Functional Assessment of Hearing Aid Benefit: Incorporating Verification and Aided Speech Recognition Testing into Routine Practice

Potential cochlear implant (CI) candidates arrive to the clinic with a variety of hearing loss configurations, hearing aid history, and aided capabilities. CI candidacy is primarily determined based on aided speech recognition capability, which relies on benefit derived from use of hearing aids. Therefore, contemporary evaluation for CI candidacy should incorporate a battery of testing to determine abilities and limitations and must be predicated on appropriate verification of the hearing aid fitting. However, recent reports, including a retrospective chart review of patients presenting to Cleveland Clinic for CI evaluation, suggest that a significant subset of patients may be using inappropriately fit or programmed amplification. Thus, a combination of simulated real-ear measurements and aided speech recognition testing is essential for fully assessing the effect of amplification and ultimately determination of CI candidacy. Furthermore, waiting to incorporate these tools until CI candidacy is suspected may delay timely identification of problems or need to change technology. Utilization of evidence-based decision drivers ultimately leads clinicians to timely patient-specific interventions which may include surgical intervention or other amplification options. As audiology moves into a healthcare era in which payers consider the benefit of our services to overall health and well-being, demonstrating timely, optimal outcomes using thorough, multifactorial evaluation is essential.

Noradrenergic arousal after encoding reverses the course of systems consolidation in humans

It is commonly assumed that episodic memories undergo a time-dependent systems consolidation process, during which hippocampus-dependent memories eventually become reliant on neocortical areas. Here we show that systems consolidation dynamics can be experimentally manipulated and even reversed. We combined a single pharmacological elevation of post-encoding noradrenergic activity through the α2-adrenoceptor antagonist yohimbine with fMRI scanning both during encoding and recognition testing either 1 or 28 days later. We show that yohimbine administration, in contrast to placebo, leads to a time-dependent increase in hippocampal activity and multivariate encoding-retrieval pattern similarity, an indicator of episodic reinstatement, between 1 and 28 days. This is accompanied by a time-dependent decrease in neocortical activity. Behaviorally, these neural changes are linked to a reduced memory decline over time after yohimbine intake. These findings indicate that noradrenergic activity shortly after encoding may alter and even reverse systems consolidation in humans, thus maintaining vividness of memories over time.

A Subtle Profile With a Significant Impact: Language and Communication Difficulties for Autistic Females Without Intellectual Disability

The presentation of autism in females is poorly understood, which is thought to contribute to missed or later- age diagnosis, especially for those without intellectual disability. Dedicated research into social and behavioral differences has indicated a specific female phenotype of autism. However, less has been done to explore language and communication profiles, despite known sex/gender differences in typically developing populations. This article provides a synthesis of recent work from this small but emerging field. It focuses on a series of four preliminary and explorative studies conducted by the authors and embeds this within the wider literature. Findings suggest a specific profile of language and communication strengths and weaknesses for autistic females without intellectual disability (compared to autistic males and typically developing females). Furthermore, despite the relatively subtle presentation of difficulties (compared to autistic males), the impact on functionality, social inter-relations and emotional well-being, appears to be equitable and significant. The discussion highlights the need for further empirical research and proposes areas for investigation. Implications for clinical practice include the need for better recognition, testing and provision of interventions dedicated to the language and communication difficulties for autistic females. This has relevance for diagnostic, mental health and speech and language therapy services.

John Van Druten’s TheWidening Circle (1957)

This chapter begins with a brief history of West Hampstead’s transformation from a sleepy bucolic hamlet on the outskirts of London to a Victorian commuter suburb. It sets out how West Hampstead’s perceived loss of innocence in the railway age spawned a tradition of nostalgic writing, forming the backdrop, and sometimes the centrepiece, of several childhood memoirs. It then looks at John Van Druten’s autobiography, The Widening Circle. Published in April 1957, eight months before he died, the book is a discursive and deeply meditative essay in nostalgia. In it Van Druten portrays his visits back to the streets of his youth in West Hampstead as not only spiritual but also physical, sensory, and characterized by the Homeric elements of recognition, testing, and tokens. The chapter examines, in particular, how these Odyssean pilgrimages were spurred by Van Druten’s ‘longing to know what I am truly composed of’, how they were an attempt to piece together an aetiology of the self.

The Impact of Speech Recognition Testing on State Anxiety in Young, Middle-Age, and Older Adults

Purpose This study assessed state anxiety as a function of speech recognition testing using three clinical measures of speech in noise and one clinical measure of dichotic speech recognition. Method Thirty young adults, 30 middle-age adults, and 25 older adults participated. State anxiety was measured pre– and post–speech recognition testing using the State–Trait Anxiety Inventory. Speech recognition was measured with the Revised Speech Perception in Noise Test, the Quick Speech-in-Noise Test, the Words-in-Noise Test, and the Dichotic Digits Test (DDT). Results Speech recognition performance was as expected: Older adults performed significantly poorer on all measures as compared to the young adults and significantly poorer on the Revised Speech Perception in Noise Test, the Quick Speech-in-Noise Test, and the Words-in-Noise Test as compared to the middle-age adults. On average, State–Trait Anxiety Inventory scores increased posttesting, with the middle-age adults exhibiting significantly greater increases in state anxiety as compared to the young and older adults. Increases in state anxiety were significantly greater for the DDT relative to the speech-in-noise tests for the middle-age adults only. Poorer DDT recognition performance was associated with higher levels of state anxiety. Conclusions Increases in state anxiety were observed after speech-in-noise and dichotic listening testing for all groups, with significant increases seen for the young and middle-age adults. Although the exact mechanisms could not be determined, multiple factors likely influenced the observed increases in state anxiety, including task difficulty, individual proficiency, and age.

Clinical Application of Spectral Modulation Detection: Speech Recognition Benefit for Combining a Cochlear Implant and Contralateral Hearing Aid

Purpose The purpose of this study was to investigate the relationship between speech recognition benefit derived from the addition of a hearing aid (HA) to the nonimplanted ear (i.e., bimodal benefit) and spectral modulation detection (SMD) performance in the nonimplanted ear in a large clinical sample. An additional purpose was to investigate the influence of low-frequency pure-tone average (PTA) of the nonimplanted ear and age at implantation on the variance in bimodal benefit. Method Participants included 311 unilateral cochlear implant (CI) users who wore an HA in the nonimplanted ear. Participants completed speech recognition testing in quiet and in noise with the CI-alone and in the bimodal condition (i.e., CI and contralateral HA) and SMD in the nonimplanted ear. Results SMD performance in the nonimplanted ear was significantly correlated with bimodal benefit in quiet and in noise. However, this relationship was much weaker than previous reports with smaller samples. SMD, low-frequency PTA of the nonimplanted ear from 125 to 750 Hz, and age at implantation together accounted for, at most, 19.1% of the variance in bimodal benefit. Conclusions Taken together, SMD, low-frequency PTA, and age at implantation account for the greatest amount of variance in bimodal benefit than each variable alone. A large portion of variance (~80%) in bimodal benefit is not explained by these variables. Supplemental Material https://doi.org/10.23641/asha.12185493

Early effects of recollection memory on viewing behavior during visual associative recognition

Memory for the context in which items were previously encountered is necessary for everyday tasks. Recollection of item-context associations can facilitate search and support earlier viewing of recognition targets. We used fixation-by-fixation analysis of viewing behavior to characterize visual fixations influenced by recollection during associative recognition. We computed the (1) aggregate proportion of viewing time on target and (2) saccades within target per fixation during recognition testing to measure the influence of recollection on viewing behavior. Proportion of viewing time on target and number of saccades within target increased after the initial fixation of recognition test. These results indicate that recollection effects occurred immediately after the initial fixation of visual associative recognition and that early, prolonged fixations and saccades within selected faces could represent a precise behavioral correlate of recollection memory.

Adult validation of a self-administered tablet audiometer

Background There is evidence to suggest that rates of hearing loss are increasing more rapidly than the capacity of traditional audiometry resources for screening. A novel innovation in tablet, self-administered portable audiometry has been proposed as a solution to this discordance. The primary objective of this study was to validate a tablet audiometer with adult patients in a clinical setting. Secondarily, word recognition with a tablet audiometer was compared against conventional audiometry. Methods Three distinct prospective adult cohorts underwent testing. In group 1 and group 2 testing with the automated tablet audiometer was compared to standard sound booth audiometry. In Group 1, participants’ pure tone thresholds were measured with an automated tablet audiometer in a quiet clinic exam room. In Group 2, participants completed monosyllabic word recognition testing using the NU-6 word lists. In Group 3, internal reliability was tested by having participants perform two automated tablet audiometric evaluation in sequence. Results Group 1 included 40 patients mean age was 54.7 ± 18.4 years old and 60% female; Group 2 included 44 participants mean age was 55.2 ± 14.8 years old and 68.2% female; Group 3 included 40 participants with mean age of 39.4 + 15.9 years old and 60.5% female. In Group 1, compared to standard audiometry, 95.7% (95% CI: 92.6–98.9%) of thresholds were within 10 dB. In Group 2, comparing word recognition results, 96.2% (95% CI: 89.5–98.7%) were clinically equivalent and within a critical difference range. In Group 3, One-way Intraclass Correlation for agreement for the both left- and right-ear pure tone average was 0.98. The mean difference between repeat assessments was 0 (SD = 2.1) in the left ear, and 0.1 (SD = 1.1) in the right ear. Conclusion Puretone audiometry and word recognition testing appears valid when performed by non-healthcare experts using a tablet audiometer outside a sound booth in a quiet environment. Trial registration ClinicalTrials.gov Identifier: NCT02761798. Registered April, 2016 < https://clinicaltrials.gov/ct2/show/NCT02761798>

Diagnostic Precision of Open-Set Versus Closed-Set Word Recognition Testing

Purpose The aim of the study was to examine the precision of forced-choice (closed-set) and open-ended (open-set) word recognition (WR) tasks for identifying a change in hearing. Method WR performance for closed-set (4 and 6 choices) and open-set tasks was obtained from 70 listeners with normal hearing. Speech recognition was degraded by presenting monosyllabic words in noise (−8, −4, 0, and 4 signal-to-noise ratios) or processed by a sine wave vocoder (2, 4, 6, and 8 channels). Results The 2 degraded speech understanding conditions yielded similarly shaped, monotonically increasing psychometric functions with the closed-set tasks having shallower slopes and higher scores than the open-set task for the same listening condition. Fitted psychometric functions to the average data were the input to a computer simulation conducted to assess the ability of each task to identify a change in hearing. Individual data were also analyzed using 95% confidence intervals for significant changes in scores for words and phonemes. These analyses found the following for the most to least efficient condition: open-set (phoneme), open-set (word), closed-set (6 choices), and closed-set (4 choices). Conclusions Closed-set WR testing has distinct advantages for implementation, but its poorer precision for identifying a change than open-set WR testing must be considered.

Deteksi Wajah Secara Real Time Menggunakan Metode Camshift

Face recognition research has now become a research topic that is occupied by many researchers both domestically and abroad because of the many benefits and uses of the research results. Some of the benefits of research introduce faces include security systems and robotics. Researchers introduced faces that have begun to develop the last few and have been applied mainly to security systems. Many methods can be used in face recognition, one of which is face recognition in real time using the Camshift method, Based on the results of trials on poses Having different results, In this experiment, it consisted of several tests namely testing of face detection and assessment and testing face is carried out in four types of testing, namely face recognition testing at a distance of 30 cm, face recognition testing at a distance of 50 cm, testing at a distance of 100 cm and testing using accessories.