Audiology Services at Remote Area Medical Expeditions in Southern Appalachia

This presentation summarizes the preparation for, and execution of, audiology series provided by East Tennessee State University\u27s Audiology, Program at Remote Area Medical (RAM) expeditiors in the Southern Appalachian region. In 2010 and 2012, ETSU audiology faculty and students evaluatd 281 patients and subsequently fit 178 hearing aids

Implementing Psychological Methods in the Management of Trauma-Associated Tinnitus

Dr. Fagelson, (Professor Audiology, ETSU) will discuss the unusual challenges facing patients and providers when tinnitus severity is linked to traumatic exposure. Interactions between neural mechanisms associated with tinnitus, posttraumatic stress-disorder (PTSD), and traumatic memory will be reviewed with particular attention to the way and degree to which such interactions affect tinnitus and disorders of sound tolerance. Conference attendees will be provided theoretical models of emotional memory consolidation that underscore trauma‘s durable effects on a patient‘s emotional state, reaction to the tinnitus signal, and to potentially-triggering environmental sounds. The putative benefits of tinnitus counseling will be presented in the context of trauma interventions that employ well-established counseling techniques as an element of patient-centered care. Audiologists must provide trauma patients a safe environment and opportunity for dialogue that contributes to a holistic understanding of the patient‘s situation and perceptions; the ultimate goal is to employ interventions and self-assessment instruments that can be used to evaluate patient needs and progress when tinnitus is related to trauma. The potentially-exacerbating effects of comprehensive audiologic assessment will also be addressed

Military Trauma and its Influence on Loudness Perception

Excerpt: It is often the case that veterans who experience hyperacusis have hearing loss and tinnitus; what sets the patient with PTSD apart is an increased likelihood that will rate sound tolerance problems as more severe than tinnitus and hearing loss

Tinnitus and Trauma

Trauma-provoked tinnitus challenges patients and clinicians. Effects of trauma may exacerbate tinnitus, and patients with both tinnitus and posttraumatic stress disorder rate distress levels as higher than patients who experience only one or the other. This presentation will highlight links between tinnitus and trauma histories relevant to clinical audiologists

Auditory Filters Measured at Neighboring Center Frequencies

Auditory filters were derived in 20 normal-hearing human listeners at center frequencies (CFs) of 913, 1095, 3651, and 4382 Hz using the roex (p,r) method. Comparisons were made between slopes of the filters\u27 skirts at the neighboring CFs with filter output levels of 45 and 70 dB. The same comparisons were made with regard to filter equivalent rectangular bandwidth (ERB). In the 1000-Hz region, the low-frequency slopes (Pl) of filters centered at 913 and 1095 Hz were significantly correlated at both stimulus levels, while the high-frequency slopes (Pu) were similar only at the high test level. In the 4000-Hz region, for sinusoids of 3651 and 4382 Hz, the level effect was clearer as both Pu and Pl values diverged at the low level but were related at high levels. The ERBs centered at the same CFs displayed a similar level dependence. At the stimulus level most likely to be affected by an active feedback mechanism, auditory filters centered at nearly the same frequency displayed quite distinct frequency selectivity, and this trend was stronger in the 4000-Hz region than the 1000-Hz region. The findings suggest that a saturating, active cochlear mechanism may not be distributed evenly, or contribute to peripheral tuning with equal effectiveness throughout the length of the partition

Hearing Loss in the Dental Office: The Effects of High Speed Dental Drills on Dentists\u27 Hearing

Hearing test results of 23 dentists obtained before and after working hours are compared to determine if dentists experience any temporary hearing loss. The aim of the project is to determine whether dental drills cause hearing loss and to document the consequences of the loss. Hearing evaluations include pure-tone audiometry, middle-ear testing, and measurements of otoacoustic emissions. The results are expected to convince dentists of the danger of noise exposure and the need for hearing protectio

Dismantling Internet-Based Cognitive Behavioral Therapy for Tinnitus. The Contribution of Applied Relaxation: A Randomized Controlled Trial

Background: Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT. Aims: This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression. Methods: A parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer\u27s only analysis were undertaken. Results: Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group. Conclusion: Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention\u27s effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this

Linking the Undergraduate Degree to the Graduate Degree: Core Curriculum Issues

There are many issues that relate to the efficacy of the undergraduate degree in the field of communicative disorders. Some have advocated for the elimination of the degree while others vigorously fight to maintain it. Some believe that there should be clinic associated with the undergraduate degree while others argue to have the degree but without clinic. Some state departments of education allow persons with an undergraduate degree in communicative disorders to practice in the schools, others do not. Colleges and universities are afraid that without an undergraduate degree program, their departments will be seen as vulnerable to elimination in the academy. Other colleges and universities want to close their undergraduate programs to concentrate on their master\u27s and doctoral degrees, especially because of the shortage of doctoral level faculty to adequately staff all their programs. All of these issues and many more play into the debate about the continuation of the undergraduate degree in the field of communicative disorders. Today you are going to hear from three members of the Council who have very different viewpoints on the issue. We hope to stimulate discussion that will be productive in helping you and your departments determine the efficacy of your undergraduate degree in the fiel

Noise Exposure Effects in Extended High Frequencies

Hearing loss is a one of the most common chronic conditions. Although it is most common to be diagnosed with hearing loss later in life due to aging, there are multiple causes of hearing loss across the lifespan. One of the main types of hearing loss is noise-induced hearing loss. Some individuals may complain of decreased hearing or word understanding in background noise but when tested, they appear to have normal hearing sensitivity in the standard audiometric frequencies (250 – 8000 Hz). This may be due to decreased hearing sensitivity in extended high frequencies, above 8000 Hz. There is growing evidence that decreased extended high frequency thresholds may be a precursor to noise-induced hearing loss. This study aimed to analyze how noise exposure affects young adult’s extended high frequency thresholds and word identification in noise as well as traditional audiological testing (pure tones, speech recognition, word discrimination in quiet, etc). Young adults (18-25 years old) were recruited through ETSU affiliated social media, ETSU faculty, and word of mouth. An online noise survey was conducted to calculate each participant’s noise exposure. An otoscopic examination was completed on each study participant. Tympanometry was performed to ensure normal middle ear immittance. If an individual did not have normal middle ear immittance they were dismissed from the study. A 12-frequency diagnostic Distortion Product Otoacoustic Emissions (DPOAEs) was performed to check integrity of the individual’s outer hair cells. Speech Recognition testing was completed to determine the lowest level the individual could repeat back 50% of the words correctly. Word Recognition testing was completed to determine the percentage of words the individual could hear and correctly identify at suprathreshold level. Words-in-Noise testing was completed to determine how an individual could hear and correctly identify speech when in the presence of noise. Puretone air conduction was completed at the standard audiometric frequencies: 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz. If an individual had abnormal hearing sensitivity in these frequencies, they were dismissed from the study. Finally, extended high frequency testing was completed at 10,000, 12,500, 14,000, and 16,000 Hz. Data collection is still in progress and will close on March 7th, 2022. It is expected that noise exposure will be negatively correlated to extended high frequency thresholds and word understanding in noise (i.e., participants with more noise exposure will have poorer extended high frequency thresholds and poorer word understanding in noise)