and the clinical significance.  We do not know if an asymptomatic newborn with a mutation in the gene will experience hearing loss or not.  Hearing loss is genetically very heterogeneous, and it involves mutations in many genes.  It is not possible to predict the risk of developing the hearing loss by assessing a single or even a selection of genes that are currently identified. 

For example, we know that the most frequent causative gene is GJB2.  GJB2 has at least 300 mutations.  In order to assay this, we would have to have measures that would search for 300 different mutations on just one gene.  I think you can imagine the load that would be required for doing a thorough screening for hearing loss.  There have been about 70 genes for nonsyndromic hearing loss identified to date.  It is anticipated that more than 500 genes, some with hundreds of mutations per gene, are likely to be involved in causing hearing loss.  Furthermore, some of these mutations could require interactions among genes.  Identifying one gene mutation does not necessarily mean that hearing loss will be expressed. 

We also know that current methods of DNA analysis require two to five milliliters of blood, and this is simply unacceptable for a newborn screen.  This will improve over time, and the hope is that the heel prick obtained in nurseries for screening for other conditions will be sufficient for a DNA analysis, but at this point in time, that is not the case.  Additionally, whole genome sequencing would require extensive data processing and storage requirements.  The cost is rather remarkable.

Another issue, that reminds me of some of the debates that we had around universal newborn hearing screening in the 1990s, involves incidental findings.  What about the impact on the families of these results?  For example, if a whole genome is sequenced, what about all the other mutations not related to hearing loss that become available and could give rise to future diseases and conditions?  What is our ethical and moral obligation to report what is seen even beyond what was screened for?  This paper recommended that we be cautious in moving forward with genetic screening for hearing loss and that we consider testing all newborns and children with known hearing loss so that we can help to determine the etiology, as it can improve our knowledge of genetic causes of hearing loss.  However, genetically screening newborns universally, certainly at this time, is not justified. 

They did provide a lot of good information about what considerations should be made as we approach and consider genetic screening for hearing loss.  I think it would be an interesting article for all of us to read.  They also discussed the notion that in the next 10 years, it is likely that genetic screening will be much more widespread.  It is also likely that we will not just be screening for hearing loss but for many genetic indicators of chronic disease.   With newborn hearing screening, we went out on our own as a field to screen for hearing using auditory brainstem response (ABR) and otoacoustic emissions (OAE).  In the case of genetic screening, we will need to partner with our medical colleagues from other areas, because screening for genetic hearing loss will be but one part of a global screening process for children. 

I found this article to be fascinating, and it got me thinking about all kinds of changes that could be implemented with newborn hearing screening.  In other words, we now have the potential for a better mousetrap, if you will.  We have all been concerned about the number of children that we miss, especially those with milder losses through newborn screening, and the fact that we do not have an additional mandated screening until children enter school.  That is a long period of time in which we are missing hearing losses, many of which are genetically based.  I find this to be an intriguing topic and one that should be garnering the attention of anyone who has interest in pediatric audiology. 

Those are the articles that I wanted to cover with you today, and at this time we’ll take questions. 

Questions and Answers

You mentioned subjective fatigue in the Hornsby (2013) study.  Did they measure objective fatigue in that study also?  I also know that you have been involved in studies where you measure objective fatigue.  Could you talk about how that is done? 

The Hornsby et al. (2013) study was simply on the subjective fatigue measures.  This is part of a larger study that this Vanderbilt group is doing where they are objectively measuring fatigue.  However, he did not report it here.  Those results are still being analyzed, but I expect them to be out relatively soon. 

In the study that I did with Hicks (2002), we objectively measured fatigue.  We did this through the use of salivary cortisol levels, and that is a common way to measure fatigue.  In our study, we took salivary cortisol levels early in the school day for each child, and then later in the school day for each child.  We looked at whether or not there were significant differences in the cortisol levels, which are indicators of fatigue, for the children with hearing loss versus their normal hearing counterparts.  In that particular study, we did not find significant differences.  We think that that was probably due to methodological limitations, because it is very critical what time of day you take the measurements and how the time relates to when a child eats and other factors.  The cortisol can be affected by diet.  In any case, we did not find between-group differences. 

The Vanderbilt team has a new approach to how they are measuring salivary cortisol in the current study.  I am very interested to see if they improved that technique such that they could measure fatigue effects.  One of the complicating features of using cortisol is that you get increased cortisol levels with stress and decreased cortisol with fatigue.  If one assumes that children get stressed when they cannot hear and perform in a classroom, you could have some interactions that could mitigate the findings.  It is complicated, but also very interesting, and I am optimistic that Ben and his colleagues will be able to reveal something from their cortisol findings. 

Dr. Mueller :  It is certainly an interesting area.  I know these types of measures are going a step further with adults to evaluate if these types of things can be used to measure the benefit of given hearing aid features.  Do you have less fatigue when noise reduction is turned on?  Do you have less fatigue when you are using directional microphone technology?  Do you have less fatigue when you are fitted to a prescriptive method rather than some other way?  I am guessing with both children and adults that we are going to be seeing a lot of things in this area down the road.

Do you think hearing aid wear time would go down again in the teen years?

Dr. Tharpe: Absolutely.  I would venture to guess that when teenagers get to school, a lot of those hearing aids go right into their backpacks.    Again, I think the issue would be how significant the hearing loss is and whether or not the teenager thought they could get by without the hearing aid.  I expect an interaction between age and degree of hearing loss. 

Have you developed a protocol for counseling families on data logging and hearing aid use?

We have not.  I would be interested to know if anyone else has developed a protocol.  Right now we are approaching this on an individual basis.  For the most part, I would say that we do not tell our families that we are checking their data logging when we check hearing aids.  We just say we are checking the features of the hearing aid.  We are also very cognizant of trying to build trusting relationships with our families, and we do not want them to feel that we are scolding them when we find that they have not been using the hearing aids.  We would like to know that we have accurate information from the data logging and that it could raise a red flag for certain families who may need some more support in hearing aid use.  Data logging allows us the opportunity to identify those families. 

Should we be sharing with the family that as the child gets older, it may be easier to deal with the use of the hearing aids?  I am concerned that perhaps parents will relax and wait for the child to grow up before implementing consistent hearing aid use.

I think that is a wonderful point.  We always are walking a fine line of trying to reassure families without making them feel that it is not a big deal.  I think that we should let families know that they are not alone.  I think that is the message more than anything else, and that we expect things to get better over time as the child grows.  At the same time, we need to talk about how critical it is that we increase the hours that children are wearing their hearing aids.  I think we should be talking about the importance of those early years in developing speech, language and communication skills as opposed to talking about increasing wear time by a certain amount each day.  The families are much more concerned about communicating with their children than they are with how many hours the children wear their hearing aids.  We need to make that connection for them in our discussions.

Are there standard recommendations for children diagnosed with hearing loss to go to other specialties besides otolaryngology (ENT)?

Yes, there are.  The JCIH (2007, 2013) provide specific guidelines about medical management and intervention. Recommendations can include ophthalmology, genetic counseling, and depending on the results of the etiologic evaluations, we would make referrals to cardiology or to nephrology to test kidney function, et cetera.  I hope it goes without saying that all children with hearing loss will be referred to their state early intervention system. 

Bess, F. H., Dodd-Murphy, J., Parker, R. A. (1998). Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear and Hearing, 19 (5), 339-354.

Bess, F. H., & Tharpe, A. M. (1984). Unilateral hearing impairment in children. Pediatrics, 74 (2), 206-216.

Hicks, C. B., & Tharpe, A. M. (2002). Listening effort and fatigue in school-age children with and without hearing loss. Journal of Speech, Language, and Hearing Research, 45 (3), 573-584.

Hornsby, B. W. Y. (2013). The effects of hearing aid use on listening effort and mental fatigue associated with sustained speech processing demands. Ear and Hearing, 34 (5), 523-534. doi: 10.1097/AUD.0b013e31828003d8.

Hornsby, B. W. Y., Werfel, K., Camarata, S. & Bess, F. H. (2013). Subjective fatigue in children with hearing loss: Some preliminary findings. American Journal of Audiology, 23 (1), 129-134. doi: 10.1044/1059-0889(2013/13-0017).

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Jones, C. (2013, December). What do we know about the fitting and daily life usage of hearing instruments in pediatrics? Session presented at the 6 th International Pediatric Audiology Conference, A Sound Foundation through Early Amplification, Chicago, IL.

Kramer, S. E., Kapteyn, T. S., & Houtgast, T. (2006). Occupational performance: comparing normally-hearing and hearing-impaired employees using the Amsterdam Checklist for Hearing and Work. International Journal of Audiology, 45 (9), 503-512.

Moeller, M. P., Hoover, B., Peterson, B., & Stelmchowicz, P. (2009). Consistency of hearing aid use in infants with early-identified hearing loss. American Journal of Audiology, 18 (1), 14-23. doi: 10.1044/1059-0889(2008/08-0010).

Phillips, L. L., Bitner-Glindzicz, M., Lench, N., Steel, K. P., Langford, C., Dawson, S. J., et al. (2013). The future role of genetic screening to detect newborns at risk of childhood-onset hearing loss. International Journal of Audiology, 52 (2), 124-133.

Russ, S. A., Hanna, D., DesGeorges, J., & Forsman, I. (2010). Improving follow up to newborn hearing screening: a learning-collaborative experience. Pediatrics, 126 (Suppl 1), S59-S69. doi: 10.1542/peds.2010-0354K.

Seewald, R., & Tharpe, A. M. (2010). Comprehensive handbook of pediatric audiology . San Diego, CA: Plural Publishing.

Van der Linden, D., Frese, M., & Meijman, T. F. (2003). Mental fatigue and the control of cognitive processes: effects on perseveration and planning. Acta Psychologica, 11 (3), 45-65.

Varni, J. W., Burwinkle, T. M., Katz, E. R., Meeske, K., & Dickinson, P. (2002). The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module.  Cancer, 94 (7), 2090-2106.

Varni, J. W., Burwinkle, T. M., & Szer, I. S. (2004). The PedsQL multidimensional fatigue scale in pediatric rheumatology: reliability and validity. The Journal of Rheumatology, 31 (12), 2494-2500.

Varni, J. W., Limbers, C. A., Bryant, W. P., Wilson, D. P. (2009). The PedsQL multidimensional fatigue scale in type 1 diabetes: feasibility, reliability, and validity. Pediatric Diabetes, 10 (5), 321-328. doi: 10.1111/j.1399-5448.2008.00482.x.

Varni, J. W., Limbers, C. A., Bryant, W. P., Wilson, D. P. (2010). The PedsQL multidimensional fatigue scale in pediatric obesity: feasibility, reliability and validity. International Journal of Pediatric Obesity, 5 (1), 34-42. doi: 10.3109/17477160903111706.

Walker, E. A., Spratford, M., Moeller, M. P., Oleson, J., Ou, H., Rousch, P., et al. (2013). Predictors of hearing aid use time in children with mild-to-severe hearing loss. Language, Speech, and Hearing Services in Schools, 44 (1), 73-88. doi: 10.1044/0161-1461(2012/12-0005).

Cite this content as:

Tharpe, A. (2014, September). Current issues in pediatric audiology - Vanderbilt Audiology’s Journal Club.  AudiologyOnline , Article 12918 Retrieved from:  https://www.audiologyonline.com

Anne Marie Tharpe, Professor and Chair of the Department of Hearing and Speech Science at Vanderbilt University and Associate Director of the Vanderbilt Bill Wilkerson Center, is the author of over 75 journal articles, books, and book chapters dealing with pediatric audiology. In addition, she has spoken to numerous audiences around the world about various aspects of childhood hearing loss.  Dr. Tharpe maintains a small clinical practice in addition to running a research laboratory and teaching audiology, speech-language pathology, and deaf education graduate students. Most of her research has focused on the early identification and intervention of hearing loss in the pre-school and school-age child. Specifically, she is interested in the impact of hearing loss on overall child development.

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Effect of steplike high-temperature treatment on the composition and structure of the primary carbides in R6M5 high-speed steel ingots

• Published: 25 May 2011
• Volume 2011 , pages 29–32, ( 2011 )

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• I. V. Doronin 1 ,
• Yu. A. Lukina 2 ,
• I. O. Bannykh 3 &
• P. L. Alekseev 1  

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The effect of steplike high-temperature treatment (SHTT) on the composition and structure of carbides in the ledeburite eutectic of R6M5 high-speed steel ingots is studied. It is shown that SHTT processes lead to fragmentation and a change in the composition of the primary carbides, which causes their disintegration and a decrease in the carbide size during hot deformation.

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Original Russian Text © I.V. Doronin, Yu.A. Lukina, I.O. Bannykh, P.L. Alekseev, 2011, published in Metally, 2011, No. 1, pp. 35–38.

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Doronin, I.V., Lukina, Y.A., Bannykh, I.O. et al. Effect of steplike high-temperature treatment on the composition and structure of the primary carbides in R6M5 high-speed steel ingots. Russ. Metall. 2011 , 29–32 (2011). https://doi.org/10.1134/S0036029511010071

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Title : Active carbons as nanoporous materials for solving of environmental problems

However, up to now, the main carriers of catalytic additives have been mineral sorbents: silica gels, alumogels. This is obviously due to the fact that they consist of pure homogeneous components SiO2 and Al2O3, respectively. It is generally known that impurities, especially the ash elements, are catalytic poisons that reduce the effectiveness of the catalyst. Therefore, carbon sorbents with 5-15% by weight of ash elements in their composition are not used in the above mentioned technologies. However, in such an important field as a gas-mask technique, carbon sorbents (active carbons) are carriers of catalytic additives, providing effective protection of a person against any types of potent poisonous substances (PPS). In ESPE “JSC "Neorganika" there has been developed the technology of unique ashless spherical carbon carrier-catalysts by the method of liquid forming of furfural copolymers with subsequent gas-vapor activation, brand PAC. Active carbons PAC have 100% qualitative characteristics of the three main properties of carbon sorbents: strength - 100%, the proportion of sorbing pores in the pore space – 100%, purity - 100% (ash content is close to zero). A particularly outstanding feature of active PAC carbons is their uniquely high mechanical compressive strength of 740 ± 40 MPa, which is 3-7 times larger than that of  such materials as granite, quartzite, electric coal, and is comparable to the value for cast iron - 400-1000 MPa. This allows the PAC to operate under severe conditions in moving and fluidized beds.  Obviously, it is time to actively develop catalysts based on PAC sorbents for oil refining, petrochemicals, gas processing and various technologies of organic synthesis.

Victor M. Mukhin was born in 1946 in the town of Orsk, Russia. In 1970 he graduated the Technological Institute in Leningrad. Victor M. Mukhin was directed to work to the scientific-industrial organization "Neorganika" (Elektrostal, Moscow region) where he is working during 47 years, at present as the head of the laboratory of carbon sorbents.     Victor M. Mukhin defended a Ph. D. thesis and a doctoral thesis at the Mendeleev University of Chemical Technology of Russia (in 1979 and 1997 accordingly). Professor of Mendeleev University of Chemical Technology of Russia. Scientific interests: production, investigation and application of active carbons, technological and ecological carbon-adsorptive processes, environmental protection, production of ecologically clean food.   

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