Determination and evaluation of clinically efficient stopping criteria for the multiple auditory steady-state response technique

Background: Although the auditory steady-state response (ASSR) technique utilizes objective statistical detection algorithms to estimate behavioural hearing thresholds, the audiologist still has to decide when to terminate ASSR recordings introducing once more a certain degree of subjectivity. Aims: The present study aimed at establishing clinically efficient stopping criteria for a multiple 80-Hz ASSR system. Methods: In Experiment 1, data of 31 normal hearing subjects were analyzed off-line to propose stopping rules. Consequently, ASSR recordings will be stopped when (1) all 8 responses reach significance and significance can be maintained for 8 consecutive sweeps; (2) the mean noise levels were ≤ 4 nV (if at this “≤ 4-nV” criterion, p-values were between 0.05 and 0.1, measurements were extended only once by 8 sweeps); and (3) a maximum amount of 48 sweeps was attained. In Experiment 2, these stopping criteria were applied on 10 normal hearing and 10 hearing-impaired adults to asses the efficiency. Results: The application of these stopping rules resulted in ASSR threshold values that were comparable to other multiple-ASSR research with normal hearing and hearing-impaired adults. Furthermore, in 80% of the cases, ASSR thresholds could be obtained within a time-frame of 1 hour. Investigating the significant response-amplitudes of the hearing-impaired adults through cumulative curves indicated that probably a higher noise-stop criterion than “≤ 4 nV” can be used. Conclusions: The proposed stopping rules can be used in adults to determine accurate ASSR thresholds within an acceptable time-frame of about 1 hour. However, additional research with infants and adults with varying degrees and configurations of hearing loss is needed to optimize these criteria

Clinical validation of a public health policy-making platform for hearing loss (EVOTION): protocol for a big data study

INTRODUCTION: The holistic management of hearing loss (HL) requires an understanding of factors that predict hearing aid (HA) use and benefit beyond the acoustics of listening environments. Although several predictors have been identified, no study has explored the role of audiological, cognitive, behavioural and physiological data nor has any study collected real-time HA data. This study will collect ‘big data’, including retrospective HA logging data, prospective clinical data and real-time data via smart HAs, a mobile application and biosensors. The main objective is to enable the validation of the EVOTION platform as a public health policy-making tool for HL. METHODS AND ANALYSIS: This will be a big data international multicentre study consisting of retrospective and prospective data collection. Existing data from approximately 35 000 HA users will be extracted from clinical repositories in the UK and Denmark. For the prospective data collection, 1260 HA candidates will be recruited across four clinics in the UK and Greece. Participants will complete a battery of audiological and other assessments (measures of patient-reported HA benefit, mood, cognition, quality of life). Patients will be offered smart HAs and a mobile phone application and a subset will also be given wearable biosensors, to enable the collection of dynamic real-life HA usage data. Big data analytics will be used to detect correlations between contextualised HA usage and effectiveness, and different factors and comorbidities affecting HL, with a view to informing public health decision-making. ETHICS AND DISSEMINATION: Ethical approval was received from the London South East Research Ethics Committee (17/LO/0789), the Hippokrateion Hospital Ethics Committee (1847) and the Athens Medical Center’s Ethics Committee (KM140670). Results will be disseminated through national and international events in Greece and the UK, scientific journals, newsletters, magazines and social media. Target audiences include HA users, clinicians, policy-makers and the general public. TRIAL REGISTRATION NUMBER: NCT03316287; Pre-results

Development of an ABA Tool Kit for Audiologists to Increase Hearing Aid Wear Time in Individuals with Autism

When working with individuals with the dual-diagnosis of hearing loss and Autism Spectrum Disorder (ASD), audiologists are often faced with unique challenges and must adapt their approach in order to more effectively address the needs of these individuals. Currently, there is only a small body of research focused on the special considerations required for appropriately fitting and utilizing amplification for children with the dual-diagnosis of hearing loss and ASD. Subsequently, recommendations and strategies for clinicians to implement when faced with these common challenges, specifically of hearing aid compliance and appropriate hearing aid wear time, are lacking. It is important to find new strategies and techniques for audiologists to implement when working with individuals with this dual-diagnosis of hearing loss and ASD to more effectively overcome challenges and improve hearing aid compliance. The field of applied behavior analysis (ABA) shows promise regarding its potential implementation for audiologists when working with individuals with ASD. ABA is an approach to treatment with individuals with ASD with a significant body of research supporting its utilization in a variety of fields and settings. The ABA Tool Kit for Audiologist was developed in this capstone project to address the need for recommendations and strategies to utilize when encountering issues with hearing aid compliance and wear time with individuals with the dual-diagnosis of ASD and hearing loss. This tool kit is comprised of a variety of materials for audiologists to both familiarize themselves with ABA techniques and utilize on an individual patient basis. The primary goal of this tool kit is to equip audiologists with the knowledge and tools needed to foster patient-centered care and improve hearing aid compliance and wear time for individuals with the dual-diagnosis of ASD and hearing loss through the evidence-based approach of ABA

The neurobiology of speech perception decline in aging

Speech perception difficulties are common amongst elderlies; yet the underlying neural mechanisms are still poorly understood. New empirical evidence suggesting that brain senescence may be an important contributor to these difficulties have challenged the traditional view that peripheral hearing loss was the main factor in the aetiology of these difficulties. Here we investigated the relationship between structural and functional brain senescence and speech perception skills in aging. Following audiometric evaluations, participants underwent MRI while performing a speech perception task at different intelligibility levels. As expected, with age speech perception declined, even after controlling for hearing sensitivity using an audiological measure (pure tone averages), and a bioacoustical measure (DPOAEs recordings). Our results reveal that the core speech network, centered on the supratemporal cortex and ventral motor areas bilaterally, decreased in spatial extent in older adults. Importantly, our results also show that speech skills in aging are affected by changes in cortical thickness and in brain functioning. Age-independent intelligibility effects were found in several motor and premotor areas, including the left ventral premotor cortex and the right SMA. Agedependent intelligibility effects were also found, mainly in sensorimotor cortical areas, and in the left dorsal anterior insula. In this region, changes in BOLD signal had an effect on the relationship of age to speech perception skills suggesting a role for this region in maintaining speech perception in older ages perhaps by. These results provide important new insights into the neurobiology of speech perception in aging

The effect of healthy aging on change detection and sensitivity to predictable structure in crowded acoustic scenes

The auditory system plays a critical role in supporting our ability to detect abrupt changes in our surroundings. Here we study how this capacity is affected in the course of healthy ageing. Artifical acoustic ‘scenes’, populated by multiple concurrent streams of pure tones (‘sources’) were used to capture the challenges of listening in complex acoustic environments. Two scene conditions were included: REG scenes consisted of sources characterized by a regular temporal structure. Matched RAND scenes contained sources which were temporally random. Changes, manifested as the abrupt disappearance of one of the sources, were introduced to a subset of the trials and participants (‘young’ group N = 41, age 20-38 years; ‘older’ group N = 41, age 60-82 years) were instructed to monitor the scenes for these events. Previous work demonstrated that young listeners exhibit better change detection performance in REG scenes, reflecting sensitivity to temporal structure. Here we sought to determine: (1) Whether ‘baseline’ change detection ability (i.e. in RAND scenes) is affected by age. (2) Whether aging affects listeners’ sensitivity to temporal regularity. (3) How change detection capacity relates to listeners’ hearing and cognitive profile (a battery of tests that capture hearing and cognitive abilities hypothesized to be affected by aging). The results demonstrated that healthy aging is associated with reduced sensitivity to abrupt scene changes in RAND scenes but that performance does not correlate with age or standard audiological measures such as pure tone audiometry or speech in noise performance. Remarkably older listeners’ change detection performance improved substantially (up to the level exhibited by young listeners) in REG relative to RAND scenes. This suggests that the ability to extract and track the regularity associated with scene sources, even in crowded acoustic environments, is relatively preserved in older listeners

Characterisation of disordered auditory processing in adults who present to audiology with hearing difficulties in presence of normal hearing thresholds: Correlation between auditory tests and symptoms

The diagnosis of auditory processing disorder (APD) remains controversial. Quantifying symptoms in individuals with APD by using validated questionnaires may help better understand the disorder and inform appropriate diagnostic evaluation. Aims: This study was aimed at characterising the symptoms in APD and correlating them with the results of auditory processing (AP) tests. Methods: Phase 1: Normative data of a speech-in-babble test, to be used as part of the APD test battery, were collected for 69 normal volunteers aged 20–57 years. Phase 2: Sixty adult subjects with hearing difficulties and normal audiogram and 38 healthy age-matched controls completed three validated questionnaires (Amsterdam Inventory for Auditory Disability; Speech, Spatial and Qualities of Hearing Scale; hyperacusis questionnaire) and underwent AP tests, including dichotic digits, frequency and duration pattern, gaps-in-noise, speech-in-babble and suppression of otoacoustic emissions by contralateral noise. The subjects were categorised into the clinical APD group or clinical non- APD group depending on whether they met the criterion of two failed tests. The questionnaire scores in the three groups were compared. Phase 3: The questionnaire scores were correlated with the APD test results in 58/60 clinical subjects and 38 of the normal subjects. Results: Phase 1: Normative data for the speech-in-babble test afforded an upper cut-off mean value of 4.4 dB for both ears Phase 2: Adults with APD presented with hearing difficulties in quiet and noise; difficulties in localising, recognising and detecting sounds and hyperacusis with significantly poorer scores compared to clinical non- APD subjects and normal controls. Phase 3: Weak to moderate correlations were noted among the scores of the three questionnaires and the APD tests. Correlations were the strongest for the gaps-in-noise, speech-in-babble, dichotic digit tests with all three questionnaires. Conclusions: The three validated questionnaires may help identify adults with normal hearing who need referral for APD assessment

Computer aided hearing assessment : towards an automated audiometric tool

[Resumen]La pérdida de audición consiste en una disminución parcial o total de la capacidad para percibir sonidos que afecta a un amplio rango de población y tiene un impacto negativo en sus actividades diarias. La audiometría tonal liminar es uno de los tests estándard para la evaluación de la capacidad auditiva. Durante la realización de esta evaluación el audiólogo trata paralelamente de identificar pacientes con tiempos de respuesta anormalmente lentos. Esta identificación es relevante pues podría tratarse de un síntoma asociado a alguna patología que debiera ser estudiada. El otro objetivo principal es la evaluación de pacientes con deterioro cognitivo o trastornos graves de comunicación, puesto que no es posible mantener una interacción típica de preguntarespuesta cuando se evalúa su audición. En estos casos, el experto debe centrar su atención en la detección de reacciones gestuales espontáneas al sonido. La subjetividad implicada en la interpretación de ambos objetivos puede afectar a la clasificación, introducir imprecisiones, limitar la reproducibilidad y también producir un alto grado de inter e intra varibialidad del observador. En este sentido, el desarrollo de un método automatizado, objetivo y sistemático para el análisis y clasificación de los tiempos de respuesta y de las reacciones gestuales al sonido es, por tanto, altamente conveniente, permitiendo un diagnóstico homogéneo y relevando a los expertos de esta tediosa tarea. El propósito de esta investigación es el diseño de un sistema automático para la evaluación de las reacciones gestuales y los tiempos de respuesta a través del análisis de secuencias de vídeo grabadas durante el desarrollo de la prueba audiométrica. Por una parte, los tiempos de respuesta se miden detectando el envío de estímulos y la respuesta positiva del paciente (expresada levantando la mano). Por otra, las reacciones gestuales son identificadas analizando los movimientos de la mirada usando dos aproximaciones diferentes. Las diferentes propuestas automatizadas presentadas ahorran tiempo a los expertos, mejoran la precisión y proporcionan resultados objetivos que no se ven afectados por factores subjetivos.[Abstract]Hearing loss is a partial or full decrease in the ability to detect or understand sounds which affects a wide range of population, and has a negative impact on their daily activities. Pure Tone Audiometry is the standard test for the evaluation of the hearing capacity. During the performance of this hearing assessment the audiologist also tries to identify patients with abnormally slow responsiveness by means of their response times to the perceived sounds. This identificacion is relevant since it could be a symptom of any medical condition that should be studied. The other main target is the evaluation of patients with cognitive decline or severe communication disorders, since when evaluating this specific group of patients it is not possible to maintain a normal question-answer interaction. In these cases the expert must focus his attention on the detection of unconscious gestural reactions to the sound. The subjective involved in the interpretation of both aims may affect the classiffication, introduces imprecisions, limits the reproducibility and also a high degree of inter- and also intra- observer variability can be produced. In this manner, the development of a systematic, objective computerized method for the analysis and classiffication of response times and gestural reactions to the sound is thus highly desirable, allowing for homogeneous diagnosis and relieving the experts from this tedious task. The proposal of this research is the design of an automatic system to assess the gestural reactions to the sound and the patient's response times by analyzing video sequences recorded during the performance of the audiometric evaluations. On the one hand, the response times are measured by detecting the auditory stimuli delivering and the patient's hand raising (which corresponds with a positive response). On the other hand, the gestural reactions to the sound are identifed by analyzing the eye movements using two different approximations. The different automated assessments proposed save time for experts, improve the precision and provide unbiased results which are not affected by subjective factors.[Resumo] A perda de audición consiste nunha disminución parcial ou total da capacidade para percibir sons que afecta a un amplo rango da poboación e ten un impacto negativo nas súas actividades diarias. A audiometría tonal liminar é un dos tests estándard para a avaliación da capacidade auditiva. Durante a realización desta avaliación o audiólogo trata paralelamente de identificar pacientes con tempos de resposta anormalmente lentos. Esta identificación é relevante pois poderá tratarse dun síntoma asociado a algunha patoldXÍa que dehese ser estudada. O autro obxectivo principal é a avaliación de pacientes con deterioro cognitivo ou trastornos graves de comunicación, posto que non é posible manter unha interacción típica de preguota-resposta cando se avalía a súa audición. Nestes casos, o experto debe centrar a súa atención na detección de reacCÍóns xestuWs espontáneas ao son. A subxectividade implicada na interpretación de ambos obxectivos pode afectar á clasificación, introducir impreci.,ións, limitar a reproducibilidade e tamén producir un alto grao de inter e intra varibialidade do observador. Neste sentido, o desenvolvemento dun método automatizado, obxectivo e sistemático para a análise e clasificación dos tempos de resposta e das reaccións xestuais, ao son é, por tanto, altamente conveniente, permitindo unha diagnose homoxénea e relevando aoS expertos desta tediosa tarea. O propósito desta investigación é o diseño dun sistema automático para a avaliación das reaccións xestuais e os tempos de resposta a través da análise de secuencias de vídeo grabadas durante o desenvolvemento da proba audiométrica. Por unha parte, OS tempos de resposta mídense detectando o envío de estímulos e a resposta positiva do paciente (expresada levantando a msn). Por outra, as reaccións xestuais son identificadas analizando os movementos da mirada usando dúas aproximacións diferentes. As diferentes propostas automatizadas presentadas aforran tempo aoS expertos, melloran a precisión e proporcionan resultados obxectivos que no se ven afectados por factores subxectivos