On prediction of aided behavioural measures using speech auditory brainstem responses and decision trees

Current clinical strategies to assess benefits from hearing aids (HAs) are based on self-reported questionnaires and speech-in-noise (SIN) tests; which require behavioural cooperation. Instead, objective measures based on Auditory Brainstem Responses (ABRs) to speech stimuli would not require the individuals’ cooperation. Here, we re-analysed an existing dataset to predict behavioural measures with speech-ABRs using regression trees. Ninety-two HA users completed a self-reported questionnaire (SSQ-Speech) and performed two aided SIN tests: sentences in noise (BKB-SIN) and vowel-consonant-vowels (VCV) in noise. Speech-ABRs were evoked by a 40 ms [da] and recorded in 2x2 conditions: aided vs. unaided and quiet vs. background noise. For each recording condition, two sets of features were extracted: 1) amplitudes and latencies of speech-ABR peaks, 2) amplitudes and latencies of speech-ABR F0 encoding. Two regression trees were fitted for each of the three behavioural measures with either feature set and age, digit-span forward and backward, and pure tone average (PTA) as possible predictors. The PTA was the only predictor in the SSQ-Speech trees. In the BKB-SIN trees, performance was predicted by the aided latency of peak F in quiet for participants with PTAs between 43 and 61 dB HL. In the VCV trees, performance was predicted by the aided F0 encoding latency and the aided amplitude of peak VA in quiet for participants with PTAs ≤ 47 dB HL. These findings indicate that PTA was more informative than any speech-ABR measure, as these were relevant only for a subset of the participants. Therefore, speech-ABRs evoked by a 40 ms [da] are not a clinical predictor of behavioural measures in HA users.

Factors Affecting Hearing Aid Adoption by Adults With High-Frequency Hearing Loss: The Beaver Dam Offspring Study

Purpose Hearing loss (HL) is common among middle-age and older adults, but hearing aid adoption is low. The purpose of this study was to measure the 10-year incidence of hearing aid adoption in a sample of primarily middle-age adults with high-frequency HL and identify factors associated with hearing aid adoption. Method This study included 579 adults (ages 34–80 years) with high-frequency pure-tone average > 25 dB HL (3–8 kHz) enrolled in the Beaver Dam Offspring Study. Hearing aid adoption was measured at 5- and 10-year follow-up examinations. Cox discrete-time proportional hazards models were used to evaluate factors associated with hearing aid adoption (presented as hazards ratios [HRs] and 95% confidence intervals [95% CI]). Results The 10-year cumulative incidence of hearing aid adoption was 14 per 1,000 person years. Factors significantly associated with adoption in a multivariable model were higher education (vs. 16+ years; 0–12: HR: 0.36, 95% CI [0.19, 0.69]; 13–15: HR: 0.52, 95% CI [0.27, 0.98]), worse high-frequency pure-tone average (per +1 dB; HR: 1.04, 95% CI [1.02, 1.06]), self-reported hearing handicap (screening versions of the Hearing Handicap Inventory score > 8; HR: 1.85, 95% CI [1.02, 3.38]), answering yes to “Do friends and relatives think you have a hearing problem?” (HR: 3.18, 95% CI [1.60, 6.33]) and using closed captions (HR: 2.86, 95% CI [1.08, 7.57]). Effects of age and sex were not significant. Conclusions Hearing aid adoption rates were low. Hearing sensitivity, socioeconomic status, and measures of the impact of HL on daily life were associated with adoption. Provider awareness of associated factors can contribute to timely and appropriate intervention.

The correlation between glycosylated haemoglobin levels with pure tone average values in type 2 diabetes mellitus patients

Hearing plays an important role in our daily activities, if it is impaired or lost the quality of life is affected by improper communication. The diabetes mellitus is a chronic metabolic disorder and affects all the systems in the body including auditory system. So assessment of hearing is important in diabetics to know the type, extent of hearing impairment which helps to take treatment decisions and preventive measures. Present study is focused on relationship between glycosylated haemoglobin (HbA1c) levels with pure tone average (PTA) values in type 2 diabetics. Type 2 diabetic patients with (WHI) and without (WoHI) hearing impairment, both the gender was included with age limit between 35-55 years and also ten normal subjects were included as controls. Pure tone average (PTA) is the average of hearing threshold levels at different frequencies; it gives information about an individual’s hearing level in each ear. All the data were expressed as mean ± SE. The mean were analyzed by one way ANOVA. Pearson correlation test was done to see the relationship between right and left ear PTA values in normal subjects, WoHI and WHI groups with HbA1c values. In both the groups pure tone average values are not statistically correlated with HbA1c. The left ear of both WoHI (P=0.977) and WHI (P=0.490) groups shows negative correlation with HbA1c. The HbA1c values are correlated with PTA values in all subjects. The pure tone audiometry is helpful to know the status of hearing sensitivity and type, severity of the hearing impairment in the T2DM patients in relation to HbA1c levels.

Longitudinal associations between hearing aid usage and cognition in community-dwelling Japanese older adults with moderate hearing loss

We investigated the associations between hearing aids (HA) and the maintenance of cognitive function among community-dwelling older adults with moderate hearing loss. A total of 407 participants aged 60 years or older with moderate hearing loss were recruited from the National Institute for Longevity Sciences, Longitudinal Study for Aging (NILS-LSA). Moderate hearing loss was defined as a pure-tone average of 40–69 dB at 500, 1000, 2000, and 4000 Hz of the better ear, according to the definition proposed by the Japan Audiological Society. Cognitive function was evaluated using the four subtests of the Japanese version of the Wechsler Adult Intelligence Scale-Revised Short Forms (WAIS-R-SF): Information, Similarities, Picture completion, and Digit Symbol Substitution (DSST). A longitudinal analysis of 1192 observations with a mean follow-up period of 4.5 ± 3.9 years was performed. The HA use rate at any time during the follow-up period was 31.4%, and HA users were significantly younger (t-test, p = 0.001), had worse hearing (p < .0001) and higher education (p = 0.001), participated more frequently in the survey (p < .0001), and were less depressed (χ2 test, p = 0.003) than the older adults not using HA. General linear mixed models consisted of the fixed effects of HA use, follow-up time, and an HA use × time interaction term adjusted for age and pure-tone average thresholds at baseline, sex, education, and other possible confounders. HA use showed significant main effects on the scores for Picture completion and DSST after adjustment; scores were better in the HA use group than in the no HA use group. The HA use × time interaction was significant for the Information score (p = 0.040). The model-predicted 12-year slope with centralizing age indicated that the no HA use group showed greater decline over time on Information scores than did HA use group. The slopes did not differ between HA users and non-users for the Similarities, Picture completion and DSST. In conclusion, HA use may have a protective effect on the decline in general knowledge in older adults with moderate hearing loss.

Impacts of Diabetes, Aging, and Hearing Loss on Speech-on-Speech Masking and Spatial Release in a Large Veteran Cohort

Purpose Type 2 diabetes mellitus (DM2) is associated with impaired hearing. However, the evidence is less clear if DM2 can lead to difficulty understanding speech in complex acoustic environments, independently of age and hearing loss effects. The purpose of this study was to estimate the magnitude of DM2-related effects on speech understanding in the presence of competing speech after adjusting for age and hearing. Method A cross-sectional study design was used to investigate the relationship between DM2 and speech understanding in 190 Veterans ( M age = 47 years, range: 25–76). Participants were classified as having no diabetes ( n = 74), prediabetes ( n = 19), or DM2 that was well controlled ( n = 24) or poorly controlled ( n = 73). A test of spatial release from masking (SRM) was presented in a virtual acoustical simulation over insert earphones with multiple talkers using sentences from the coordinate response measure corpus to determine the target-to-masker ratio (TMR) required for 50% correct identification of target speech. A linear mixed model of the TMR results was used to estimate SRM and separate effects of diabetes group, age, and low-frequency pure-tone average (PTA-low) and high-frequency pure-tone average. A separate model estimated the effects of DM2 on PTA-low. Results After adjusting for hearing and age, diabetes-related effects remained among those whose DM2 was well controlled, showing an SRM loss of approximately 0.5 dB. Results also showed effects of hearing loss and age, consistent with the literature on people without DM2. Low-frequency hearing loss was greater among those with DM2. Conclusions In a large cohort of Veterans, low-frequency hearing loss and older age negatively impact speech understanding. Compared with nondiabetics, individuals with controlled DM2 have additional auditory deficits beyond those associated with hearing loss or aging. These results provide a potential explanation for why individuals who have diabetes and/or are older often report difficulty understanding speech in real-world listening environments. Supplemental Material https://doi.org/10.23641/asha.16746475

Longitudinal associations of subclinical hearing loss with cognitive decline

Background Several studies have demonstrated that age-related hearing loss is associated with cognitive decline. We investigated whether subclinical hearing loss (SCHL), or imperfect hearing traditionally categorized as normal (pure tone average ≤25 dB), may be similarly linked to cognitive decline and risk of incident mild cognitive impairment (MCI)/dementia. Methods Participants from the Baltimore Longitudinal Study of Aging were cognitively normal adults ≥50 years old with cognitive assessments from 1991-2019 and pure-tone average ≤25 dB measured between 1991-1994 (n=263). The exposure was hearing based on the better ear pure-tone average. Outcomes were test scores in various cognitive domains. Multivariable linear-mixed effects models modeled the association between hearing and change in cognition over time, adjusting for age, sex, education, vascular burden, and race. Kaplan–Meier survival curves and Cox proportional hazards models portrayed associations between hearing and incident MCI/dementia diagnosis based on predefined criteria. Results Of 263 participants, 145 (55.1%) were female; mean age was 68.3 years (standard deviation, SD=8.9). Follow-up ranged up to 27.7 years (mean=11.7 years). Adjusting for multiple comparisons, a 10-dB increase in hearing loss was associated with an annual decline of -0.02 SDs (95% confidence interval, [CI]: -0.03, -0.01) in Letter Fluency. No significant relationships were observed between hearing and incident MCI/dementia. Conclusions A relationship between SCHL and cognitive decline was observed for the Letter Fluency test. Further studies are necessary to determine when in the spectrum of hearing loss there begins to be an observable relationship between hearing and cognitive decline.

Speech Recognition Outcomes in Adults With Slim Straight and Slim Modiolar Cochlear Implant Electrode Arrays

Objective To compare differences in audiologic outcomes between slim modiolar electrode (SME) CI532 and slim lateral wall electrode (SLW) CI522 cochlear implant recipients. Study Design Retrospective cohort study. Setting Tertiary academic hospital. Methods Comparison of postoperative AzBio sentence scores in quiet (percentage correct) in adult cochlear implant recipients with SME or SLW matched for preoperative AzBio sentence scores in quiet and aided and unaided pure tone average. Results Patients with SLW (n = 52) and patients with SME (n = 37) had a similar mean (SD) age (62.0 [18.2] vs 62.6 [14.6] years, respectively), mean preoperative aided pure tone average (55.9 [20.4] vs 58.1 [16.4] dB; P = .59), and mean AzBio score (percentage correct, 11.1% [13.3%] vs 8.0% [11.5%]; P = .25). At last follow-up (SLW vs SME, 9.0 [2.9] vs 9.9 [2.6] months), postoperative mean AzBio scores in quiet were not significantly different (percentage correct, 70.8% [21.3%] vs 65.6% [24.5%]; P = .29), and data log usage was similar (12.9 [4.0] vs 11.3 [4.1] hours; P = .07). In patients with preoperative AzBio <10% correct, the 6-month mean AzBio scores were significantly better with SLW than SME (percentage correct, 70.6% [22.9%] vs 53.9% [30.3%]; P = .02). The intraoperative tip rollover rate was 8% for SME and 0% for SLW. Conclusions Cochlear implantation with SLW and SME provides comparable improvement in audiologic functioning. SME does not exhibit superior speech recognition outcomes when compared with SLW.

Evaluation of Postinfection Hearing with Audiological Tests in Patients with COVID-19: A Case–Control Study

Background Some viral infections can cause congenital or acquired unilateral or bilateral hearing loss. It is predicted that the coronavirus disease 2019 (COVID-19) virus, which can affect many systems in the body, may also have a negative effect on hearing. Purpose This study evaluated the effects of COVID-19 infection on pure-tone average. Research Design A case–control study. Materials and Methods A total of 104 volunteers (48 control, 56 experimental group) who applied to the ENT clinic of Adıyaman University Training and Research Hospital were included in this study. After the detailed clinical examination and medical history, 13 volunteers of the experimental group and 5 volunteers from the control group were excluded from the study. In this way, each group consisted of 43 volunteers. While the experimental group consisted of patients who did not have any hearing problems before but had COVID-19. The control group consisted of healthy volunteers who did not have any hearing problems and were not infected with COVİD-19. Audiological test was applied to all volunteers to determine their pure-tone average. On the data obtained, it was analyzed whether COVID-19 affects the pure-tone average and how it changes according to variables such as age and gender. Results The evaluation of the 43 (50.0%) COVID-19-positive patients and 43 (50.0%) healthy controls showed no significant differences (p > 0.05) at 250 and 500 Hz, whereas at 4000, 6000, and 8000 Hz, the two groups differed significantly. In addition, significant differences were found in the left and right ears at 1000 and 2000 Hz (p < 0.05). The differences between the two groups in the pure-tone average of the left and right ear were statistically significant (p < 0.05). However, there were no significant sex-based differences in the pure-tone average between males and females (p > 0.05) Conclusion The pure-tone average of COVID-19 positive patients was significantly worse than those of the healthy control group. Thus, COVID-19 should also be considered in patients presenting with unexplained hearing loss. Further studies should investigate the effects of COVID-19 on hearing and the underlying pathophysiology.

Long-Term Effects of Hearing Aids on Hearing Ability in Patients with Sensorineural Hearing Loss

Background A frequent concern surrounding amplification with hearing aids for patients with sensorineural hearing loss is whether these devices negatively affect hearing ability. To date, there have been few studies examining the long-term effects of amplification on audiometric outcomes in adults. Purpose In the present study, we examined how hearing aids affect standard audiometric outcomes over long-term periods of follow-up. Research Design We retrospectively collected audiometric data in adults with sensorineural hearing loss, constructing a model of long-term outcomes. Study Sample This retrospective cohort study included 802 ears from 401 adult patients with bilateral sensorineural hearing loss eligible for amplification with hearing aids at a single institution. Intervention Of the eligible patients, 88 were aided bilaterally, and 313 were unaided. Data Collection and Analysis We examined the standard three-frequency pure-tone average (PTA3-Freq), a novel extended pure-tone average (PTAExt), and word recognition score (WRS) per-ear at each encounter. We then modeled the association between the use of hearing aids for 5 years and these audiometric outcomes using targeted maximum likelihood estimation. Results In comparing aided and unaided ears at the end of 5 years, there were discernible effects for all measurements. The PTA3-Freq was 5 dB greater in aided ears (95% CI: 1.37–8.64, p = 0.007), WRS was 4.5 percentage points lower in aided ears (95% CI: −9.14 to 0.15, p = 0.058), and PTAExt was 5 dB greater in aided ears (95% CI: 2.18–7.82, p < 0.001), adjusting for measured confounders. Conclusion Our analysis revealed discernible effects of 5 years of hearing aid use on hearing ability, specifically as measured by the PTA3-Freq, novel PTAExt, and WRS, suggesting a greater decline in hearing ability in patients using hearing aids. Future studies are needed to examine these effects between treatment groups over longer periods of time and in more heterogeneous populations to improve clinical practice guidelines and safety of both prescriptive fitting nonprescriptive amplification.

Stapes Surgery in Far-Advanced Otosclerosis

Introduction: Surgical treatment of patients with far-advanced otosclerosis (FAO) has not yet been standardized. Patients with FAO are the candidates for stapes surgery or cochlear implant (CI). Although many surgeons consider stapes surgery as the first choice, other authors prefer CI because of the excellent hearing results. Objective: The authors discuss their experience in the treatment of patients with FAO, potentially candidates for CI, who underwent stapedotomy. Materials and Methods: Eleven adult patients with FAO underwent stapedotomy from 2006 to 2016. Pure-tone average (PTA) between 0.5-1-2-3 kHz and speech perception test with hearing aids were determined before and after stapedotomy. Results: The results show a statistically significant improvement in air condition threshold (PTA) and satisfactory results with regard to speech recognition in 9 (81.8%) cases. Postoperative results are not influenced by the type of stapedotomy prosthesis employed and do not change during follow-up (3 years). Conclusions: The authors suggest first performing stapes surgery in patients with FAO and reserving CI in case of failure.