Development of Bisyllabic Speech Audiometry Word Lists for Adult Malay Speakers

Standardised speech audiometry material is essential in assessing hearing for speech; however, material in Malay language, particularly for speech reception threshold test, is limited and not thoroughly validated. This thesis examines the development of standardised, phonemically-balanced bisyllabic Malay speech reception threshold (SRT) test word lists for Malay-speaking adults. The effect of having a mixture of familiar and nonsense words on speech recognition is also explored. The processes of developing the word lists include selecting and compiling the words using content analysis research method, testing for homogeneity and consistency and validating the acoustic content, both using correlational research method, and assessing the clinical validity using concurrent validity method. The familiar words were selected from a corpus of familiar words extracted from daily newspapers while the nonsense words were formed based on linguistic properties of Malay. The preliminary set consisted of fifteen lists with 10 familiar words and 5 nonsense words in each. The analyses of the findings show consistency of speech discrimination using the word lists using Friedman test to have statistically no significant difference in correct scores achieved using any of the word lists, Χ2 = 19.584, p>0.05. Homogeneity test for all lists using Cronbach’s alpha showed a value of 0.78, indicating a strong agreement and good homogeneity among the lists. When five lists with inter-item correlation ≤0.8 were excluded from the homogeneity analysis, the alpha value for the remaining 10 lists increased to 0.88. Consistency analysis of acoustic content using repeated measures ANOVA showed no significant difference between the list and the LTASS, F=1.229, p>0.05. All 15 lists were then tested for clinical validity. Two versions of list content were assessed, an all-words version (AWL) containing all 15 words each list, and a meaningful-words only version (MWL) containing 10 meaningful words for each list. Correlation analyses between half peak level (HPL) of the speech recognition curve and pure tone (PT) thresholds showed that, in consideration of both normal hearing and hearing impaired listeners, the HPL correlated best with PT average of 250, 500, 1000, 2000 and 4000 Hz for both AWL (r = 0.67 to 0.95) and MWL (r = 0.65 to 0.95). A comparison between HPL and PT average of 250, 500, 1000, 2000 and 4000 Hz showed mean differences of 4 dB (SD = 3) and 3 dB (SD = 4) with the range of tolerance (95% confidence) of ±7 dB and ±8 dB for AWL and MWL respectively. Sensitivity, specificity, and positive and negative predictive values, when set at tolerance level of ±10 dB, were mostly >0.90 for normal hearing and hearing loss listeners using either versions. It was concluded that the addition of nonsense words does not significantly affect SRT. The correlation between the SRT obtained using the bisyllabic Malay word lists and the PT thresholds suggested that the word lists were robust enough to be used in assessing speech hearing clinically. In conclusion, the current study has achieved to develop and produce a standardised, phonemically balanced bisyllabic Malay speech audiometry (BMSA) word lists for assessing speech reception threshold and discrimination in adult Malay speakers

Validation of the LittlEARS® Questionnaire and the Adaptive Auditory Speech Test (AAST) in normal-hearing Maltese-speaking children

Despite the widespread screening of hearing loss at birth, some children with permanent hearing loss still go undetected, and delayed onset hearing loss remains a concern. Screening post Universal Newborn Hearing Screening (UNHS) is attracting increased interest across researchers and clinicians alike. This study aimed to develop tools that evaluate auditory development and speech recognition skills of Maltese speaking children. A translated version of the LittlEARS® questionnaire was used to examine auditory development in 398 young children less than 2 years of age. Analysis aimed at generating normative data from the total scores of the participants and their age in months. A Maltese version of the Adaptive Auditory Speech Test (AAST) was used to examine the speech recognition skills of 208 children and 40 adults in Quiet, Noise and High Frequency. The aims were to determine the norms in these 3 settings, in adults and children aged 4 years and older. This study confirmed that the Maltese version of LittlEARS® is a valid and reliable tool to evaluate auditory development in children less than two years of age. Norm curves were comparable to the original German data. The Maltese version of AAST confirms an age dependent norm threshold with a significant improvement in threshold being observed as children grow older, similar to other AAST versions. This was evident across the 3 test settings. An approximate difference of 10dB was also noted between 4-year-old and 10-year-old children in AAST in Quiet. Thresholds of 10-year-olds and adults were similar in both the Quiet and High frequency versions. Implications for post UNHS using these tools are addressed

EFFICACY OF AUTOMATED WIRELESS HEARING TEST SYSTEM IMPLEMENTED IN AN EXERCISE-BASED CANCER REHABILITATION PROGRAM

Cancer patients are at risk of hearing loss due to the ototoxicity of chemotherapeutics and radiation treatments. Gaining clinical access to ototoxic monitoring is a challenge for patients, and physicians are often hesitant to burden their patients with more travel and appointment scheduling to obtain hearing testing. The current pilot study evaluated the feasibility of utilizing the newly developed Creare Wireless Automated Hearing Test System (WAHTS) in an exercise-based cancer rehabilitation center setting. Nine cancer patients were recruited for hearing testing. Hearing tests were conducted using an automated testing algorithm (WAHTS) in an open room and then tested again using manual audiometry conducted in a clinical sound booth test environment. Statistical analysis (t-test) revealed no significant difference between the hearing tests conducted in an open room in the exercise center and those conducted in the clinical setting (p\u3e.05). Future research is needed to investigate the implementation of the WAHTS as a means of monitoring cancer patients for ototoxicity while receiving chemotherapeutics or radiation treatments and simultaneously participating in an exercise-based cancer rehabilitation program

A MULTIMODAL ANALYSIS OF HEAR-A MOBILE HEARING SCREENING APPLICATION

Presented here are the results of a series of three studies focused on the need, validation, and improvement of hEAR, a mobile hearing screening application. The first study was a systematic review of 37 peer-reviewed studies to assess the efficacy of different types of audiology mHealth interventions, especially in high-risk populations. Four main modes of technology used to deliver the mHealth intervention were identified, out of which remote computing was found to be most effective. Smartphone applications were found to be as efficacious, but the results were dependent on the population characteristics. The study resulted in demonstrating the need for hEAR in high risk populations. The purpose of the second study was to validate headphone hardware for use with hEAR, when compared to a pure tone audiometric test. Both hEAR and the audiologist’s test used 7 frequencies (independent variable), 125 Hz, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and 8000 Hz, and the recorded measurements were sound pressure levels (dependent variable) measured in decibels. Participants (30) from Texas A&M University were recruited based on a screener, and were randomly assigned and counterbalanced to one of two groups, differing in the order the hEAR tests and the audiologist’s test were administered. Data were analyzed using a generalized estimating equation model at α=0.05, which showed that Pioneer headphones, were comparably similar to the audiologist’s test at all frequencies. The third study was a multi-method assessment of hEAR based on user-centered design principles. Six nurses and thirty students from the Bryan Independent School District were recruited and the assessments were conducted at the participants’ schools. Nurses used hEAR to screen their students, after which the nurses filled out two questionnaires: The System Usability Scale and the After-Scenario Questionnaire. The time taken to complete the tasks, as well as the number of errors committed were also observed. The nurses participated in individual in-depth interviews. The result of the assessments revealed 8 problems that the nurses encountered during their use of hEAR, which were then grouped into 4 usability themes to derive user-centered design recommendations for similar mHealth applications

Comparison of efficacy and safety of intranasal Midazolam with syrup Chloral hydrate for procedural sedation of children undergoing Auditory Brainstem evoked Response audiometry: A Randomized, Double-blinded, Placebo controlled trial

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of intranasal Midazolam compared to syrup Chloral hydrate for procedural sedation in children undergoing Auditory Brainstem evoked Response audiometry (ABR). METHODS: A prospective, randomized, double-blinded placebo controlled trial was carried out in the audiology lab of a tertiary care hospital over a period of 18 months. 82 children between the age group of 1 to 6 years (mean 2 years) irrespective of their developmental maturity, belonging to ASA class I and II who were referred for ABR testing were recruited. Children were randomized to receive either midazolam spray with oral placebo or syrup chloral hydrate with nasal placebo spray. The nasal spray was dosed at 0.5 mg/kg delivered as 100mcg per spray and oral syrup at a dose of 50 mg/kg. Those children who did not show onset of sedation at 30 minutes were administered the second dose at half the initial dose. Randomization was computer generated and allocation concealment was achieved by opaque sequentially numbered sealed envelopes that were employed serially to the participating children. The primary outcome measured were safety which was measured in terms of heart rate, respiratory rate, oxygen saturation and efficacy was measured in terms of level of consciousness (uninterrupted sleep without movement) and successful completion of the procedure. The various secondary outcomes were time to onset of sedation, time to parental separation, nature of parental separation, duration of procedure, parental satisfaction, audiologist’s satisfaction, time to recovery and number of attempts. RESULTS: The trial was completed over a period of 18 months when 41 children were studied in each arm. Both the drugs were found to be safe with no major adverse events. One child who had received Midazolam developed transient hypoxia. It was corrected with appropriate head positioning. Minor side effects noted were sneezing, hiccups and crying. Children on Chloral hydrate had an earlier onset of sedation (66% of children) at or less than 30 minutes as compared to only 33% from the Midazolam group. Developmentally delayed children had an earlier onset of sedation compared to developmentally normal group irrespective of the drug they received. Parental separation was earlier for chloral hydrate group at 20 minutes than for midazolam at 30 minutes. There was no statistically significant difference in the duration of procedure. There was a significant difference noted in the time to recovery (Chloral hydrate children (78 minutes) as compared to Midazolam children (105 minutes). Parental and audiologists satisfaction were higher for Chloral hydrate (95% and 75% respectively) than for Midazolam (49% and 29%). A larger number of patients (80%) slept with the first dose of Chloral hydrate as against Midazolam children who required a second dose. Overall, sedation was successful among 95% of children who received chloral hydrate compared to 51% of children who received Midazolam. Once sedation was achieved, both the drugs were efficacious in maintaining sedation with no intra-procedural interruption in sedation. CONCLUSION: Intranasal Midazolam and oral Chloral hydrate are both safe and efficacious for pediatric procedural sedation in ABR. However, Chloral hydrate had a superior efficacy to intranasal Midazolam with an earlier time to onset of sedation, a faster recovery, better parental and audiologist’s satisfaction and successful sedation even with the first attempt. There was no difference in the duration of the procedure. Developmentally delayed children showed an earlier onset of sedation and faster recovery compared to their normal counterparts irrespective of the drug regimen they received

A MULTIMODAL ANALYSIS OF HEAR-A MOBILE HEARING SCREENING APPLICATION

Presented here are the results of a series of three studies focused on the need, validation, and improvement of hEAR, a mobile hearing screening application. The first study was a systematic review of 37 peer-reviewed studies to assess the efficacy of different types of audiology mHealth interventions, especially in high-risk populations. Four main modes of technology used to deliver the mHealth intervention were identified, out of which remote computing was found to be most effective. Smartphone applications were found to be as efficacious, but the results were dependent on the population characteristics. The study resulted in demonstrating the need for hEAR in high risk populations. The purpose of the second study was to validate headphone hardware for use with hEAR, when compared to a pure tone audiometric test. Both hEAR and the audiologist’s test used 7 frequencies (independent variable), 125 Hz, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and 8000 Hz, and the recorded measurements were sound pressure levels (dependent variable) measured in decibels. Participants (30) from Texas A&M University were recruited based on a screener, and were randomly assigned and counterbalanced to one of two groups, differing in the order the hEAR tests and the audiologist’s test were administered. Data were analyzed using a generalized estimating equation model at α=0.05, which showed that Pioneer headphones, were comparably similar to the audiologist’s test at all frequencies. The third study was a multi-method assessment of hEAR based on user-centered design principles. Six nurses and thirty students from the Bryan Independent School District were recruited and the assessments were conducted at the participants’ schools. Nurses used hEAR to screen their students, after which the nurses filled out two questionnaires: The System Usability Scale and the After-Scenario Questionnaire. The time taken to complete the tasks, as well as the number of errors committed were also observed. The nurses participated in individual in-depth interviews. The result of the assessments revealed 8 problems that the nurses encountered during their use of hEAR, which were then grouped into 4 usability themes to derive user-centered design recommendations for similar mHealth applications

Educational audiology in Ghana- developing screening tools for hearing in infants and children

Abstract The following objectives were set for this thesis: 1. To investigate the appropriateness of the LittlEARS® Auditory Questionnaire as a screening tool for hearing loss and other related educationally significant disorders in Ghanaian children aged 4 - 36 months. 2. To adapt and evaluate the multiple Frequency Animal Sound Test (mFAST) as an alternative to pure tone audiometry in screening children. 3: To construct, norm and validate four (4) language versions (Asante, Akuapem, Fante and Ghanaian English) of the Adaptive Auditory Speech Test (AAST) in quiet and in noise. In order to attain the set objectives, six (6) research questions were raised. Design: A cross- sectional design was used to select a total of 1820 participants for the study. This sample included parents, younger and older children as well as adults. For validation of LittlEARS® Auditory Questionnaire, norm data were collected for N=448 children. The effect of ‘administration mode’ was investigated by collecting data from N=152 parents (respondents) and the feasibility of using LittlEARS® Auditory Questionnaire as a screening tool between 24-36 months was investigated by collecting data from N=513 respondents. Validation data for mFAST were collected from N=45 students aged between 20 and 30 years with normal hearing. In order to determine the Akan AAST norm, data were collected from (N=581) children who spoke Asante, Akuapem and Fanti as their native language. Finally, in order to determine learning effects data were collected from (N= 81) children. Results: Results show that the Ghanaian and German norm curves are comparable and it does not make any difference whether LittlEARS® Auditory Questionnaire is administered via self administration or by interview. The data also supports the use of the LittlEARS® Auditory Questionnaire to screen for hearing loss in Ghanaian infants and children from 4 months old up to the age of 3 years. Overall the results support the proposition that the LittlEARS® Auditory Questionnaire, the multiple Frequency Animal Sound Test (mFAST) and the Adaptive Auditory Speech Test (AAST) are appropriate tools for the early identification of Ghanaian children with hearing loss