Characteristics of Hearing Aid Fittings in Infants and Young Children

Hearing aids provide the basis for improving audibility and minimizing developmental delays in children with mild to severe hearing loss. Multiple guidelines exist to recommend methods for optimizing amplification in children, but few previous studies have reported hearing aid fitting outcomes for a large group of children. The current study sought to evaluate the proximity of the fitting to prescriptive targets and aided audibility of speech, as well as survey data from pediatric audiologists who provided hearing aids for the children in the current study. Deviations from prescriptive target were predicted to have a negative impact on aided audibility. Additionally, children who were fitted using verification with probe microphone measurements were expected to have smaller deviations from prescriptive targets and improved audibility than cohorts fitted without these measures

Effects of Age and Hearing Impairment on the Ability to Benefit From Temporal and Spectral Modulation

At poor signal-to-noise ratios, speech understanding may depend upon the ability to combine speech fragments that are distributed across time and frequency. The goal of this study was to determine the effects of development and hearing impairment on this ability

Effects of Nonlinear Frequency Compression on Speech Identification in Children With Hearing Loss

This study evaluated effects of nonlinear frequency compression (NLFC) processing in children with hearing loss for consonant identification in quiet and for spondee identification in competing noise or speech. It was predicted that participants would benefit from NLFC for consonant identification in quiet when access to high-frequency information was critical, but that NLFC would be less beneficial, or even detrimental, when identification relied on mid-frequency cues. Further, it was hypothesized that NLFC could result in greater susceptibility to masking in the spondee task. The rationale for these predictions is that improved access to high-frequency information comes at the cost of decreased spectral resolution

Objective hearing threshold estimation in children with auditory neuropathy spectrum disorder: Electrophysiology and ANSD

, 123:2859–2861, 201

Influence of Hearing Loss on Children’s Identification of Spondee Words in a Speech-Shaped Noise or a Two-Talker Masker

This study compared spondee identification performance in presence of speech-shaped noise or two competing talkers across children with hearing loss and age-matched children with normal hearing. The results showed a greater masking effect for children with hearing loss compared to children with normal hearing for both masker conditions. However, the magnitude of this group difference was significantly larger for the two-talker compared to the speech-shaped noise masker. These results support the hypothesis that hearing loss influences children’s perceptual processing abilities

Acoustically Evoked Auditory Change Complex in Children With Auditory Neuropathy Spectrum Disorder: A Potential Objective Tool for Identifying Cochlear Implant Candidates

The overall aim of the study was to evaluate the feasibility of using electrophysiological measures of the auditory change complex (ACC) to identify candidates for cochlear implantation in children with auditory neuropathy spectrum disorder (ANSD). In order to achieve this overall aim, this study 1) assessed the feasibility of measuring the ACC evoked by temporal gaps in a group of children with ANSD across a wide age range; and 2) investigated the association between gap detection thresholds (GDTs) measured by the ACC recordings and open-set speech-perception performance in these subjects

Shared midgut binding sites for Cry1A.105, Cry1Aa, Cry1Ab, Cry1Ac and Cry1Fa proteins from Bacillus thuringiensis in two important corn pests, Ostrinia nubilalis and Spodoptera frugiperda

First generation of insect-protected transgenic corn (Bt-corn) was based on the expression of Cry1Ab or Cry1Fa proteins. Currently, the trend is the combination of two or more genes expressing proteins that bind to different targets. In addition to broadening the spectrum of action, this strategy helps to delay the evolution of resistance in exposed insect populations. One of such examples is the combination of Cry1A.105 with Cry1Fa and Cry2Ab to control O. nubilalis and S. frugiperda. Cry1A.105 is a chimeric protein with domains I and II and the C-terminal half of the protein from Cry1Ac, and domain III almost identical to Cry1Fa. The aim of the present study was to determine whether the chimeric Cry1A.105 has shared binding sites either with Cry1A proteins, with Cry1Fa, or with both, in O. nubilalis and in S. frugiperda. Brush-border membrane vesicles (BBMV) from last instar larval midguts were used in competition binding assays with 125I-labeled Cry1A.105, Cry1Ab, and Cry1Fa, and unlabeled Cry1A.105, Cry1Aa, Cry1Ab, Cry1Ac, Cry1Fa, Cry2Ab and Cry2Ae. The results showed that Cry1A.105, Cry1Ab, Cry1Ac and Cry1Fa competed with high affinity for the same binding sites in both insect species. However, Cry2Ab and Cry2Ae did not compete for the binding sites of Cry1 proteins. Therefore, according to our results, the development of cross-resistance among Cry1Ab/Ac, Cry1A.105, and Cry1Fa proteins is possible in these two insect species if the alteration of shared binding sites occurs. Conversely, cross-resistance between these proteins and Cry2A proteins is very unlikely in such case

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Characteristics of Hearing Aid Fittings in Infants and Young Children

OBJECTIVES: Hearing aids provide the basis for improving audibility and minimizing developmental delays in children with mild to severe hearing loss. Multiple guidelines exist to recommend methods for optimizing amplification in children, but few previous studies have reported hearing aid fitting outcomes for a large group of children. The current study sought to evaluate the proximity of the fitting to prescriptive targets and aided audibility of speech, as well as survey data from pediatric audiologists who provided hearing aids for the children in the current study. Deviations from prescriptive target were predicted to have a negative impact on aided audibility. Additionally, children who were fitted using verification with probe microphone measurements were expected to have smaller deviations from prescriptive targets and improved audibility than cohorts fitted without these measures. DESIGN: Hearing aid fitting data from 195 children with mild to severe hearing losses were analyzed as part of a multicenter study evaluating outcomes in children with hearing loss. Proximity of fitting to prescriptive targets was quantified by calculating the average RMS error of the fitting compared to Desired Sensation Level prescriptive targets for 500, 1000, 2000 and 4000 Hz. Aided audibility was quantified using the speech intelligibility index (SII). Survey data from the pediatric audiologists who fit amplification for children in the current study were collected to evaluate trends in fitting practices and relate those patterns to proximity of the fitting to prescriptive targets and aided audibility. RESULTS: More than half (55%) of the children in the study had at least one ear that deviated from prescriptive targets by more than 5 dB RMS on average. Deviation from prescriptive target was not predicted by pure tone average (PTA), assessment method or reliability of assessment. Study location was a significant predictor of proximity to prescriptive target with locations who recruited subjects who were fit at multiple clinical locations (University of Iowa and Boys Town National Research Hospital) having larger deviations from target than the location where the subjects were recruited primarily from a single, large pediatric audiology clinic (University of North Carolina). Fittings based on average real-ear to coupler differences (RECD) resulted in larger deviations from prescriptive targets than fittings based on individually-measured RECD. Approximately 26% of the children in the study had aided audibility less than .65. Aided audibility was significantly predicted by the proximity to prescriptive targets and PTA, but not age in months. CONCLUSIONS: Children in the study had a wide range of fitting outcomes in terms of proximity to prescriptive targets (RMS error) and aided speech audibility (SII). Even when recommended hearing aid verification strategies were reported, fittings often exceeded the criteria for both proximity to the prescriptive target and aided audibility. The implications for optimizing amplification for children are discussed

Effects of Nonlinear Frequency Compression on Speech Identification in Children With Hearing Loss

OBJECTIVE: This study evaluated effects of nonlinear frequency compression (NLFC) processing in children with hearing loss for consonant identification in quiet and for spondee identification in competing noise or speech. It was predicted that participants would benefit from NLFC for consonant identification in quiet when access to high-frequency information was critical, but that NLFC would be less beneficial, or even detrimental, when identification relied on mid-frequency cues. Further, it was hypothesized that NLFC could result in greater susceptibility to masking in the spondee task. The rationale for these predictions is that improved access to high-frequency information comes at the cost of decreased spectral resolution. DESIGN: A repeated-measures design compared speech perception outcomes in 17 pediatric hearing aid users (9-17 years) wearing Naida V SP “laboratory” hearing aids with NLFC on and off. Data were also collected in an initial baseline session in which children wore their personal hearing aids. Children with a wide range of audiometric configurations were included, but all participants were full-time users of hearing aids with active NLFC. For each hearing aid condition, speech perception was assessed in the sound field using a closed-set 12-alternative consonant-vowel identification measure in quiet, and a closed-set 4-alternative spondee identification measure in a speech-shaped noise or in a two-talker speech masker. RESULTS: No significant differences in performance were observed between laboratory hearing aid conditions with NLFC activated or deactivated for either speech perception measure. An unexpected finding was that the majority of participants had no difficulty identifying the high-frequency consonant /s/, even when NLFC was deactivated. Investigation into individual differences revealed that subjects with a greater difference in audible bandwidth with NLFC on versus NLFC off were less likely to demonstrate improvements in high-frequency consonant identification in quiet, but were more likely to demonstrate improvements in spondee identification in speech-shaped noise. Group results observed in the initial baseline assessment using personal aids fitted with more aggressive NLFC settings than used in laboratory aids indicated better consonant identification accuracy in quiet. However spondee identification in the two-talker masker was poorer with personal compared with laboratory hearing aids. Comparisons across personal and laboratory hearing aids are tempered, however, by the potential of an order effect. CONCLUSIONS: The observation of comparable performance with NLFC on and off in the laboratory aids provides evidence that NLFC is neither detrimental nor advantageous when modest in strength. Results with personal hearing aids fitted with stronger compression settings than laboratory aids (NLFC on) highlight the critical need for further research to determine the impact of NLFC processing on speech perception for a wider range of speech perception measures and compression settings