International Journal of Audiology

Objective: To explore if experience with hearing aid (HA) amplification affects speech-evoked cortical potentials reflecting comprehension abilities. Design: N400 and late positive complex (LPC) responses as well as behavioural response times to congruent and incongruent digit triplets were measured. The digits were presented against stationary speech-shaped noise 10 dB above individually measured speech recognition thresholds. Stimulus presentation was either acoustic (digits 1-3) or first visual (digits 1-2) and then acoustic (digit 3). Study sample: Three groups of older participants (N = 3 × 15) with (1) pure-tone average hearing thresholds <25 dB HL from 500-4000 Hz, (2) mild-to-moderate sensorineural hearing loss (SNHL) but no prior HA experience, and (3) mild-to-moderate SNHL and >2 years of HA experience. Groups 2-3 were fitted with test devices in accordance with clinical gain targets. Results: No group differences were found in the electrophysiological data. N400 amplitudes were larger and LPC latencies shorter with acoustic presentation. For group 1, behavioural response times were shorter with visual-then-acoustic presentation. Conclusion: When speech audibility is ensured, comprehension-related electrophysiological responses appear intact in individuals with mild-to-moderate SNHL, regardless of prior experience with amplified sound. Further research into the effects of audibility versus acclimatisation-related neurophysiological changes is warranted.

Investigating whether hearing-aid fitting based on user-operated audiometry is non-inferior to hearing-aid fitting based on traditional audiometry.

Research on Cochlear implant (CI) outcomes has been mainly focused on verbal communication, whereas music perception has been less extensively explored. This study evaluated a music rehabilitation program, based on the mobile phone app Meludia (Meludia, France) to improve quality of life (QoL) and verbal perception in CI patient. In this non-randomized clinical trial, the experimental group underwent 16 Meludia sessions, while controls did not receive any music-specific rehabilitation. Patient-reported outcome (PRO) measures, including the MUSQUAV questionnaire and NCIQ domains, were utilized alongside Matrix speech perception tests (which measure speech understanding in noise). Forty patients with CI were considered: experimental group (21 patients) and control group (19 patients). Significant improvements (p=0.017, and p<0.001) in music-related PRO measures (MUSQUAV), and general CI PRO measures (NCIQ), respectively, were found in the experimental group. No significant differences were found in Matrix speech perception tests post-rehabilitation. Overall, 57% of participants in the experimental group reported subjective improvements in music perception. This study showed the potential of home-based music rehabilitation in enhancing QoL for CI patients, supporting the possibility of implementing specific musical training programs in audiological care. Larger, randomized, controlled trials are necessary for further characterization of this topic.

Objective: It is thought that decreased sound tolerance can be subdivided into distinct types including misophonia (involving specific trigger sounds) and hyperacusis (broader in profile). However, there are few established methods for differentially assessing these disorders and this is complicated by the fact that some measures (e.g. the HQ Hyperacusis Questionnaire) were developed before the concept of misophonia was accepted. Design/study sample: We took a group of N = 119 participants with misophonia (varying in severity) and asked them about the presence of hyperacusis (based on a scoping review definition). Results: Scores for some items on the HQ were correlated with scores for misophonia severity (e.g. social impact of sound) and others with scores for hyperacusis (e.g. ability to concentrate in noise). Similarly, some trigger sounds were more indicative of hyperacusis (e.g. dishes being stacked) and others were more indicative of misophonia in the absence of hyperacusis (e.g. chewing). Conclusions: These double dissociations provide compelling evidence for separable forms of sound intolerance. Moreover, our research suggests that a single-item question about hyperacusis is associated with other characteristics of hyperacusis, even when assessed 18 months later.

Objective: Employing automated language analysis, specifically Meaning Extraction Method (MEM) and Principal Component Analysis (PCA), to identify key factors in open-text responses about hearing aid experiences. Design: Exploratory, cross-sectional design, using an online questionnaire. Responses to a single open-ended question were analysed using MEM, PCA, regression, and correlation analyses. Study sample: Participants (n = 538) included adult hearing aid users sampled from the Hearing Tracker website community and Lexie Hearing user databases in the United States. Results: The MEM-derived items revealed six factors related to hearing aid experiences: (1) life change, (2) social situation, (3) quality of life, (4) impact and speech understanding, (5) communication and interaction, and (6) music and environmental sounds. IOI-HA item 3 had the most statistically significant correlations with PCA factors. Quantile regression revealed that factors one and two significantly predicted the IOI-HA total score. Positive correlations were observed between self-reported hearing difficulty and factors one, four, and five, as well as between factor one and general health and factor two and physical activity. Conclusion: Natural language analysis of open-ended textual responses can offer valuable insights into hearing aid users' experiences. Future studies should aim to refine this methodology to enhance clinical relevance and generalisability.

Objective: This study aimed to evaluate long-term cochlear implant (CI) outcomes in individuals with mono-allelic pathogenic variants in WFS1, which is associated with both Wolfram-like syndrome and DFNA6/14/38. Design: Retrospective case series. Study sample: Seven CI recipients, ranging from eight months to 58 years of age, were included in the study, including four with Wolfram-like syndrome and three with DFNA6/14/38. A total of ten cochlear implantations were performed among these subjects. Results: At one-year post-implantation, a mean phoneme score of 90 ± 9% at 65 dB SPL in quiet was found, which remained stable up to ten years post-implantation with a mean phoneme score of 94 ± 6%. Despite these excellent outcomes, one subject achieved no speech recognition with CI and eventually became a non-user. This individual had a prolonged absence of auditory stimulation prior to implantation and encountered multiple challenges during rehabilitation. Conclusion: Individuals with Wolfram-like syndrome or DFNA6/14/38 demonstrate consistently good outcomes following implantation, which remain stable over time. These findings affirm cochlear implantation as an effective rehabilitation option for these individuals. Furthermore, the stable and good CI outcomes contradict the suggested link between WFS1-associated sensorineural hearing loss and auditory neuropathy.

Objective: To investigate the perspectives and experiences of adults with hearing loss (HL), their family members, and hearing care professionals on how they respond to the stigma of HL and hearing aids (HAs). Design: Qualitative descriptive approach using semi-structured interviews. Study sample: Three participant groups were recruited, including 20 adults over the age of 50 years with HL, 20 family members who had a close relationship to the adults with HL, and 25 hearing care professionals. Results: Three themes described how adults with HL, family members, and hearing care professionals respond to the stigma of HL and HAs, namely: (1) some people tell others about their HL and HAs and some people don't; (2) telling or not telling depends on the situation; and (3) people deal with the stigma of HL and HAs in different ways. Conclusions: This study revealed a range of volitional responses to the stigma of HL and HAs. People affected by HL may not tell others about their HL and/or HAs because of the stigma, and these volitional responses are influenced by situational cues. Adults with HL and family members manage the stigma of HL and HAs in different ways and require a person-centred approach.

Objective: We assessed the interaction between self-efficacy and joint problems and self-efficacy and visual problems on the risk of hearing aid abandonment in older adults. Design: A retrospective cohort study comprising older adults who received hearing aids in Chile was conducted. Hearing aid self-efficacy was measured using the S-MARS-HA questionnaire, while joint and visual problems were assessed through self-reported questions. Survival regression models were conducted to investigate the interaction between self-efficacy and joint problems, as well as self-efficacy and visual problems. Study sample: The study included 355 older adults who received hearing aids through the Chilean public health sector. Results: A significant interaction effect indicated that the relationship between self-efficacy and the risk abandonment was influenced by joint problems (p<0.05). In the subpopulation with joint problems, self-efficacy was associated with a reduced risk of hearing aid abandonment (HR=0.81), whereas in the subpopulation without joint problems, the protective effect was more pronounced (HR=0.52). The interaction between self-efficacy and visual problems was not significant. Conclusions: The interaction between self-efficacy and joint problems was associated with the risk of abandonment. Addressing limitations associated with joint problems and individuals’ confidence in using their hearing aids could reduce the abandonment.

Objective: To compare the performance of a selection of machine learning algorithms, trained to label peaks I, III, and V of the auditory brainstem response (ABR) waveform. An additional algorithm was trained to provide a confidence measure related to the ABR wave latency estimates. Design: Secondary data analysis of a previously published ABR dataset. Five types of machine learning algorithm were compared within a nested k-fold cross-validation procedure. Study sample: A set of 482 suprathreshold ABR waveforms were used. These were recorded from 81 participants with audiometric thresholds within normal limits. Results: A convolutional recurrent neural network (CRNN) outperformed the other algorithms evaluated. The algorithm labelled 95.9% of ABR waves within ±0.1 ms of the target. The mean absolute error was 0.025 ms, averaged across the outer validation folds of the nested cross-validation procedure. High confidence levels were generally associated with greater wave-labelling accuracy. Conclusions: Machine learning algorithms have the potential to assist clinicians with ABR interpretation. The present work identifies a promising machine learning approach, but any algorithm to be used in clinical practice would need to be trained on a large, accurately labelled, heterogeneous dataset and evaluated in clinical settings in follow-on work.

Objective: Up to 10% of adults seeking hearing healthcare for significant hearing concerns have diagnostic test results that indicate normal hearing. Knowledge of the interactions between patients with unexplained hearing concerns and hearing healthcare providers is minimal. In this study, we explored what themes emerged when individuals with unexplained hearing concerns discuss their experiences seeking hearing healthcare. Design: We employed a prospective, cross-sectional qualitative design with semi-structured interviews. Study sample: Fifteen adults who had sought professional hearing evaluations in the United States due to hearing concerns but had audiological testing that indicated hearing within normal limits, and no other medical explanation for their hearing concerns participated in the study. Saturation of themes was reached by Interview #2, suggesting sufficient sampling. Results: Thematic analysis revealed 3 themes from the interviews: (1) dismissive healthcare providers, (2) misalignment of patient concerns and assessment protocols, and (3) doctor shopping. Conclusion: These findings highlight the need for improved care for patients with unexplained hearing concerns. Clinicians could help improve care provision for patients with unexplained hearing concerns, despite a lack of professional guidance on diagnostic tests or treatment recommendations, by soliciting, listening to, and trusting patient experiences as they seek support for their hearing concerns.

Objective: To describe the application of the Behaviour Change Wheel (BCW) to the development of a family-centred intervention for families of children with hearing loss transitioning into early intervention. Design: The BCW was used in a mixed methods design to understand the gaps in family-centred service provision and to identify appropriate intervention functions and implementation options to address these gaps. Study sample: Families and health professionals participated in different steps of the BCW. Results: The qualitative interviews revealed that families required individualised information and support. The quantitative and interview data suggested inconsistencies in the provision of information and support to some families. It was determined that administration of a needs assessment by the support professionals was the most appropriate target behaviour to address this issue. In the analysis of the professionals' capabilities, opportunities, and motivations for administration of a needs assessment, a resource limitation was identified, and therefore, a Minimum Data Set for a Needs Assessment Tool was developed to facilitate the assessment of families' needs during the transition period. Conclusions: This study provided an example of how the BCW could be successfully applied to the design of a family-centred intervention for families of children with hearing loss.

Objective: This study aimed to gather opinions and establish consensus among audiologists and patients on supporting individuals with mental health concerns in audiology settings. Design: Utilising a modified electronic Delphi survey, a panel of 25 experts engaged in three rounds of data collection over 12 weeks. Participants provided open-text responses in Round 1 describing "clinical practices that can be employed to support to patients presenting with mental health concerns", and the research team combined these with relevant clinical practices from literature searches. In subsequent rounds, panellists then rated their level of agreement with the combined list of statements; individually (Round 2) and again after seeing the panel's collated responses (Round 3). Study sample: Panel experts included 11 patients (adults with hearing loss; Mage 73.8 years) and 14 audiologists (with M 11.8 years of experience working in audiology). Results: Consensus was met for 123 items categorised into: Detection, Education, Effective Communication, Provision of Emotional Support, Personal Qualities and Attitudes of the Audiologist, Interventions, Connecting the Patient to Additional Support Services, Normal Processes that are Especially Important in these Cases, and Organisational Considerations. Conclusions: The study highlights the diversity of approaches audiologists can employ to support patients with mental health concerns.