Determinants of objective and subjective auditory disability in patients with normal hearing

A proportion of individuals consulting audiology clinics complain of difficulties discriminating speech in noisy environments but have clinically 'normal' hearing, do not have signs of middle ear pathology, nor any other obvious basis for their complaints. The syndrome was named 'Obscure Auditory Dysfunction (OAD)'. Following a small scale study, a Special Investigative Clinic was started to investigate factors underlying OAD. Patients' performance on psychoacoustic, central/cognitive and personality-related tests was compared with the performance of matched controls. Results showed OAD to be a multifactorial syndrome. Patients have a genuine performance deficit for discrimination of speech-in-noise, influenced by a combination of psychoacoustic and central/cognitive deficits. Patients' relatively minor performance deficit did not completely explain their reported disability and handicap; this was mainly influenced by their underestimating their hearing ability. Anxiety-related factors and a history of otological disorder were found to underlie the seeking of medical attention. Based on these results, a clinical package was devised to enable diagnosis and understanding of OAD in individuals consulting in the clinic. The parallels between OAD and another syndrome without obvious organic pathology (women complaining of lower abdominal pain) were investigated. A double dissociation between personality-related factors and psychoacoustic/cognitive factors was demonstrated. It was concluded that personality factors should be considered when dealing with individuals seeking medical advice for minor organic pathology, but that such individuals should not simply be dismissed as being neurotic. Finally, correlational analyses using the combined data of all subjects, were carried out to investigate relationships between self-rated auditory disability/handicap, psychoacoustic, central/cognitive and personality-related variables. Self-rated disability/handicap were found to correlate best with performance on a test of speech-in-noise, less well with subtle auditory function but not with pure tone sensitivity. Cognitive function also correlated with reported disability/handicap, as did anxiety level and otological history. It was concluded that performance measures could be used to validate reports of disability/handicap, but that personality factors should be taken into account when interpreting such reports. Performance on a speech-in-noise test correlated with psychoacoustic and central/cognitive functions, but not with personality factors. It was concluded that minor sensory dysfunction can be reflected in a sensitive performance test but that performance is not affected by 'normal' personality traits

The impact of face coverings on audio-visual contributions to communication with conversational speech

The use of face coverings can make communication more difficult by removing access to visual cues as well as affecting the physical transmission of speech sounds. This study aimed to assess the independent and combined contributions of visual and auditory cues to impaired communication when using face coverings. In an online task,150 participants rated videos of natural conversation along three dimensions: (1) how much they could follow, (2) how much effort was required, and (3) the clarity of the speech. Visual and audio variables were independently manipulated in each video, so that the same video could be presented with or without a superimposed surgical-style mask, accompanied by one of four audio conditions (either unfiltered audio, or audio-filtered to simulate the attenuation associated with a surgical mask, an FFP3 mask, or a visor). Hypotheses and analyses were pre-registered. Both the audio and visual variables had a statistically significant negative impact across all three dimensions. Whether or not talkers’ faces were visible made the largest contribution to participants’ ratings. The study identifies a degree of attenuation whose negative effects can be overcome by the restoration of visual cues. The significant effects observed in this nominally low-demand task (speech in quiet) highlight the importance of the visual and audio cues in everyday life and that their consideration should be included in future face mask designs

Determinants of objective and subjective auditory disability in patients with normal hearing

A proportion of individuals consulting audiology clinics complain of difficulties discriminating speech in noisy environments but have clinically 'normal' hearing, do not have signs of middle ear pathology, nor any other obvious basis for their complaints. The syndrome was named 'Obscure Auditory Dysfunction (OAD)'. Following a small scale study, a Special Investigative Clinic was started to investigate factors underlying OAD. Patients' performance on psychoacoustic, central/cognitive and personality-related tests was compared with the performance of matched controls. Results showed OAD to be a multifactorial syndrome. Patients have a genuine performance deficit for discrimination of speech-in-noise, influenced by a combination of psychoacoustic and central/cognitive deficits. Patients' relatively minor performance deficit did not completely explain their reported disability and handicap; this was mainly influenced by their underestimating their hearing ability. Anxiety-related factors and a history of otological disorder were found to underlie the seeking of medical attention. Based on these results, a clinical package was devised to enable diagnosis and understanding of OAD in individuals consulting in the clinic. The parallels between OAD and another syndrome without obvious organic pathology (women complaining of lower abdominal pain) were investigated. A double dissociation between personality-related factors and psychoacoustic/cognitive factors was demonstrated. It was concluded that personality factors should be considered when dealing with individuals seeking medical advice for minor organic pathology, but that such individuals should not simply be dismissed as being neurotic. Finally, correlational analyses using the combined data of all subjects, were carried out to investigate relationships between self-rated auditory disability/handicap, psychoacoustic, central/cognitive and personality-related variables. Self-rated disability/handicap were found to correlate best with performance on a test of speech-in-noise, less well with subtle auditory function but not with pure tone sensitivity. Cognitive function also correlated with reported disability/handicap, as did anxiety level and otological history. It was concluded that performance measures could be used to validate reports of disability/handicap, but that personality factors should be taken into account when interpreting such reports. Performance on a speech-in-noise test correlated with psychoacoustic and central/cognitive functions, but not with personality factors. It was concluded that minor sensory dysfunction can be reflected in a sensitive performance test but that performance is not affected by 'normal' personality traits

Complete arsenic-based respiratory cycle in the marine microbial communities of pelagic oxygen-deficient zones.

Author Posting. © The Author(s), 2019. This is the author's version of the work. It is posted here by permission of National Academy of Sciences for personal use, not for redistribution. The definitive version was published in Proceedings of the National Academy of Sciences of the United States of America 116(20), (2019):9925-9930, doi:10.1073/pnas.1818349116.Microbial capacity to metabolize arsenic is ancient, arising in response to its pervasive presence in the environment, which was largely in the form of As(III) in the early anoxic ocean. Many biological arsenic transformations are aimed at mitigating toxicity; however, some microorganisms can respire compounds of this redox-sensitive element to reap energetic gains. In several modern anoxic marine systems concentrations of As(V) are higher relative to As(III) than what would be expected from the thermodynamic equilibrium, but the mechanism for this discrepancy has remained unknown. Here we present evidence of a complete respiratory arsenic cycle, consisting of dissimilatory As(V) reduction and chemoautotrophic As(III) oxidation, in the pelagic ocean. We identified the presence of genes encoding both subunits of the respiratory arsenite oxidase AioA and the dissimilatory arsenate reductase ArrA in the Eastern Tropical North Pacific (ETNP) oxygen-deficient zone (ODZ). The presence of the dissimilatory arsenate reductase gene arrA was enriched on large particles (>30 um), similar to the forward bacterial dsrA gene of sulfate-reducing bacteria, which is involved in the cryptic cycling of sulfur in ODZs. Arsenic respiratory genes were expressed in metatranscriptomic libraries from the ETNP and the Eastern Tropical South Pacific (ETSP) ODZ, indicating arsenotrophy is a metabolic pathway actively utilized in anoxic marine water columns. Together these results suggest arsenic-based metabolisms support organic matter production and impact nitrogen biogeochemical cycling in modern oceans. In early anoxic oceans, especially during periods of high marine arsenic concentrations, they may have played a much larger role.We thank John Baross and Rika Anderson for helpful discussions and feedback on this project. We also thank the chief scientists of the research cruise, Al Devol and Bess Ward, as well as the captain and crew of the R/V Thomas G. Thompson. This work was supported through a NASA Earth and Space Sciences Graduate Research Fellowship to J.K.S. and National Science Foundation Grant OCE-1138368 (to G.R.).2019-10-2

Electronic health records as a platform for audiological research: data validity, patient characteristics and hearing-aid use persistence among 731,213 US Veterans

Objectives: This article presents a summary of audiological, general health, and hearing aid (HA) outcome data in a large sample of U.S. Veterans receiving HAs. The current article also provides the foundation for a series of papers that will explore relationships between a wide range of factors and HA outcomes.Design: The patient sample is all (n = 731,213) patients for whom HAs were ordered between April 2012 and October 2014 through the U.S. Veterans Health Administration Remote Order Entry System. For these patients, Veterans Affairs electronic health records (EHRs) stored in various databases provided data on demographics, received diagnostic and procedure codes (2007 to 2017), audiometry, self-reported outcomes up to 6 months postfitting, and HA battery orders (to 2017). Data cleaning and preparation was carried out and is discussed with reference to insights that provide potential value to other researchers pursuing similar studies. HA battery order data over time was used to derive a measure of long-term HA use persistence. Descriptive statistics were used to characterize the sample, comparative analyses against other data supported basic validity assessment, and bivariate analyses probed novel associations between patient characteristics and HA use persistence at 2 years postfitting.Results: Following extensive cleaning and data preparation, the data show plausible characteristics on diverse metrics and exhibit adequate validity based on comparisons with other published data. Further, rates of HA use persistence are favorable when compared against therapy persistence data for other major chronic conditions. The data also show that the presence of certain comorbid conditions (Parkinson’s disease, diabetes, arthritis, and visual impairment) are associated with significantly lower HA use persistence, as are prior inpatient admissions (especially among new HA recipients), and that increasing levels of multimorbidity, in general, are associated with decreasing HA use persistence. This is all despite the fact that deriving relevant audiological care-process variables from the available records was not straightforward, especially concerning the definition of the date of HA fitting, and the use of battery ordering data to determine long-term HA use persistence.Conclusions: We have shown that utilizing EHRs in audiology has the potential to provide novel insights into clinical practice patterns, audiologic outcomes, and relations between factors pertaining to hearing and to other health conditions in clinical populations, despite the potential pitfalls regarding the lack of control over the variables available and limitations on how the data are entered. We thus conclude that research using EHRs has the potential to be an integral supplement to population-based and epidemiologic research in the field of audiology

Dancer Performance on the Lower Quarter Y Balance Test: A Longitudinal Study

Purpose: There is a need in the current literature for further information regarding dancer performance on the Y Balance Test (YBT). This study tracked the test scores of a group of dancers to assess change over time and relationship of balance scores to injury risk. It is hoped that clinicians may be able to use the information found in this study to more accurately screen dancers for asymmetries, deficits, and changes over time using the YBT. Such screenings would allow for more effective care and better assessment of readiness to return to dance. Method: A group of 12 dancers between 18 and 23 years of age were recruited as volunteers from the State University of New York (SUNY) at Purchase Conservatory of Dance. All participants signed informed consent forms. Both the Hunter College Human Research Participation Program and the SUNY Purchase Institutional Review Board approved this research. The subjects filled out questionnaires and were assessed using the YBT on two dates, 14 weeks apart. The questionnaires documented years of training, injury history and current injury status. The standardized YBT protocol delineated by Plisky et al. (2009) was used. The researchers hypothesized that the subjects’ scores would remain the same or even improve during the study. Data Analysis: Scores were compiled for each subject’s reach distances, and injury status was recorded. Composite reach scores were subsequently calculated. All reach distances were normalized using subject leg length for comparison between subjects. Reach scores were analyzed for statistical significance using a confidence level of 95% (2x standard error) and an independent t-test analysis (p\u3c0.05) was performed to assess relationship of injury to reach distance. Results: No statistically significant change in reach scores was found for the group as a whole, and no correlation of reach distances with presence of injury was found for the group as a whole. Some individuals did show significant changes, but no pattern was discernible with relation to injury. Discussion/Conclusion: Further research is needed on the performance of dancers on balance tests such as the YBT. It is possible that more sensitive instruments or more dance-specific normative values are needed to truly assess dancers’ balance performance and injury risk

Impact of SARS-CoV-2 Virus (COVID-19) preventative measures on communication : a scoping review

INTRODUCTION : Face coverings and distancing as preventative measures against the spread of the Coronavirus disease 2019 may impact communication in several ways that may disproportionately affect people with hearing loss. A scoping review was conducted to examine existing literature on the impact of preventative measures on communication and to characterize the clinical implications. METHOD : A systematic search of three electronic databases (Scopus, PubMed, CINAHL) was conducted yielding 2,158 articles. After removing duplicates and screening to determine inclusion eligibility, key data were extracted from the 50 included articles. Findings are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, including the PRISMA-ScR checklist. RESULTS : Studies fell into three categories: Studies addressing the impacts of personal protective equipment (PPE) and/or distancing on communication in healthcare contexts (n = 20); studies examining the impact of preventative measures on communication in everyday life (n = 13), and studies measuring the impact of face coverings on speech using acoustic and/or behavioral measures (n = 29). The review revealed that masks disrupt verbal and non-verbal communication, as well as emotional and social wellbeing and they impact people with hearing loss more than those without. These findings are presumably because opaque masks attenuate sound at frequencies above 1 kHz, and conceal the mouth and lips making lipreading impossible, and limit visibility of facial expressions. While surgical masks cause relatively little sound attenuation, transparent masks and face shields are highly attenuating. However, they are preferred by people with hearing loss because they give access to visual cues. CONCLUSION : Face coverings and social distancing has detrimental effects that extend well beyond verbal and non-verbal communication, by affecting wellbeing and quality of life. As these measures will likely be part of everyday life for the foreseeable future, we propose that it is necessary to support effective communication, especially in healthcare settings and for people with hearing loss.Sonova, AG and NIHR Manchester Biomedical Research Centre.https://www.frontiersin.org/journals/public-health#hj2022Speech-Language Pathology and Audiolog

Fitting a Hearing Aid on the Better Ear, Worse Ear, or Both: Associations of Hearing-aid Fitting Laterality with Outcomes in a Large Sample of US Veterans

Longitudinal electronic health records from a large sample of new hearing-aid (HA) recipients in the US Veterans Affairs healthcare system were used to evaluate associations of fitting laterality with long-term HA use persistence as measured by battery order records, as well as with short-term HA use and satisfaction as assessed using the International Outcome Inventory for Hearing Aids (IOI-HA), completed within 180 days of HA fitting. The large size of our dataset allowed us to address two aspects of fitting laterality that have not received much attention, namely the degree of hearing asymmetry and the question of which ear to fit if fitting unilaterally. The key findings were that long-term HA use persistence was considerably lower for unilateral fittings for symmetric hearing loss (HL) and for unilateral worse-ear fittings for asymmetric HL, as compared to bilateral and unilateral better-ear fittings. In contrast, no differences across laterality categories were observed for short-term self-reported HA usage. Total IOI-HA score was poorer for unilateral fittings of symmetric HL and for unilateral better-ear fittings compared to bilateral for asymmetric HL. We thus conclude that bilateral fittings yield the best short- and long-term outcomes, and while unilateral and bilateral fittings can result in similar outcomes on some measures, we did not identify any HL configuration for which a bilateral fitting would lead to poorer outcomes. However, if a single HA is to be fitted, then our results indicate that a better-ear fitting has a higher probability of long-term HA use persistence than a worse-ear fitting

A measure of long-term hearing-aid use persistence based on battery re-ordering data

Objective: We describe the construction of a hearing-aid long-term use persistence measure based on battery reorder data. The measure is derived from the notion that hearing-aid users keep using their devices for some time after placing a battery order. Design: A hearing-aid user is defined as persistent at time í µí± if they placed a battery order within a timespan í µí± preceding í µí±. We characterize and validate this measure using electronic health records from a large sample of US Veterans. Results: We describe how to choose parameters í µí± and í µí± for calculating persistence rates in the patient sample. For validation, the associations of persistence with (a) the duration over which users received outpatient hearing-aid care, (b) self-reported hearing-aid use shortly after fitting, (c) patient age and hearing loss are investigated. In all cases, plausible dependencies are observed. Conclusions: We conclude that our persistence measure is viable and hope this will motivate its use in similar studies