Background: Binaural hearing improves our ability to understand speech and to localize sounds. Hearing loss can interfere with binaural cues, and despite the success of amplification, ∼25% of people with bilateral hearing loss fit with two hearing aids choose to wear only one (e.g., Brooks and Bulmer, 1981). One explanation is reduced binaural processing, which occurs when the signal presented to one ear interferes with the perception of the signal presented to the other ear (e.g., Jerger et al, 1993). Typical clinical measures, however, are insensitive to binaural processing deficits. Purpose: The purpose of this study was to determine the extent to which behavioral measures of binaural performance were related to electrophysiological measures of binaural processing in subjects with symmetrical pure-tone sensitivity. Research Design: The relationship between middle latency responses (MLRs) and behavioral performance on binaural listening tasks was assessed by Spearman's rho correlation analyses. Separate repeated measures analyses of variance (RMANOVAs) were performed for MLR latency and MLR amplitude. Study Sample: Nineteen subjects were recruited for the present study based on a clinical presentation of symmetrical pure-tone sensitivity with asymmetrical performance on a word-recognition in noise test. This subpopulation of patients included both subjects with and subjects without hearing loss. Data Collection and Analysis: Monaural and binaural auditory processing was measured behaviorally and electrophysiologically in right-handed subjects. The behavioral tests included the Words-in-Noise test (WIN), the dichotic digits test (DDT), and the 500 Hz masking level difference (MLD). Electrophysiologic responses were measured by the binaural interaction component (BIC) of the MLR. The electrophysiological responses were analyzed to examine the effects of peak (Na, Pa, and Nb) and condition (monaural left, monaural right, binaural, and BIC) on MLR amplitude and latency. Results: Significant correlations were found among electrophysiological measures of binaural hearing and behavioral tests of binaural hearing. A strong correlation between the MLD and the binaural Na-Pa amplitude was found (r =.816). Conclusions: The behavioral and electrophysiological measures used in the present study clearly showed evidence of reduced binaural processing in ∼10 of the subjects in the present study who had symmetrical pure-tone sensitivity. These results underscore the importance of understanding binauralauditory processing and how these measures may or may not identify functional auditory problems.

There are a number of clinical options available for speech-language pathologists to choose from to analyze a child's phonological system, select treatment targets, and design intervention. Frequently, each of these areas of clinical options is viewed independently of one another or approached within an eclectic framework. In this article, an integrated and systemic approach is presented which assumes that a dynamic interaction exists among assessment, target selection, and intervention. Systemic Phonological Assessment of Child Speech, the distance metric approach to target selection, and the multiple oppositions treatment approach are described, with examples provided for each component. Finally, a case study is presented that examines the systemic approach of multiple oppositions relative to the approach of minimal pairs.

Objective: To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms. Setting: Administrative medical record data from the Department of Veterans Affairs (VA). Participants: Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation. Design: A cross-sectional, retrospective, observational study. Main Measures: International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory. Results: Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses. Conclusions: Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.

Objectives: The purpose of this study was to compare hearing difficulties and hearing aid outcomes in veterans with Posttraumatic Stress Disorder (PTSD) to a group of veterans with no medical diagnosis of PTSD. Our hypothesis was that veterans with PTSD would have poorer hearing aid outcomes in certain domains (e.g., those related to loudness or interactions with the environment) relative to patients without PTSD. Assessing these differences could help identify unique factors that may lead to the development of tailored aural rehabilitation for hearing aid users with PTSD. Design: This descriptive study employed subjective outcome measures and surveys; the Abbreviated Profile for Hearing Aid Benefit (APHAB) served as the primary outcome measure. An additional questionnaire was developed to assess views of the subjects’ hearing in unaided and aided conditions in an effort to explore the relation between hearing aid benefit and PTSD symptoms. A total of 60 veterans with sensorineural hearing loss and bilateral hearing aid use were recruited from the Audiology Clinic at the James H. Quillen Veterans Affairs Medical Center in Mountain Home, TN. Participants were divided into two groups of subjects either with or without PTSD (n=30 in each). Diagnosis of PTSD was confirmed via a chart review of the veteran’s medical record. Results: Results from the APHAB revealed a significant difference between groups in global benefit scores as well as the aversiveness subscale in the unaided condition. Overall, the PTSD group showed lower benefit scores, however outcomes indicated that both groups received benefit when aided. Results from the study questionnaire showed a significant difference between the two groups in both unaided and aided conditions for the questions focused on hyper-arousal and re-experiencing symptoms. Conclusions: Hearing aid users with PTSD perceive less benefit from hearing aid use on traditional hearing aid outcome measures. Additionally, these hearing aid users were more affected by hyper-arousal, re-experiencing symptoms, and avoidance compared to hearing aid users without PTSD. The clinical implications of this work suggest that hearing aid users with PTSD may need modified hearing aid fittings and/or additional counseling to meet their unique listening needs.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.