Measures of Acoustic Reflexes in Typically Developing Children and Children with Suspected Auditory Processing Disorder

A series of studies were conducted to examine the acoustic reflex in normal hearing adults, typically developing children and children with suspected auditory processing disorder (APD). Elevated acoustic reflex thresholds (ART) and shallower acoustic reflex growth functions (ARGF) were found in children with suspected APD in comparison to typically developing children and normal hearing adults. These effects were strongest in the crossed condition. There were no group differences for acoustic reflex latency (ARL) or acoustic reflex decay (ARD). In all studies the children with suspected APD were divided into two groups based on the diagnosis made on the basis of a behavioral APD battery; (1) APD which included children who received APD diagnosis and (2) Clinical non-APD who did not receive APD diagnosis. Children in the clinical non-APD and APD groups had similar ART and ARGF abnormalities highlighting a potential weakness in relying strictly on behavioral tests in the assessment of children suspected of APD. The effect of acoustic reflex activation on middle ear absorbance (MEA) and middle ear resonant frequency (MERF) was also investigated. It was found that the activation of the acoustic reflex resulted in a decrease of MEA between 226 and 1000 Hz, an increase MEA between 1000 and 2000 Hz and shift of MERF to a higher frequency. These changes in middle ear function may be critical to speech in noise perception. The effect of reflex activation was diminished in children with suspected APD. Across studies, acoustic reflex measures including ART, ARGF and the effect of the reflex on MEA and MERF showed a trend suggesting age-related changes but the trends did not reach statistical significance. However, a significant developmental trend in ARTs was found when corrected for ear canal volume differences. These results suggest that acoustic reflex measures in clinical children should be compared with those of typically developing children rather adults

Critical appraisal of speech in noise tests: a systematic review and survey

Speech in noise tests that measure the perception of speech in presence of noise are now an important part of audiologic tests battery and hearing research as well. There are various tests available to estimate the perception of speech in presence of noise, for example, connected sentence test, hearing in noise test, words in noise, quick speech-in-noise test, bamford-kowal-bench speech-in-noise test, and listening in spatialized noise-sentences. All these tests are different in terms of target age, measure, procedure, speech material, noise, normative, etc. Because of the variety of tests available to estimate speech-in-noise abilities, audiologists often select tests based on their availability, ease to administer the test, time required in running the test, age of the patient, hearing status, type of hearing disorder and type of amplification device if using. A critical appraisal of these speech-in-noise tests is required for the evidence based selection and to be used in audiology clinics. In this article speech-in-noise tests were critically appraised for their conceptual model, measurement model, normatives, reliability, validity, responsiveness, item/instrument bias, respondent burden and administrative burden. Selection of a standard speech-in-noise test based on this critical appraisal will also allow an easy comparison of speech-in-noise ability of any hearing impaired individual or group across audiology clinics and research centers. This article also describes the survey which was done to grade the speech in noise tests on the various appraisal characteristics

Computed tomography virtual oesophagography for the grading of oesophageal varices in cirrhotic liver disease patients with upper gastrointestinal endoscopic examination as the gold standard : a diagnostic validation study

Purpose: Virtual endoscopy is a postprocessing method using three-dimensional computed tomography (CT), which produces views of the inner surfaces of the human body like those produced by fibreoptic endoscopy. To evaluate and categorise patients who require medical or endoscopic band ligation to prevent oesophageal variceal bleed, a less invasive, less expensive, better tolerated, and more sensitive modality is required, as well as to reduce the use of invasive procedures in the follow-up of patients who do not require endoscopic variceal band ligation. Material and methods: A cross-sectional study was conducted in the Department of Radiodiagnosis in association with the Department of Gastroenterology. The study was conducted over a period of 18 months from July 2020 to January 2022. The sample size was calculated as 62 patients. Patients were recruited on the basis of inclusion and exclusion criteria after giving informed consent. CT virtual endoscopy was performed through a dedicated protocol. Classification of variceal grading was done independently by a radiologist and endoscopist who were blinded to each other's findings. Results: The diagnostic performance of oesophageal varices detection by CT virtual oesophagography was good, with sensitivity: 86%, specificity: 90%, PPV: 98%, NPV: 56%, and diagnostic accuracy: 87%. There was substantial agreement between the 2 methods, and this agreement was statistically significant (Cohen's k = 0.616, p ≤ 0.001). Conclusions: Based on our findings, we conclude that the current study has the potential to change the way chronic liver disease is managed, as well as generate similar medical research endeavours. A multicentric study with a large number of patients is needed to improve the experience with this modality

Acoustic reflexes in normal-hearing adults, typically developing children, and children with suspected auditory processing disorder: Thresholds, real-ear corrections, and the role of static compliance on estimates

Background: Previous studies have suggested elevated reflex thresholds in children with auditory processing disorders (APDs). However, some aspects of the child\u27s ear such as ear canal volume and static compliance of the middle ear could possibly affect the measurements of reflex thresholds and thus impact its interpretation. Sound levels used to elicit reflexes in a child\u27s ear may be higher than predicted by calibration in a standard 2-cc coupler, and lower static compliance could make visualization of very small changes in impedance at threshold difficult. For this purpose, it is important to evaluate threshold data with consideration of differences between children and adults. Purpose: A set of studies were conducted. The first compared reflex thresholds obtained using standard clinical procedures in children with suspected APD to that of typically developing children and adults to test the replicability of previous studies. The second study examined the impact of ear canal volume on estimates of reflex thresholds by applying real-ear corrections. Lastly, the relationship between static compliance and reflex threshold estimates was explored. Research Design: The research is a set of case-control studies with a repeated measures design. Study Sample: The first study included data from 20 normal-hearing adults, 28 typically developing children, and 66 children suspected of having an APD. The second study included 28 normal-hearing adults and 30 typically developing children. Data Collection and Analysis: In the first study, crossed and uncrossed reflex thresholds were measured in 5-dB step size. Reflex thresholds were analyzed using repeated measures analysis of variance (RM-ANOVA). In the second study, uncrossed reflex thresholds, real-ear correction, ear canal volume, and static compliance were measured. Reflex thresholds were measured using a 1-dB step size. The effect of real-ear correction and static compliance on reflex threshold was examined using RM-ANOVA and Pearson correlation coefficient, respectively. Results: Study 1 replicated previous studies showing elevated reflex thresholds in many children with suspected APD when compared to data from adults using standard clinical procedures, especially in the crossed condition. The thresholds measured in children with suspected APD tended to be higher than those measured in the typically developing children. There were no significant differences between the typically developing children and adults. However, when real-ear calibrated stimulus levels were used, it was found that children\u27s thresholds were elicited at higher levels than in the adults. A significant relationship between reflex thresholds and static compliance was found in the adult data, showing a trend for higher thresholds in ears with lower static compliance, but no such relationship was found in the data from the children. Conclusions: This study suggests that reflex measures in children should be adjusted for real-ear-tocoupler differences before interpretation. The data in children with suspected APD support previous studies suggesting abnormalities in reflex thresholds. The lack of correlation between threshold and static compliance estimates in children as was observed in the adults may suggest a nonmechanical explanation for age and clinically related effects

Crossed and uncrossed acoustic reflex growth functions in normal-hearing adults, typically developing children, and children with suspected auditory processing disorder

Previous data suggested that children with suspected auditory processing disorders (APD) often show elevated or absent acoustic reflex thresholds, especially in crossed conditions (e.g. Allen & Allan, 2014). This study further explored these effects by measuring acoustic reflex growth functions (ARGF). Design: Crossed and uncrossed ARGF slopes were obtained by linear fits between reflex amplitudes and increases in activator level from threshold to 15 dB above it. Study sample: Normal-hearing adults, typically developing children and children with reported listening difficulties and suspected of having an APD, participated. Results: The ARGF slopes were shallower in crossed than in uncrossed conditions for all groups but the magnitude of the effect was significantly greater in the children with suspected APD. There were no differences between the typically developing children and the adults. Conclusions: The results suggest shallower ARGFs in children with suspected APD. Given the role of the acoustic reflex in facilitating hearing speech in noise these findings may begin to shed light on physiologic explanations for some of the difficulties that are reported by children with suspected APD

Critical appraisal of speech in noise tests: a systematic review and survey

Speech in noise tests that measure the perception of speech in presence of noise are now an important part of audiologic tests battery and hearing research as well. There are various tests available to estimate the perception of speech in presence of noise, for example, connected sentence test, hearing in noise test, words in noise, quick speech-in-noise test, bamford-kowal-bench speech-in-noise test, and listening in spatialized noise-sentences. All these tests are different in terms of target age, measure, procedure, speech material, noise, normative, etc. Because of the variety of tests available to estimate speech-in-noise abilities, audiologists often select tests based on their availability, ease to administer the test, time required in running the test, age of the patient, hearing status, type of hearing disorder and type of amplification device if using. A critical appraisal of these speech-in-noise tests is required for the evidence based selection and to be used in audiology clinics. In this article speech-in-noise tests were critically appraised for their conceptual model, measurement model, normatives, reliability, validity, responsiveness, item/instrument bias, respondent burden and administrative burden. Selection of a standard speech-in-noise test based on this critical appraisal will also allow an easy comparison of speech-in-noise ability of any hearing impaired individual or group across audiology clinics and research centers. This article also describes the survey which was done to grade the speech in noise tests on the various appraisal characteristics

Functional consequences of extended high frequency hearing impairmenEvidence from the speech, spatial, and qualities of hearing scale

Hearing loss in the extended high frequencies, despite a normal audiogram, could affect speech-in-noise recognition. However, it is not known if extended high frequency (EHF) hearing loss is associated with everyday listening and communication deficits. The present study aimed to determine the functional effects of impaired EHF hearing among adults using the Speech, Spatial, and Qualities of Hearing Scale (SSQ). A secondary objective was to evaluate the relationship between objective (speech-in-noise recognition) and subjective (SSQ) measures of hearing function. Listeners with EHF hearing loss provided lower SSQ ratings compared with their EHF-normal counterparts. The lower ratings could not be attributed to the age or standard audiogram of the listeners. Ratings from more than 50% of EHF-impaired listeners were below the 2 SD cutoff point obtained from EHF-normal listeners. The mean speech recognition threshold was poorer for EHF-impaired listeners, and a poorer speech recognition threshold was associated with lower SSQ ratings, i.e., poorer self-reported hearing ability. For some listeners, EHF hearing loss could be the missing link between self-reported hearing difficulty in the presence of a normal audiogram. These findings provide evidence for the functional deficits associated with EHF hearing loss and invoke the need for future investigations into the management of EHF loss

Explainable machine learning reveals the relationship between hearing thresholds and speech-in-noise recognition in listeners with normal audiograms

Some individuals complain of listening-in-noise difficulty despite having a normal audiogram. In this study, machine learning is applied to examine the extent to which hearing thresholds can predict speech-in-noise recognition among normal-hearing individuals. The specific goals were to (1) compare the performance of one standard (GAM, generalized additive model) and four machine learning models (ANN, artificial neural network; DNN, deep neural network; RF, random forest; XGBoost; eXtreme gradient boosting), and (2) examine the relative contribution of individual audiometric frequencies and demographic variables in predicting speech-in-noise recognition. Archival data included thresholds (0.25–16 kHz) and speech recognition thresholds (SRTs) from listeners with clinically normal audiograms (n = 764 participants or 1528 ears; age, 4–38 years old). Among the machine learning models, XGBoost performed significantly better than other methods (mean absolute error; MAE = 1.62 dB). ANN and RF yielded similar performances (MAE = 1.68 and 1.67 dB, respectively), whereas, surprisingly, DNN showed relatively poorer performance (MAE = 1.94 dB). The MAE for GAM was 1.61 dB. SHapley Additive exPlanations revealed that age, thresholds at 16 kHz, 12.5 kHz, etc., on the order of importance, contributed to SRT. These results suggest the importance of hearing in the extended high frequencies for predicting speech-in-noise recognition in listeners with normal audiograms