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Colbert BM, Lanting C, Smeal M, Blanton S, Dykxhoorn DM, Tang PC, Getchell RL, Velde H, Fehrmann M, Thorpe R, Chapagain P, Elkhaligy H, Kremer H, Yntema H, Haer-Wigman L, Redfield S, Sun T, Bruijn S, Plomp A, Goderie T, van de Kamp J, Free RH, Wassink-Ruiter JK, Widdershoven J, Vanhoutte E, Rotteveel L, Kriek M, van Dooren M, Hoefsloot L, de Gier HHW, Schaefer A, Kolbe D, Azaiez H, Rabie G, Aburayyan A, Kawas M, Kanaan M, Holder J, Usami SI, Chen Z, Dai P, Holt J, Nelson R, Choi BY, Shearer E, Smith RJH, Pennings R, Liu XZ. The natural history and genotype-phenotype correlations of TMPRSS3 hearing loss: an international, multi-center, cohort analysis. Hum Genet 2024; 143:721-734. [PMID: 38691166 PMCID: PMC11098735 DOI: 10.1007/s00439-024-02648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/21/2024] [Indexed: 05/03/2024]
Abstract
TMPRSS3-related hearing loss presents challenges in correlating genotypic variants with clinical phenotypes due to the small sample sizes of previous studies. We conducted a cross-sectional genomics study coupled with retrospective clinical phenotype analysis on 127 individuals. These individuals were from 16 academic medical centers across 6 countries. Key findings revealed 47 unique TMPRSS3 variants with significant differences in hearing thresholds between those with missense variants versus those with loss-of-function genotypes. The hearing loss progression rate for the DFNB8 subtype was 0.3 dB/year. Post-cochlear implantation, an average word recognition score of 76% was observed. Of the 51 individuals with two missense variants, 10 had DFNB10 with profound hearing loss. These 10 all had at least one of 4 TMPRSS3 variants predicted by computational modeling to be damaging to TMPRSS3 structure and function. To our knowledge, this is the largest study of TMPRSS3 genotype-phenotype correlations. We find significant differences in hearing thresholds, hearing loss progression, and age of presentation, by TMPRSS3 genotype and protein domain affected. Most individuals with TMPRSS3 variants perform well on speech recognition tests after cochlear implant, however increased age at implant is associated with worse outcomes. These findings provide insight for genetic counseling and the on-going design of novel therapeutic approaches.
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Affiliation(s)
- Brett M Colbert
- Department of Otolaryngology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL, 33136, USA
- Medical Scientist Training Program, University of Miami Miller School of Medicine, Miami, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, USA
| | - Cris Lanting
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Molly Smeal
- Department of Otolaryngology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL, 33136, USA
| | - Susan Blanton
- Department of Otolaryngology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL, 33136, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, USA
| | - Derek M Dykxhoorn
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, USA
| | - Pei-Ciao Tang
- Department of Otolaryngology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL, 33136, USA
| | - Richard L Getchell
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, USA
| | - Hedwig Velde
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mirthe Fehrmann
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ryan Thorpe
- Department of Otolaryngology, University of Iowa, Iowa City, USA
| | - Prem Chapagain
- Department of Physics and Biomolecular Sciences Institute, Florida International University, Miami, USA
| | - Heidy Elkhaligy
- Department of Physics and Biomolecular Sciences Institute, Florida International University, Miami, USA
| | - Hannie Kremer
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helger Yntema
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lonneke Haer-Wigman
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Tieqi Sun
- Boston Children's Hospital, Boston, USA
| | - Saskia Bruijn
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Astrid Plomp
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Thadé Goderie
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Rolien H Free
- Groningen University Medical Center, Groningen, The Netherlands
| | | | | | - Els Vanhoutte
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | | | | | - Amanda Schaefer
- Department of Otolaryngology, University of Iowa, Iowa City, USA
| | - Diana Kolbe
- Department of Otolaryngology, University of Iowa, Iowa City, USA
| | - Hela Azaiez
- Department of Otolaryngology, University of Iowa, Iowa City, USA
| | - Grace Rabie
- Hereditary Research Laboratory and Department of Life Sciences, Bethlehem University, Bethlehem, Palestine
| | | | - Mariana Kawas
- Hereditary Research Laboratory and Department of Life Sciences, Bethlehem University, Bethlehem, Palestine
| | - Moien Kanaan
- Hereditary Research Laboratory and Department of Life Sciences, Bethlehem University, Bethlehem, Palestine
| | | | | | - Zhengyi Chen
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary and Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
| | - Pu Dai
- PLA General Hospital, Beijing, China
| | | | - Rick Nelson
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, USA
| | - Byung Yoon Choi
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | | | - Ronald Pennings
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Xue Zhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL, 33136, USA.
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, USA.
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Shannon CM, Schvartz-Leyzac KC, Dubno JR, McRackan TR. Determinants of Cochlear Implant Satisfaction and Decisional Regret in Adult Cochlear Implant Users. Otol Neurotol 2023; 44:e722-e729. [PMID: 37853774 PMCID: PMC10840889 DOI: 10.1097/mao.0000000000004028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Determine associations expected and actual cochlear implant (CI) outcomes, decisional regret, and satisfaction in experienced adult CI users. STUDY DESIGN Cross-sectional cohort study. SETTING Tertiary medical center. PATIENTS Thirty-nine adult CI users meeting traditional bilateral hearing loss indications with ≥12 months CI experience. INTERVENTIONS/MAIN OUTCOME MEASURES Patients completed the validated Satisfaction with Amplification in Daily Living and Decisional Regret instruments. Pre- and post-CI outcomes (CI Quality of Life [CIQOL]-Expectations; CIQOL-35 Profile; CNC words, AzBio Sentences) were obtained from a prospectively maintained clinical database. RESULTS Using established cutoff scores, 29% of patients reported a substantial degree of post-CI decisional regret. For each CIQOL domain, patients without decisional regret obtained post-CI outcome scores closer to pre-CI expectations compared with patients with decisional regret ( d = 0.34 to 0.91); similar results were observed with higher CI user satisfaction ( d = 0.17-0.83). Notably, the degree of pre- to post-CI improvement in CNC or AzBio scores did not differ between patients with and without decisional regret or with lower and higher satisfaction. Finally, greater pre-/postimprovement in CIQOL-35 Profile domain scores demonstrated far stronger associations with lower decisional regret and higher satisfaction than changes in speech recognition scores. CONCLUSIONS Patients with better alignment of their pre-CI expectations and post-CI outcomes and greater pre-/post-CIQOL improvement had lower decisional regret and higher satisfaction. This emphasizes the importance of evidence-based pre-CI counseling regarding real-world CI benefits and caution against assuming that improvements in speech recognition are related to patient satisfaction.
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Affiliation(s)
- Christian M. Shannon
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kara C. Schvartz-Leyzac
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R. Dubno
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R. McRackan
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Raymond MJ, Ma C, Schvartz-Leyzac KC, Camposeo EL, Nguyen SA, Meyer TA, McRackan TR. Association of Cognitive Impairment Screening Scores With Improvements in Speech Recognition and Quality of Life After Cochlear Implantation. JAMA Otolaryngol Head Neck Surg 2023; 149:344-351. [PMID: 36729460 PMCID: PMC9896371 DOI: 10.1001/jamaoto.2022.4825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/02/2022] [Indexed: 02/03/2023]
Abstract
Importance Many cochlear implant centers screen patients for cognitive impairment as part of the evaluation process, but the utility of these scores in predicting cochlear implant outcomes is unknown. Objective To determine whether there is an association between cognitive impairment screening scores and cochlear implant outcomes. Design, Setting, and Participants Retrospective case series of adult cochlear implant recipients who underwent preoperative cognitive impairment screening with the Montreal Cognitive Assessment (MoCA) from 2018 to 2020 with 1-year follow-up at a single tertiary cochlear implant center. Data analysis was performed on data from January 2018 through December 2021. Exposures Cochlear implantation. Main Outcomes and Measures Preoperative MoCA scores and mean (SD) improvement (aided preoperative to 12-month postoperative) in Consonant-Nucleus-Consonant phonemes (CNCp) and words (CNCw), AzBio sentences in quiet (AzBio Quiet), and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile domain and global scores. Results A total of 52 patients were included, 27 (52%) of whom were male and 46 (88%) were White; mean (SD) age at implantation was 68.2 (13.3) years. Twenty-three (44%) had MoCA scores suggesting mild and 1 (2%) had scores suggesting moderate cognitive impairment. None had been previously diagnosed with cognitive impairment. There were small to medium effects of the association between 12-month postoperative improvement in speech recognition measures and screening positive or not for cognitive impairment (CNCw mean [SD]: 48.4 [21.9] vs 38.5 [26.6] [d = -0.43 (95% CI, -1.02 to 0.16)]; AzBio Quiet mean [SD]: 47.5 [34.3] vs 44.7 [33.1] [d = -0.08 (95% CI, -0.64 to 0.47)]). Similarly, small to large effects of the associations between 12-month postoperative change in CIQOL-35 scores and screening positive or not for cognitive impairment were found (global: d = 0.32 [95% CI, -0.59 to 1.23]; communication: d = 0.62 [95% CI, -0.31 to 1.54]; emotional: d = 0.26 [95% CI, -0.66 to 1.16]; entertainment: d = -0.005 [95% CI, -0.91 to 0.9]; environmental: d = -0.92 [95% CI, -1.86 to 0.46]; listening effort: d = -0.79 [95% CI, -1.65 to 0.22]; social: d = -0.51 [95% CI, -1.43 to 0.42]). Conclusions and Relevance In this case series, screening scores were not associated with the degree of improvement of speech recognition or patient-reported outcome measures after cochlear implantation. Given the prevalence of screening positive for cognitive impairment before cochlear implantation, preoperative screening can be useful for early identification of potential cognitive decline. These findings support that screening scores may have a limited role in preoperative counseling of outcomes and should not be used to limit candidacy.
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Affiliation(s)
- Mallory J. Raymond
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Cheng Ma
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kara C. Schvartz-Leyzac
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Elizabeth L. Camposeo
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Theodore R. McRackan
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
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McRackan TR, Hand BN, Velozo CA, Dubno JR. Development and Implementation of the Cochlear Implant Quality of Life (CIQOL) Functional Staging System. Laryngoscope 2022; 132 Suppl 12:S1-S13. [PMID: 36082873 PMCID: PMC9650765 DOI: 10.1002/lary.30381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The purpose of this study is to develop and implement a functional staging system using the Cochlear Implant Quality of Life (CIQOL) framework. The CIQOL-35 Profile was developed and validated following a rigorous research design and found to be more comprehensive and psychometrically sound than previous patient-reported outcome measures (PROMs) applied to adult CI users. However, interpreting the CIQOL-35 Profile (and all PROMs) relative to real-world functioning remains difficult for patients and clinicians, which limits the capacity of PROMs to direct clinical care. To address this limitation, a functional staging system based on PROM scores was developed to provide detailed descriptions of patients' self-reported abilities (clinical vignettes) without sacrificing the inherent value of the psychometrically derived scores. The current study (1) creates an evidence-based CIQOL functional staging system using advanced psychometric techniques, (2) confirms the clarity and meaningfulness of the staging system with patients, and (3) implements the staging system to measure CIQOL stage progression using data from a longitudinal study design. METHODS Item response theory (IRT) analyses of CIQOL-35 Profile data from 705 experienced adult CI users and expert opinion were used to determine the cut-scores that separated adjacent stages for the six CIQOL-35 domains (communication, emotional, entertainment, environment, listening effort, and social). The research team then created clinical vignettes based on item response patterns for each stage. Semi-structured key informant interviews were conducted with 10 adult CI users to determine the clarity and meaningfulness of the CIQOL stages and associated clinical vignettes. Finally, we prospectively collected CIQOL-35 Profile scores from 42 CI users prior to cochlear implantation and then at 3- and 6-months post-CI activation to measure CIQOL stage progression. RESULTS Psychometric analyses identified five statistically distinct stages for the communication domain and three stages for all other domains. Using IRT analysis results for guidance, research team members independently identified the cut-scores that represented transitions between the functional stages for each domain with excellent agreement (κ = 0.98 [95% confidence interval 0.96-0.99]). Next, the key informant interviews revealed that CI users found the clinical vignettes to be clear and only minor changes were required. Participants also agreed that stage progression represented meaningful improvements in functional abilities. Finally, 88.1% of 42 patients in the prospective cohort (n = 37) improved from pre-CI functional stage by at least one functional stage in one or more domains. The communication domain had the greatest number of patients improve by one or more stages (59.5%) and the social domain the fewest (25.6%). There was also a trend for less improvement at 3- and 6-months post-CI activation for patients at higher pre-CI functional stages, even though higher stages were achievable. CONCLUSION The new CIQOL functional staging system provides an evidence-based understanding of the real-world functional abilities of adult CI users from pre-CI to 3- to 6-months post-CI activation across multiple domains. In addition, study results provide the proportion of CI users in each stage at each timepoint. Results can be used during discussions of expectations with potential CI users to provide enhanced insight regarding realistic outcomes and the anticipated timing for improvements. The use of the CIQOL functional staging system also presents an opportunity to develop individualized goal-based rehabilitation strategies that target barriers to stage advancement faced by CI users. LEVEL OF EVIDENCE 2 Laryngoscope, 132:S1-S13, 2022.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Craig A Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Hoppe U, Hocke T, Iro H. Age-Related Decline of Speech Perception. Front Aging Neurosci 2022; 14:891202. [PMID: 35813942 PMCID: PMC9257541 DOI: 10.3389/fnagi.2022.891202] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022] Open
Abstract
Hearing loss is one of the most common disorders worldwide. It affects communicative abilities in all age groups. However, it is well known that elderly people suffer more frequently from hearing loss. Two different model approaches were employed: A generalised linear model and a random forest regression model were used to quantify the relationship between pure-tone hearing loss, age, and speech perception. Both models were applied to a large clinical data set of 19,801 ears, covering all degrees of hearing loss. They allow the estimation of age-related decline in speech recognition for different types of audiograms. Our results show that speech scores depend on the specific type of hearing loss and life decade. We found age effects for all degrees of hearing loss. A deterioration in speech recognition of up to 25 percentage points across the whole life span was observed for constant pure-tone thresholds. The largest decrease was 10 percentage points per life decade. This age-related decline in speech recognition cannot be explained by elevated hearing thresholds as measured by pure-tone audiometry.
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Affiliation(s)
- Ulrich Hoppe
- Department of Audiology, ENT-Clinic, University of Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Ulrich Hoppe,
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Hanover, Germany
| | - Heinrich Iro
- Department of Audiology, ENT-Clinic, University of Erlangen-Nürnberg, Erlangen, Germany
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Reddy P, Dornhoffer JR, Camposeo EL, Dubno JR, McRackan TR. Using Clinical Audiologic Measures to Determine Cochlear Implant Candidacy. Audiol Neurootol 2022; 27:235-242. [PMID: 35038700 PMCID: PMC9133005 DOI: 10.1159/000520077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 10/06/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Only a small percentage (6-10%) of patients who are candidates receive cochlear implants (CIs). One potential reason contributing to low usage rates may be confusion regarding which patients to refer for CI evaluation. The extent to which information provided by standard clinical audiologic assessments is sufficient for selecting appropriate CI evaluation referrals is uncertain. The objective of this study is to evaluate the capacity of standard clinical audiologic measures to differentiate CI candidates from noncandidates. METHOD The study design is a retrospective review of a prospectively maintained CI database from a university-based tertiary medical center of 518 patients undergoing CI evaluations from 2012 to 2020. Each ear of each patient was treated as an independent value. Receiver operating characteristic (ROCs) curves were constructed using aided AzBio sentence recognition scores in quiet and aided AzBio +10 dB signal-to-noise ratio scores <60% as binary classifiers for CI candidacy. For each ROC, we examined the capacity of multiple pure-tone thresholds, pure-tone average (PTA), and CNC word recognition scores (WRSs) measured under earphones to determine CI candidacy. Area under the curve ROC (AUC-ROC) values were calculated to demonstrate the capacity of each model to differentiate CI candidates from noncandidates. RESULTS Variables with the greatest capacity to accurately differentiate CI candidates from noncandidates using aided AzBio in quiet scores were earphone CNC WRS, earphone pure-tone threshold at 1,000 Hz, and earphone PTA (AUC-ROC values = 0.86-0.88). Using aided AzBio +10 scores as the measure for candidacy, only CNC word recognition had a fair capacity to identify candidates (AUC-ROC value = 0.73). Based on the ROCs, a 1,000 Hz pure-tone threshold >50 dB HL, PTA >57 dB HL, and a monosyllabic WRS <60% can each serve as individual indicators for referral for CI evaluations. CONCLUSION The current study provides initial indicators for referral and a first step at developing evidence-based criteria for CI evaluation referral using standard audiologic assessments.
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Affiliation(s)
- Priyanka Reddy
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James R Dornhoffer
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth L Camposeo
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Dubno
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Reis M, McMahon CM, Távora-Vieira D, Humburg P, Boisvert I. Effectiveness of Computer-Based Auditory Training for Adult Cochlear Implant Users: A Randomized Crossover Study. Trends Hear 2021; 25:23312165211025938. [PMID: 34591702 PMCID: PMC8488513 DOI: 10.1177/23312165211025938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to assess whether a computer-based speech-in-noise auditory training (AT) program would lead to short- and long-term changes in trained and untrained measures of listening, cognition, and quality of life. A secondary aim was to assess whether directly training the underlying cognitive abilities required for speech perception in noise, using a computer-based visual training (VT) program without the auditory component, would elicit comparable outcomes as the AT program. A randomized crossover study with repeated measures was conducted with 26 adult cochlear implant users. Participants completed either 6 weeks of speech perception in noise training followed by 6 weeks of masked text recognition training, or vice versa. Outcome measures were administered twice before each training program, as well as twice after the completion of each program. The test battery was designed to evaluate whether training led to improvements in listening abilities, cognitive abilities, or quality of life. Mixed-effects models were conducted to analyze whether changes occurred on the trained tasks and on untrained outcome measures after training. Statistically significant improvements were shown for verbal recognition performance during both training programs, in particular for consonants in words, and during the first 2 weeks of training. This on-task learning, however, did not lead to clear improvements in outcomes measured beyond the training programs. This suggests that experienced cochlear implant users may not show transfer of on-task learning to untrained tasks after computer-based auditory and visual training programs such as the ones used in this study.
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Affiliation(s)
- Mariana Reis
- The HEARing Cooperative Research Centre, Melbourne, Australia.,Department of Linguistics, 7788Macquarie University, Macquarie University, Sydney, Australia
| | - Catherine M McMahon
- The HEARing Cooperative Research Centre, Melbourne, Australia.,Department of Linguistics, 7788Macquarie University, Macquarie University, Sydney, Australia.,Macquarie University HEAR Centre, Sydney, Australia
| | - Dayse Távora-Vieira
- Otolaryngology, Head & Neck Surgery, Medical School, University of Western Australia, Perth, Australia.,Fiona Stanley Fremantle Hospitals Group, Perth, Australia
| | - Peter Humburg
- Stats Central, Mark Wainwright Analytical Centre, UNSW, Sydney, Australia
| | - Isabelle Boisvert
- The HEARing Cooperative Research Centre, Melbourne, Australia.,Department of Linguistics, 7788Macquarie University, Macquarie University, Sydney, Australia.,Macquarie University HEAR Centre, Sydney, Australia.,Sydney School of Health Sciences, University of Sydney, Sydney, Australia
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McLean WJ, Hinton AS, Herby JT, Salt AN, Hartsock JJ, Wilson S, Lucchino DL, Lenarz T, Warnecke A, Prenzler N, Schmitt H, King S, Jackson LE, Rosenbloom J, Atiee G, Bear M, Runge CL, Gifford RH, Rauch SD, Lee DJ, Langer R, Karp JM, Loose C, LeBel C. Improved Speech Intelligibility in Subjects With Stable Sensorineural Hearing Loss Following Intratympanic Dosing of FX-322 in a Phase 1b Study. Otol Neurotol 2021; 42:e849-e857. [PMID: 33617194 PMCID: PMC8279894 DOI: 10.1097/mao.0000000000003120] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES There are no approved pharmacologic therapies for chronic sensorineural hearing loss (SNHL). The combination of CHIR99021+valproic acid (CV, FX-322) has been shown to regenerate mammalian cochlear hair cells ex vivo. The objectives were to characterize the cochlear pharmacokinetic profile of CV in guinea pigs, then measure FX-322 in human perilymph samples, and finally assess safety and audiometric effects of FX-322 in humans with chronic SNHL. STUDY DESIGNS Middle ear residence, cochlear distribution, and elimination profiles of FX-322 were assessed in guinea pigs. Human perilymph sampling following intratympanic FX-322 dosing was performed in an open-label study in cochlear implant subjects. Unilateral intratympanic FX-322 was assessed in a Phase 1b prospective, randomized, double-blinded, placebo-controlled clinical trial. SETTING Three private otolaryngology practices in the US. PATIENTS Individuals diagnosed with mild to moderately severe chronic SNHL (≤70 dB standard pure-tone average) in one or both ears that was stable for ≥6 months, medical histories consistent with noise-induced or idiopathic sudden SNHL, and no significant vestibular symptoms. INTERVENTIONS Intratympanic FX-322. MAIN OUTCOME MEASURES Pharmacokinetics of FX-322 in perilymph and safety and audiometric effects. RESULTS After intratympanic delivery in guinea pigs and humans, FX-322 levels in the cochlear extended high-frequency region were observed and projected to be pharmacologically active in humans. A single dose of FX-322 in SNHL subjects was well tolerated with mild, transient treatment-related adverse events (n = 15 FX-322 vs 8 placebo). Of the six patients treated with FX-322 who had baseline word recognition in quiet scores below 90%, four showed clinically meaningful improvements (absolute word recognition improved 18-42%, exceeding the 95% confidence interval determined by previously published criteria). No significant changes in placebo-injected ears were observed. At the group level, FX-322 subjects outperformed placebo group in word recognition in quiet when averaged across all time points, with a mean improvement from baseline of 18.9% (p = 0.029). For words in noise, the treated group showed a mean 1.3 dB signal-to-noise ratio improvement (p = 0.012) relative to their baseline scores while placebo-treated subjects did not (-0.21 dB, p = 0.71). CONCLUSIONS Delivery of FX-322 to the extended high-frequency region of the cochlea is well tolerated and enhances speech recognition performance in multiple subjects with stable chronic hearing loss.
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Affiliation(s)
- Will J. McLean
- Frequency Therapeutics, Woburn, MA & Farmington, CT
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT
| | | | | | - Alec N. Salt
- Department of Otolaryngology, Central Institute for the Deaf, Fay and Carl Simons Center for Hearing and Deafness, Washington University School of Medicine, Saint Louis, MO
| | - Jared J. Hartsock
- Department of Otolaryngology, Central Institute for the Deaf, Fay and Carl Simons Center for Hearing and Deafness, Washington University School of Medicine, Saint Louis, MO
| | - Sam Wilson
- Frequency Therapeutics, Woburn, MA & Farmington, CT
| | | | - Thomas Lenarz
- Department of Otolaryngology and Cluster of Excellence of the German Research Foundation “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Athanasia Warnecke
- Department of Otolaryngology and Cluster of Excellence of the German Research Foundation “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Nils Prenzler
- Department of Otolaryngology and Cluster of Excellence of the German Research Foundation “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Heike Schmitt
- Department of Otolaryngology and Cluster of Excellence of the German Research Foundation “Hearing4all”, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | - Christina L. Runge
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - René H. Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Steven D. Rauch
- Department of Otolaryngology, Harvard Medical School and Massachusetts Eye and Ear, Boston
| | - Daniel J. Lee
- Department of Otolaryngology, Harvard Medical School and Massachusetts Eye and Ear, Boston
| | - Robert Langer
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA
| | - Jeffrey M. Karp
- Center for Nanomedicine, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School Boston MA
- Harvard-MIT Division of Health Science and Technology
- Harvard Stem Cell Institute, Harvard University, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Carl LeBel
- Frequency Therapeutics, Woburn, MA & Farmington, CT
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Dornhoffer JR, Reddy P, Meyer TA, Schvartz-Leyzac KC, Dubno JR, McRackan TR. Individual Differences in Speech Recognition Changes After Cochlear Implantation. JAMA Otolaryngol Head Neck Surg 2021; 147:280-286. [PMID: 33410869 DOI: 10.1001/jamaoto.2020.5094] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Cochlear implantation is highly effective at improving hearing outcomes, but results have been limited to groupwise analysis. That is, limited data are available for individual patients that report comparisons of preoperative aided speech recognition and postimplantation speech recognition. Objective To assess changes in preoperative aided vs postoperative speech recognition scores for individual patients receiving cochlear implants when considering the measurement error for each speech recognition test. Design, Setting, and Participants This cross-sectional study used a prospectively maintained database of patients who received cochlear implants between January 1, 2012, and December 31, 2017, at a tertiary, university-based referral center. Adults with bilateral sensorineural hearing loss undergoing cochlear implantation with 6- or 12-month postoperative measures using 1 or more speech recognition tests were studied. Exposures Cochlear implantation. Main Outcomes and Measures Postoperative word recognition (consonant-nucleus-consonant word test), sentence recognition (AzBio sentences in quiet), and sentence recognition in noise (AzBio sentences in +10-dB signal-to-noise ratio) scores, and association of each speech recognition score change with aided preoperative score to each test's measurement error. Results Analysis of data from a total of 470 implants from 323 patients included 253 male (53.8%) patients; the mean (SD) age was 61.2 (18.3) years. Most patients had statistically significant improvement in all speech recognition tests postoperatively beyond measurement error, including 262 (84.8%) for word recognition, 226 (87.6%) for sentence recognition, and 33 (78.6%) for sentence recognition in noise. A small number of patients had equivalent preoperative and postoperative scores, including 45 (14.5%) for word recognition, 28 (10.9%) for sentence recognition, and 9 (21.4%) for sentence recognition in noise. Four patients (1.6%) had significantly poorer scores in sentence recognition after implantation. The associations between age at implantation and change in speech recognition scores were -0.12 (95% CI, -0.23 to -0.01) for word recognition, -0.22 (95% CI, -0.34 to -0.10) for sentence recognition, and -0.10 (95% CI, -0.39 to 0.21) for sentence recognition in noise. Patients with no significant improvement were similarly distributed between all preoperative aided speech scores for word recognition (range, 0%-58%) and sentence recognition (range, 0%-56%) testing. Conclusions and Relevance In this cross-sectional study, with respect to preoperative aided speech recognition, postoperative cochlear implant outcomes for individual patients were largely encouraging. However, improvements in scores for individual patients remained highly variable, which may not be adequately represented in groupwise analyses and reporting of mean scores. Presenting individual patient data from a large sample of individuals with cochlear implants provides a better understanding of individual differences in speech recognition outcomes and contributes to more complete interpretations of successful outcomes after cochlear implantation.
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Affiliation(s)
- James R Dornhoffer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Priyanka Reddy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kara C Schvartz-Leyzac
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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Abstract
OBJECTIVE To determine demographic and audiologic factors associated with time to treatment with cochlear implantation. METHODS Retrospective review of a prospectively maintained adult cochlear implant database. A total of 492 patients were implanted from 2012 to 2017. Time to implantation, preimplantation audiologic outcomes, and demographic data were collected. Multivariate analysis was undertaken to establish demographic/audiologic factors that predict time to cochlear implantation. RESULTS Using multivariate analysis, nonwhite race (hazard ratio 0.157, p = 0.038) and increased age (hazard ratio 0.970, p = 0.038) were associated with increased time to cochlear implantation. Nonwhite patients had significantly higher pure-tone averages and lower speech recognition scores (consonant-nucleus-consonant words and AzBio sentences in quiet) and were less likely to use hearing aids as compared with white patients (all p < 0.001). Sex (p = 0.188), health insurance type (p = 0.255), preoperative hearing aid use (p = 0.174), and audiologic outcomes were not significant predictors of time to implantation. CONCLUSION Nonwhite patients have poorer preoperative hearing and speech recognition and lower hearing aid use and are at risk for delay in referral and treatment for severe to profound sensorineural hearing loss. Other demographic factors, notably health insurance status, did not significantly predict time to cochlear implantation. Given the observed hearing healthcare disparities, special outreach programs may be needed to ensure timely cochlear implantation and effective hearing screening and rehabilitation.
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Cochlear Implantation in Patients With Menière's Disease: Does Disease Activity Affect the Outcome? Otol Neurotol 2021; 41:1296-1304. [PMID: 32925864 DOI: 10.1097/mao.0000000000002750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Menière's disease (MD) is characterized by episodes of vertigo, tinnitus, and sensorineural hearing loss. In the setting of bilateral deafness due to MD alone or contralateral pathology, cochlear implantation (CI) improves hearing. Active MD is characterized by fluctuating auditory symptoms and vertigo; whereas remittance of vertiginous symptoms and severe, permanent sensorineural hearing loss characterizes the inactive disease state. This study evaluates outcomes for MD patients compared with the general CI population and assesses if disease activity affects implant outcomes. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Twenty-four patients with MD that received CI (7 active, 16 inactive, and 1 Probable Menière's), and 24 age-matched controls. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES Word Recognition Score, Sentence Recognition Score (SRS), and Speech Reception Threshold. RESULTS Best-aided preoperative and postoperative audiometric data were compared per ear between MD patients and controls and stratified by disease status using descriptive statistics with mixed-effects modeling. Patients with MD derived significantly more benefit from CI than controls when comparing differences between preoperative and postoperative levels for Word Recognition Score (12.2%, p = 0.0236), SRS (12.8%, p = 0.0375), and Speech Reception Threshold (-14.4 dB, p = 0.0188). Active disease status does not negatively impact CI outcomes and patients with active MD may benefit from greater gains in SRS (23.5%, p = 0.0107). CONCLUSIONS CI provides greater gains in functional hearing for patients with MD compared with age-matched controls. Patients with active MD seem to perform better with respect to SRS following CI than patients with inactive status.
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McRackan TR, Reddy P, Costello MS, Dubno JR. Role of Preoperative Patient Expectations in Adult Cochlear Implant Outcomes. Otol Neurotol 2021; 42:e130-e136. [PMID: 33229876 PMCID: PMC8316998 DOI: 10.1097/mao.0000000000002873] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preoperative expectations affect patient outcomes in many health conditions, but expectations are rarely assessed in adult cochlear implant (CI) users. This study is a first step in assessing the contribution of preoperative expectations to postoperative CI outcomes, including speech recognition, CI quality of life (CIQOL), and CI satisfaction. STUDY DESIGN Cross-sectional study. SETTING Tertiary medical center. PATIENTS Fourty one adult CI patients. INTERVENTIONS/MAIN OUTCOME MEASURES Preoperative expectation questionnaire results, pre- and postoperative speech recognition (CNC and AzBio) scores, postoperative CIQOL domain scores and global scores, and CI satisfaction scores using a visual analog scale (VAS). Cohen's d was used to express effect size. RESULTS Overall, patients with lower preoperative CI performance expectations showed higher postoperative QOL. This effect was large for the emotional, entertainment, and social domains (d = 0.85-1.02) of the CIQOL-35 and medium for the communication, listening effort domains, and the Global score (d = 0.55-0.63). Preoperative performance expectations showed minimal associations with preoperative versus postoperative change in CNC (d = -0.26; -0.69-0.18) or AzBio scores (d = -0.28; -0.72-0.15). Determining the extent to which preoperative expectations played a role in postoperative satisfaction with CIs was limited by the clustering of satisfaction scores in the upper range of the scale (VAS mean 81.1). CONCLUSIONS This study provides preliminary evidence that patients' expectations before cochlear implantation may influence their postoperative quality of life and other outcomes, but not postoperative speech recognition. This suggests that an increased emphasis should be placed on measuring and counseling expectations in CI candidates. This assumption needs to be confirmed with additional research with larger sample sizes, more sensitive satisfaction measures, and a prospective design.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Wilson RH, Sanchez VA. Effects of the Carrier Phrase on Word Recognition Performances by Younger and Older Listeners Using Two Stimulus Paradigms. J Am Acad Audiol 2020; 31:412-441. [DOI: 10.3766/jaaa.19061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Background In the 1950s, with monitored live voice testing, the vu meter time constant and the short durations and amplitude modulation characteristics of monosyllabic words necessitated the use of the carrier phrase amplitude to monitor (indirectly) the presentation level of the words. This practice continues with recorded materials. To relieve the carrier phrase of this function, first the influence that the carrier phrase has on word recognition performance needs clarification, which is the topic of this study.
Purpose Recordings of Northwestern University Auditory Test No. 6 by two female speakers were used to compare word recognition performances with and without the carrier phrases when the carrier phrase and test word were (1) in the same utterance stream with the words excised digitally from the carrier (VA-1 speaker) and (2) independent of one another (VA-2 speaker). The 50-msec segment of the vowel in the target word with the largest root mean square amplitude was used to equate the target word amplitudes.
Research Design A quasi-experimental, repeated measures design was used.
Study Sample Twenty-four young normal-hearing adults (YNH; M = 23.5 years; pure-tone average [PTA] = 1.3-dB HL) and 48 older hearing loss listeners (OHL; M = 71.4 years; PTA = 21.8-dB HL) participated in two, one-hour sessions.
Data Collection and Analyses Each listener had 16 listening conditions (2 speakers × 2 carrier phrase conditions × 4 presentation levels) with 100 randomized words, 50 different words by each speaker. Each word was presented 8 times (2 carrier phrase conditions × 4 presentation levels [YNH, 0- to 24-dB SL; OHL, 6- to 30-dB SL]). The 200 recorded words for each condition were randomized as 8, 25-word tracks. In both test sessions, one practice track was followed by 16 tracks alternated between speakers and randomized by blocks of the four conditions. Central tendency and repeated measures analyses of variance statistics were used.
Results With the VA-1 speaker, the overall mean recognition performances were 6.0% (YNH) and 8.3% (OHL) significantly better with the carrier phrase than without the carrier phrase. These differences were in part attributed to the distortion of some words caused by the excision of the words from the carrier phrases. With the VA-2 speaker, recognition performances on the with and without carrier phrase conditions by both listener groups were not significantly different, except for one condition (YNH listeners at 8-dB SL). The slopes of the mean functions were steeper for the YNH listeners (3.9%/dB to 4.8%/dB) than for the OHL listeners (2.4%/dB to 3.4%/dB) and were <1%/dB steeper for the VA-1 speaker than for the VA-2 speaker. Although the mean results were clear, the variability in performance differences between the two carrier phrase conditions for the individual participants and for the individual words was striking and was considered in detail.
Conclusion The current data indicate that word recognition performances with and without the carrier phrase (1) were different when the carrier phrase and target word were produced in the same utterance with poorer performances when the target words were excised from their respective carrier phrases (VA-1 speaker), and (2) were the same when the carrier phrase and target word were produced as independent utterances (VA-2 speaker).
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Affiliation(s)
- Richard H. Wilson
- Department of Speech and Hearing Sciences, Arizona State University, Tempe, AZ
| | - Victoria A. Sanchez
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida, Tampa, FL
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Shehorn J, Strelcyk O, Zahorik P. Associations between speech recognition at high levels, the middle ear muscle reflex and noise exposure in individuals with normal audiograms. Hear Res 2020; 392:107982. [DOI: 10.1016/j.heares.2020.107982] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023]
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Abstract
OBJECTIVE Compare word recognition scores for adults undergoing cochlear implant evaluations (CIE) measured using earphones and hearing aids. STUDY DESIGN Retrospective review of data obtained during adult CIEs. SETTING Tertiary cochlear implant center. PATIENTS Two hundred eight ears in 183 subjects with greater than 10% word recognition scores measured with earphones. INTERVENTIONS/MAIN OUTCOMES MEASURED Preoperative pure-tone thresholds and word recognition scores measured with earphones and hearing aids. RESULTS A review of audiological data obtained from 2012 to 2017 during adult CIEs was conducted. Overall, a weak positive correlation (r = 0.33, 95% confidence interval 0.17-0.40, p < 0.001) was observed between word recognition scores measured with earphones and hearing aids. Earphone to aided differences (EAD) ranged from -38 to +72% (mean 14.3 ± 19.9%). Consistent with EADs, 108 ears (51.9%) had earphone scores that were significantly higher than aided word recognition scores (+EAD), as determined by 95% confidence intervals; for 14 ears (6.7%), earphone scores were significantly lower than aided scores (-EAD). Moreover, of the patients with earphone word recognition scores ≥50%, 82.6% were CI candidates based on aided AzBio+10 dB SNR scores. CONCLUSION These results demonstrate the limited diagnostic value of word recognition scores measured under earphones for patients undergoing CIE. Nevertheless, aided word recognition is rarely measured before CIEs, which limits the information available to determine CI candidacy and referral for CIEs. Earlier and routine measurement of aided word recognition may help guide clinical decision making by determining the extent to which patients are achieving maximum benefit with their hearing aids or should consider cochlear implantation.
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Holcomb MA, Burton JA, Dornhoffer JR, Camposeo EL, Meyer TA, McRackan TR. When to replace legacy cochlear implants for technological upgrades: Indications and outcomes. Laryngoscope 2018; 129:748-753. [PMID: 30484865 DOI: 10.1002/lary.27528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine indications, surgical efficacy, and audiologic outcomes of replacing Advanced Bionics Clarion C1.2 internal devices (Advanced Bionics, LLC, Valencia, CA) as a means of technology upgrade. STUDY DESIGN Retrospective review, case series. METHODS Ten patients were initially implanted as a child (mean age = 3.87 years) and underwent cochlear implant reimplantation (CIR) with current Advanced Bionics internal device as a young adult (mean duration of implant use = 15.66 years). Demographic data and pre- and post-CIR speech perception scores were collected. RESULTS Technology upgrade was the primary (9) or secondary (1) motivation for CIR. No surgical complications were noted, and full insertion was obtained in nine cases. Intraoperative impedance levels and neural response imaging measures were within normal limits for eight patients. At most recent post-CIR follow-up evaluation, all patients (100%) performed within or better than the 95% confidence interval of their pre-CIR word and sentence recognition scores; and 55.6%, 50.0%, and 50.0% of patients performed above the 95% confidence interval of their pre-CIR scores for the CNC words, sentences in quiet, and sentences in noise, respectively. CONCLUSION Post-CIR audiological benefit was stable or improved compared to pre-CIR results in all categories by 3 months after reactivation. Given these results, patients who are unable to use the most current external processors due to incompatibility with a legacy internal device could consider reimplanation to optimize their overall performance with a cochlear implant. LEVEL OF EVIDENCE 4 Laryngoscope, 129:748-753, 2019.
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Affiliation(s)
- Meredith A Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Jane A Burton
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - James R Dornhoffer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Elizabeth L Camposeo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Abstract
OBJECTIVES 1) To determine the ability of preoperative computed tomography (CT) to predict facial nerve stimulation (FNS) after cochlear implantation (CI). 2) To recognize the limitations of CT in predicting FNS. STUDY DESIGN Patient control study. SETTING Tertiary care academic medical center. SUBJECTS Adult patients with CI from 2003 to 2015. METHODS Patients with severe FNS (n = 4) were compared with randomly selected CI patients (n = 28). Three blinded reviewers evaluated preoperative temporal bone CT scans to measure the distance from the labyrinthine segment of the facial nerve to the basal turn of the cochlea and attempted to predict whether or not the subject had FNS after CI. RESULTS In total, 32 CT scans were evaluated representing 49 ears that underwent CI.The distances (mm) measured from the labyrinthine segment of the facial nerve to the basal turn of the cochlea in both the axial (0.3 ± 0.3 versus 0.6 ± 0.3) and coronal (0.4 ± 0.2 versus 0.6 ± 0.2) orientation were significantly different between the two groups (p = 0.0001 and p = 0.0034) respectively. The intraclass correlation coefficient demonstrated good (K > 0.7) reviewer correlation in both the reviewers' measurements and predictions. The sensitivity, specificity, positive predictive value, and negative predictive value for preoperative CT scans to predict FNS were 38.5, 85.1, 19.2, and 93.8% respectively. The reviewers were 23% accurate in predicting FNS. CONCLUSION Based on a blinded retrospective patient-control study, CT scan measurements show a significantly reduced distance between the labyrinthine facial nerve and the basal turn of the cochlea in patients with FNS. However, it is difficult to predict who will have FNS based on these measurements.
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Klein KE, Walker EA, Kirby B, McCreery RW. Vocabulary Facilitates Speech Perception in Children With Hearing Aids. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2281-2296. [PMID: 28738138 PMCID: PMC5829804 DOI: 10.1044/2017_jslhr-h-16-0086] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/03/2016] [Accepted: 02/04/2017] [Indexed: 05/27/2023]
Abstract
PURPOSE We examined the effects of vocabulary, lexical characteristics (age of acquisition and phonotactic probability), and auditory access (aided audibility and daily hearing aid [HA] use) on speech perception skills in children with HAs. METHOD Participants included 24 children with HAs and 25 children with normal hearing (NH), ages 5-12 years. Groups were matched on age, expressive and receptive vocabulary, articulation, and nonverbal working memory. Participants repeated monosyllabic words and nonwords in noise. Stimuli varied on age of acquisition, lexical frequency, and phonotactic probability. Performance in each condition was measured by the signal-to-noise ratio at which the child could accurately repeat 50% of the stimuli. RESULTS Children from both groups with larger vocabularies showed better performance than children with smaller vocabularies on nonwords and late-acquired words but not early-acquired words. Overall, children with HAs showed poorer performance than children with NH. Auditory access was not associated with speech perception for the children with HAs. CONCLUSIONS Children with HAs show deficits in sensitivity to phonological structure but appear to take advantage of vocabulary skills to support speech perception in the same way as children with NH. Further investigation is needed to understand the causes of the gap that exists between the overall speech perception abilities of children with HAs and children with NH.
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Affiliation(s)
- Kelsey E. Klein
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
| | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
| | - Benjamin Kirby
- Department of Communication Sciences and Disorders, Illinois State University, Normal
| | - Ryan W. McCreery
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
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Reducing Listening-Related Stress in School-Aged Children with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:2010-2022. [DOI: 10.1007/s10803-017-3114-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
OBJECTIVE Hearing loss is the most common sensory deficit and congenital anomaly, yet the decision-making processes involved in disclosing hearing loss have been little studied. To address this issue, we have explored the phrases that adults with hearing loss use to disclose their hearing loss. DESIGN Since self-disclosure research has not focused on hearing loss-specific issues, we created a 15-question survey about verbally disclosing hearing loss. English speaking adults (>18 years old) with hearing loss of any etiology were recruited from otology clinics in a major referral hospital. Three hundred and thirty-seven participants completed the survey instrument. Participants' phrase(s) used to tell people they have hearing loss were compared across objective characteristics (age; sex; type, degree, and laterality of hearing loss; word recognition scores) and self-reported characteristics (degree of hearing loss; age of onset and years lived with hearing loss; use of technology; hearing handicap score). RESULTS Participants' responses revealed three strategies to address hearing loss: Multipurpose disclosure (phrases that disclose hearing loss and provide information to facilitate communication), Basic disclosure (phrases that disclose hearing loss through the term, a label, or details about the condition), or nondisclosure (phrases that do not disclose hearing loss). Variables were compared between patients who used and who did not use each disclosure strategy using χ or Wilcoxon rank sum tests. Multipurpose disclosers were mostly female (p = 0.002); had experienced reactions of help, support, and accommodation after disclosing (p = 0.008); and had experienced reactions of being overly helpful after disclosing (p=0.039). Basic disclosers were predominantly male (p = 0.004); reported feeling somewhat more comfortable disclosing their hearing loss over time (p = 0.009); had not experienced reactions of being treated unfairly or discriminated against (p = 0.021); and were diagnosed with mixed hearing loss (p = 0.004). Nondisclosers tended not to disclose in a group setting (p = 0.002) and were diagnosed with bilateral hearing loss (p = 0.005). In addition, all of the variables were examined to build logistic regression models to predict the use of each disclosure strategy. CONCLUSIONS Our results reveal three simple strategies for verbally addressing hearing loss that can be used in a variety of contexts. We recommend educating people with hearing loss about these strategies-this could improve the experience of disclosing hearing loss, and could educate society at large about how to interact with those who have a hearing loss.
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Landegger LD, Psaltis D, Stankovic KM. Human audiometric thresholds do not predict specific cellular damage in the inner ear. Hear Res 2016; 335:83-93. [PMID: 26924453 PMCID: PMC5970796 DOI: 10.1016/j.heares.2016.02.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/23/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION As otology enters the field of gene therapy and human studies commence, the question arises whether audiograms - the current gold standard for the evaluation of hearing function - can consistently predict cellular damage within the human inner ear and thus should be used to define inclusion criteria for trials. Current assumptions rely on the analysis of small groups of human temporal bones post mortem or from psychophysical identification of cochlear "dead regions" in vivo, but a comprehensive study assessing the correlation between audiometric thresholds and cellular damage within the cochlea is lacking. METHODS A total of 131 human temporal bones from 85 adult individuals (ages 19-92 years, median 69 years) with sensorineural hearing loss due to various etiologies were analyzed. Cytocochleograms - which quantify loss of hair cells, neurons, and strial atrophy along the length of the cochlea - were compared with subjects' latest available audiometric tests prior to death (time range 5 h-22 years, median 24 months). The Greenwood function and the equivalent rectangular bandwidth were used to infer, from cytocochleograms, cochlear locations corresponding to frequencies tested in clinical audiograms. Correlation between audiometric thresholds at clinically tested frequencies and cell type-specific damage in those frequency regions was examined by calculating Spearman's correlation coefficients. RESULTS Similar audiometric profiles reflected widely different cellular damage in the cochlea. In our diverse group of patients, audiometric thresholds tended to be more influenced by hair cell loss than by neuronal loss or strial atrophy. Spearman's correlation coefficient across frequencies was at most 0.7 and often below 0.5, with 1.0 indicating perfect correlation. CONCLUSIONS Audiometric thresholds do not predict specific cellular damage in the human inner ear. Our study highlights the need for better non- or minimally-invasive tools, such as cochlear endoscopy, to establish cellular-level diagnosis and thereby guide therapy and monitor response to treatment.
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Affiliation(s)
- Lukas D Landegger
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02141, United States; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States; Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Demetri Psaltis
- Optics Laboratory, School of Engineering, Swiss Federal Institute of Technology Lausanne (EPFL), BM 4102 (Bâtiment BM), Station 17, 1015 Lausanne, Switzerland.
| | - Konstantina M Stankovic
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02141, United States; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States; Harvard Program in Speech and Hearing Bioscience and Technology, 260 Longwood Avenue, Boston, MA 02115, United States.
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Wilson RH, Irish SE. Recognition performance on words interrupted (10 ips, 50% duty cycle) with two interruption patterns referenced to word onset: Young listeners with normal hearing for pure tones and older listeners with sensorineural hearing loss. Int J Audiol 2015; 54:933-41. [PMID: 26252182 DOI: 10.3109/14992027.2015.1055839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine in an interrupted word paradigm (Maryland CNCs; 10 ips, 50% duty cycle) if different locations of the interruption pattern produce different recognition performances. DESIGN Repeated measures using two interruption patterns that were complementary halves referenced to word onset; one started with word onset (0-ms), the other started 50 ms later. The hypothesis was that recognition performance would be better on the 0-ms condition than on the 50-ms condition, but there would be some words with the reverse relation. STUDY SAMPLE Twenty-four young adults with normal hearing for pure tones and 32 older adults (mean = 67 years) with sensorineural hearing loss participated. RESULTS With the young listeners mean recognition performance on the 0-ms condition (63.1%) was significantly better than the mean performance on the 50-ms condition (47.8%). About twice as many words had better performance on the 0-ms condition. With the older listeners, who were given only stimuli on which performances were > 58% by the young normals, performances on the two conditions were the same. CONCLUSIONS The hypothesis was supported with the young listeners. The equal performance by the older listeners on the two conditions was attributed to the manner in which the words were selected.
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Affiliation(s)
- Richard H Wilson
- a VA Medical Center, Mountain Home, Tennessee and East Tennessee State University , Johnson City , USA
| | - Staci E Irish
- a VA Medical Center, Mountain Home, Tennessee and East Tennessee State University , Johnson City , USA
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Silberer AB, Bentler R, Wu YH. The importance of high-frequency audibility with and without visual cues on speech recognition for listeners with normal hearing. Int J Audiol 2015; 54:865-72. [PMID: 26068537 DOI: 10.3109/14992027.2015.1051666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the impact of visual cues, speech materials, age and listening condition on the frequency bandwidth necessary for optimizing speech recognition performance. DESIGN Using a randomized repeated measures design; speech recognition performance was assessed using four speech perception tests presented in quiet and noise in 13 LP filter conditions and presented in multimodalities. Participants' performance data were fitted with a Boltzmann function to determine optimal performance (10% below performance achieved in FBW). STUDY SAMPLE Thirty adults (18-63 years) and thirty children (7-12 years) with normal hearing. RESULTS Visual cues significantly reduced the bandwidth required for optimizing speech recognition performance for listeners. The type of speech material significantly impacted the bandwidth required for optimizing performance. Both groups required significantly less bandwidth in quiet, although children required significantly more than adults. The widest bandwidth required was for the phoneme detection task in noise where children required a bandwidth of 7399 Hz and adults 6674 Hz. CONCLUSIONS Listeners require significantly less bandwidth for optimizing speech recognition performance when assessed using sentence materials with visual cues. That is, the amount of bandwidth systematically decreased as a function of increased contextual, linguistic, and visual content.
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Affiliation(s)
- Amanda B Silberer
- a * Department of Communication Sciences and Disorders , The University of Iowa , Iowa City , USA.,b Department of Communication Sciences and Disorders , Western Illinois University , Macomb, Illinois , USA
| | - Ruth Bentler
- a * Department of Communication Sciences and Disorders , The University of Iowa , Iowa City , USA
| | - Yu-Hsiang Wu
- a * Department of Communication Sciences and Disorders , The University of Iowa , Iowa City , USA
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Han D, Wang S, Zhang H, Chen J, Jiang W, Mannell R, Newall P, Zhang L. Development of Mandarin monosyllabic speech test materials in China. Int J Audiol 2009; 48:300-11. [DOI: 10.1080/14992020802607456] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wang S, Mannell R, Newall P, Zhang H, Han D. Development and evaluation of Mandarin disyllabic materials for speech audiometry in China. Int J Audiol 2009; 46:719-31. [DOI: 10.1080/14992020701558511] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Plotkin SR, Halpin C, Blakeley JO, Slattery WH, Welling DB, Chang SM, Loeffler JS, Harris GJ, Sorensen AG, McKenna MJ, Barker FG. Suggested response criteria for phase II antitumor drug studies for neurofibromatosis type 2 related vestibular schwannoma. J Neurooncol 2009; 93:61-77. [PMID: 19430883 DOI: 10.1007/s11060-009-9867-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/16/2009] [Indexed: 01/31/2023]
Abstract
Neurofibromatosis type 2 (NF2) is a tumor suppressor gene syndrome characterized by multiple schwannomas, especially vestibular schwannomas (VS), and meningiomas. Anticancer drug trials are now being explored, but there are no standardized endpoints in NF2. We review the challenges of NF2 clinical trials and suggest possible response criteria for use in initial phase II studies. We suggest two main response criteria in such trials. Objective radiographic response is defined as a durable 20% or greater reduction in VS volume based on post-contrast T1-weighted MRI images collected with 3 mm or finer cuts through the internal auditory canal. Hearing response is defined as a statistically significant improvement in word recognition scores using 50-word recorded lists in audiology. A possible composite endpoint incorporating both radiographic response and hearing response is outlined. We emphasize pitfalls in response assessment and suggest guidelines to minimize misinterpretations of response. We also identify research goals in NF2 to facilitate future trial conduct, such as identifying the expectations for time to tumor progression and time to measurable hearing loss in untreated NF2-related VS, and the relation of both endpoints to patient prognostic factors (such as age, baseline tumor volume, and measures of disease severity). These data would facilitate future use of endpoints based on stability of tumor size and hearing, which might be more appropriate for testing certain drugs. We encourage adoption of standardized endpoints early in the development of phase II trials for this population to facilitate comparison of results across trials of different agents.
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Affiliation(s)
- Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA 02114, USA
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Music perception by cochlear implant and normal hearing listeners as measured by the Montreal Battery for Evaluation of Amusia. Ear Hear 2008; 29:618-26. [PMID: 18469714 DOI: 10.1097/aud.0b013e318174e787] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to explore the utility/possibility of using the Montreal Battery for Evaluation of Amusia (MBEA) test (Peretz, et al., Ann N Y Acad Sci, 999, 58-75) to assess the music perception abilities of cochlear implant (CI) users. DESIGN The MBEA was used to measure six different aspects of music perception (Scale, Contour, Interval, Rhythm, Meter, and Melody Memory) by CI users and normal-hearing (NH) listeners presented with stimuli processed via CI simulations. The spectral resolution (number of channels) was varied in the CI simulations to determine: (a) the number of channels (4, 6, 8, 12, and 16) needed to achieve the highest levels of music perception and (b) the number of channels needed to produce levels of music perception performance comparable with that of CI users. RESULTS CI users and NH listeners performed higher on temporal-based tests (Rhythm and Meter) than on pitch-based tests (Scale, Contour, and Interval)--a finding that is consistent with previous research studies. The CI users' scores on pitch-based tests were near chance. The CI users' (but not NH listeners') scores for the Memory test, a test that incorporates an integration of both temporal-based and pitch-based aspects of music, were significantly higher than the scores obtained for the pitch-based Scale test and significantly lower than the temporal-based Rhythm and Meter tests. The data from NH listeners indicated that 16 channels of stimulation did not provide the highest music perception scores and performance was as good as that obtained with 12 channels. This outcome is consistent with other studies showing that NH listeners listening to vocoded speech are not able to use effectively F0 cues present in the envelopes, even when the stimuli are processed with a large number (16) of channels. The CI user data seem to most closely match with the 4- and 6-channel NH listener conditions for the pitch-based tasks. CONCLUSIONS Consistent with previous studies, both CI users and NH listeners showed the typical pattern of music perception in which scores are higher on tests measuring the perception of temporal aspects of music (Rhythm and Meter) than spectral (pitch) aspects of music (Scale, Contour, and Interval). On that regard, the pattern of results from this study indicates that the MBEA is a suitable test for measuring various aspects of music perception by CI users.
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Da Costa EA. Brazilian Portuguese speech material and its application in occupational audiology. AUDIOLOGY : OFFICIAL ORGAN OF THE INTERNATIONAL SOCIETY OF AUDIOLOGY 2001; 40:123-32. [PMID: 11465294 DOI: 10.3109/00206090109073107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Brazilian Portuguese speech test material consisting of nine monosyllabic 25-word lists was developed and digitally recorded on one channel of a compact disk with a speech-weighted modulated broadband noise on the other channel. Speech recognition functions in quiet and in noise, with word and phoneme scores, were obtained, and normative speech recognition data were standardized by determination of the psychometric function in 21 normally-hearing volunteers in quiet, and in 30 normally-hearing subjects in noise. The homogeneity of the nine lists was investigated in phoneme recognition data with 30 normally-hearing subjects. Speech recognition functions in quiet and in noise, with word and phoneme scores, were obtained in 65 noise-exposed workers. These results were very close to normative data, when tested in quiet, but significantly worse when tested in noise. It is concluded that the speech test material can be useful for estimating the communication performance of noise-exposed workers.
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Affiliation(s)
- E A Da Costa
- Disciplina de Otorrinolaringologia e Area de Saúde Ocupacional, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brazil
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