Hearing loss in pediatric populations is the most common Chronic congenital condition of American children.1 The complicated link between disease, socioeconomics, and race has been established thoroughly by previous studies. This study aims to evaluate the relationship between low socioeconomic and racial minority status in the United States and whether that influences the relative rates of hearing loss in pediatric populations using multivariate logistic regression to control for potential confounding variables. The goal is to better expand the current body of literature documenting the systemic barriers minorities face when accessing the healthcare system. Additionally, our goal is that this study will better raise awareness for children diagnosed with hearing loss and will spur action to improve access to intervention both medical and educational. / 2022-12-14T00:00:00Z

Introduction: Hearing impairment is an emerging modifiable risk factor for dementia, but the relative predictive abilities of subjective and objective measures of hearing in dementia risk prediction algorithms are unclear. The objective was to develop and validate prediction models for 3-year incidence of dementia in older Canadians, and to evaluate the independent contribution of self-rated hearing impairment and audiometry-based moderate hearing loss. -- Methods: Baseline (2011 to 2015) and 3-year follow-up data from the Comprehensive cohort of the Canadian Longitudinal Study of Aging were used to build logistic regression models for 3-year incidence of dementia. Individuals who were under 55 years of age, reported physician-diagnosed dementia at baseline, and/or did not have data on dementia status at follow-up were excluded, producing a sample of 19,830 older Canadians. Hearing impairment was defined subjectively as self-reporting fair or poor hearing (versus excellent, very good, or good hearing) and was defined objectively as having a better-ear pure-tone average of the speech-frequencies (500, 1000, 2000, and 4000 Hz) above 40 dB with audiometry. -- Results: Both hearing measures were associated with dementia incidence after adjustment with other risk factors (self-rated fair/poor hearing adjusted odds ratio (aOR) 1.76, CI 0.96-3.23, audiometry-derived hearing loss aOR 2.60, CI 1.38-4.87). Audiometrically-derived hearing loss and self-rated hearing had similar population discrimination (c-statistic of model with self-rated hearing = 0.803, CI 0.752-0.859, c-statistic of model with audiometrically confirmed hearing loss = 0.808, CI 0.762-0.870) and similar calibration. -- Conclusion: Due to the accessibility of the self-reported hearing measure, the use of self-rated hearing in dementia risk prediction tools may have a larger clinical impact than audiometrically-defined hearing ability. Model performance within subgroups (e.g., older age groups, hypertension status, etc.) must be evaluated in future work to assess the magnitude of miscalibration, if any, in the use of self-reported hearing ability compared to audiometry.

Objectives: The objective of this study was to develop and evaluate abbreviated versions of the Word Auditory Recognition and Recall Measure (WARRM) as part of an iterative process in the development of a feasible test for potential future clinical use. Design: The three original WARRM (O-WARRM) randomizations were modified by altering the presentation paradigm. Instead of presenting 5 trials per set size with set size increasing from 2 to 6 as in the O-WARRM (n = 100 words), the experimental WARRM (E-WARRM) paradigm consisted of one trial from each of set sizes 2 to 6 to create a "run" (n = 20 words) with each randomization consisting of 5 runs (n = 100 words). A total of 24 younger listeners with normal hearing and 48 older listeners with hearing loss (OHL) were administered 1 randomization of the O-WARRM and 1 different randomization of the E-WARRM. Results: The recognition and recall performances on the O-WARRM and all versions of the E-WARRM (five individual runs and overall) were similar within each listener group, with the younger listeners with normal hearing outperforming the OHL listeners on all measures. Correlation analyses revealed moderate to strong associations between the abbreviated WARRM runs and the O-WARRM for the OHL listener group. Hierarchical regression modeling suggested that run 1 of the E-WARRM was a good predictor of O-WARRM performance and that adding additional runs did not improve the prediction. Taken together, these findings suggest that administering one run from the E-WARRM warrants further examination for clinical use. Additional analyses revealed equivalent scores on all five runs from the three E-WARRM randomizations for both listener groups. Conclusions: Abbreviated versions of the O-WARRM were developed as part of this study. This was accomplished by modifying the original presentation paradigm and creating 15 unique "runs" among the original 3 randomizations. The resulting 15 runs could be considered 15 unique and abbreviated WARRM lists that have potential, in the future after further studies are conducted to establish important properties, for clinic use. The abbreviated WARRM lists may be useful for quantifying auditory working memory of listeners with hearing loss during the audiologic rehabilitation process.

When families use a listening and spoken language approach to communicate with their child, access to a rich linguistic environment through an intact auditory system is essential. In children with hearing loss, optimal auditory access is achieved through the consistent use of appropriately fitted hearing devices or other assistive hearing technology, allowing these children access to an ample language environment. Parents or caregivers of children with hearing loss or hearing concerns play a large role in facilitating their child’s use of hearing devices and supporting their child’s speech and language development, a potentially overwhelming experience for these families. The "Little Ears, Enormous Purpose" (LEEP) project was created three years ago to educate caregivers of children with hearing devices and build caregiver self-efficacy, i.e., their confidence to optimize their child’s amplification use and linguistic exposure, increase family knowledge on language outcomes, and increase consistent use of amplification. This was done through an online educational workshop to families with children identified with hearing loss and/or hearing concerns. The current study is a continuation of the LEEP project and provides data for the 2022-2023 cycle. Feedback from students, faculty, and families has been implemented to improve and create methods for the 2022-2023 cycle. In this study, three to four in-person individualized educational intervention meetings were held with the families and encompassed the impact of hearing loss and/or hearing concerns on language development, the importance of language exposure, the use and care of amplification/treatment options, and empowerment to establish consistent device use in families that utilize amplification or other technology. The families’ self-efficacy skills were assessed through a pre- and post-survey, the Scale of Parent Involvement and Self-Efficacy-Revised (SPISE-R). The SPISE-R questions caregivers about their child’s device use and their perceptions of their beliefs, knowledge, confidence, and actions to support their child’s auditory access and spoken language development. The assessment and workshop incorporated in this study were modeled after Ambrose et al. (J Early Hear Detect Interv, 2020), who developed the SPISE-R as a promising tool for use in early intervention to better understand and further support parent’s strengths and needs concerning their young child’s auditory access and spoken language development. We hypothesize a significant increase in parental understanding and confidence between the pre-survey and post-survey as a result of the series of intervention meetings. Participants were recruited through the ETSU Nave Center with the use of flyers. A total of two pre-surveys were completed. Two families attended all individualized sessions, with both families also completing the post-survey. Data analysis is in process using a paired samples T-test.

Blast-induced traumatic brain injury and hearing loss are two of the most common forms of the “invisible wounds of war” resulting from the United States’ Global War on Terror. Several published studies have been confirming recent reports from VA healthcare centers of blast-exposed Service Members complaining of auditory problems despite having hearing that is, for all intents and purposes, normal. Most common among these complaints is problems understanding speech in crowded and noisy situations. We hypothesized that problems with speech comprehension could either be the result of 1) damage to sensory areas in the auditory periphery or 2) blast-induced traumatic brain injury (TBI) to cortical networks associated with the processing of attention, memory, and other executive functions related to the processing of speech and linguistic information. In Chapter 1 of this thesis, we found that in a population of blast-exposed Veteran Service Members, problems with speech comprehension in noise were due to cognitive deficits likely resulting from issues related to their post-traumatic stress disorder (PTSD) diagnoses. Chapter 2 takes and expanded look at the topics of Chapter 1 with a more comprehensive battery of audiological, electrophysiological, and neuropsychological tests in active duty Service Members with and without a history of blast exposure. Unlike in veterans with PTSD, we found subclinical levels of peripheral auditory dysfunction, as well as evidence of compromised neural processing speed in the blast-exposed group. These deficits were also consistent with poorer performance on a standardized speech-in-noise test and lower self-reported ratings on an abbreviated version of the Speech, Spatial, and Qualities (SSQ) of Hearing questionnaire (Gatehouse and Noble, 2004). In Chapter 3,we modeled outcomes from the SSQ survey using objective measures of hearing function related to audibility, distortion of the neural representation of sound, attention, age, and blast status. We found for all subjects age and high frequency hearing thresholds predicted survey outcomes related to everyday listening ability. Within non-blast controls, however, measures of attention could differentiate between good and exceptional listening ability. Results from blast exposed subjects remained inconclusive. Collectively, these findings highlight the need for audiologists to take into account more than audiometric measures alone when diagnosing and treating hearing dysfunction in this unique and specialized patient population.

Our ability to be active agents in the world depends on our cognitive system to collect complex multisensory information, i.e. information coming from different senses, and integrate it appropriately. One fundamental topic of interest in the study of cognition is to understand the consequences of deafness on the organization of brain functions, specifically when one sensory modality is either lost or the information coming from that sensory modality is limited. In my work I used the spatial cueing paradigm to study how visual attention and selection is affected by diverse grades of congenital or acquired deafness in different life stages. The goal of the first study was to validate an integrated approach of covert and overt orienting to study social and non-social cueing of attention in hearing adults. Specifically, I examined manual and oculomotor performance of hearing observers performing a peripheral discrimination task with uninformative social (gaze cue) and non-social cues (arrow cue). In Experiment 1 the discrimination task was easy and eye movements were not necessary, whereas in Experiment 2 they were instrumental in identifying the target. Validity effects on manual response time (RT) were similar for the two cues in Experiment 1 and in Experiment 2, though in the presence of eye movements, observers were overall slower to respond to the arrow cue compared to the gaze cue. Cue-direction had an effect on saccadic performance before the discrimination was presented and throughout the duration of the trial. Furthermore, I found evidence of a distinct impact of the type of cue on diverse oculomotor components. While saccade latencies were affected by whether the cue was social or not, saccade landing positions were not affected by cue-type. Critically, the manual validity effect was predicted by the landing position of the initial eye movement. This work suggests that the relationship between eye movements and attention is not straightforward. In hearing adults, in the presence of eye movements, saccade latency was related to the overall speed of manual response, while eye movements landing position was closely related to manual performance in response to the validity of the cues. In the second study, I used the above-mentioned approach to investigate the impact of early profound deafness on the oculomotor control and orienting of attention to social and non-social cues. Previous research on covert orienting to the periphery suggests that early deaf adults are less sensitive to uninformative gaze cues, though were equally or more affected by non-social arrow cues. The aim of this second study was to investigate whether spontaneous eye movement behavior helps explain the reduced contribution of this social cue in deaf adults. Twenty-five deaf and twenty-five age-matched hearing observers took part in the experiment. In both groups, the cueing effect on RT was comparable for the gaze- and arrow-cue, although deaf observers responded significantly slower than hearing controls. While deaf and hearing observers responded equally to the cue presented in isolation, deaf participants relied significantly more on eye movements than hearing controls once the discrimination target was presented. Saccade landing position in the deaf group was affected by validity but not by cue type while latency was not modulated by these factors. Saccade landing position was also strongly related to the magnitude of the validity effect on RT, such that the greater the difference in saccade landing position between invalid and valid trials, the greater the difference in manual RT between invalid and valid trials. This work suggests that the contribution of overt selection in central cueing of attention is more prominent in deaf adults and determines the manual performance. The increase in eye movements and overall slower responses in deaf observers may act as an adaptive strategy to balance the need for accuracy in a context where vision and visual attention are used to monitor the surrounding environment in the absence of auditory input. This tendency to emphasize accuracy of response at the cost of responding more slowly seems to allow them to maintain the same level of cue-driven performance as their hearing peers. In the third study I focused on partial hearing loss. Little is known on the consequences of pure presbycusis, which is usually associated with aging (Age-related Hearing Loss, ARHL). In this case, auditory information is still present, although linked to an amount of uncertainty regarding its usefulness. In this study I started to investigate the role of ARHL on cognition considering covert orienting of attention, selective attention and executive control. I compared older adults with and without mild to moderate presbycusis (26-60 dB) performing 1) a spatial cueing task with uninformative central cues (social vs. non-social cues), 2) a flanker task and 3) a neuropsychological assessment of attention. Notably, while hearing impaired individuals responded as equally fast as their normally hearing peers, they were characterized by reduced validity effects on spatial cueing of attention, though no additional group differences were found between the impact of social and non-social cues. Hearing impaired individuals also demonstrated diminished performance on the Montreal Cognitive Assessment (MoCA) and on tasks requiring divided attention and flexibility. Conversely, overall response times and flanker interference effects were comparable across groups. This work indicates that while response speed and response inhibition appear to be preserved following mild to moderate presbycusis, orienting of attention, divided attention and the ability to flexibly allocate attention, are more deteriorated in older adults with ARHL. These findings suggest that presbycusis might exacerbate the detrimental influences of aging on visual attention. Taken together, the findings of my research project highlight the different role hearing loss may play at different life stages. On the one hand, congenital and early deafness seems to induce cognitive and behavioral compensations, which may encompass oculomotor behavior as well; these changes occur progressively during development and may reflect experience-dependent plasticity. On the other hand, late-life compensations in vision and visual attention in older adults with presbycusis may not take place or do not effectively reduce the negative impact of the auditory impairment. Rather, my data suggest that in this population a deficit in audition may consequently lead to a deficit in visual attention. Future lines of research can aim to better characterize other aspects of attention in the aging population with presbycusis, e.g. peripheral visual attention and the relationship between covert and overt attention. Finally, future research may also consider intervention through early diagnosis and treatment by means of hearing aids, which can be beneficial to cognitive functions and might delay or even prevent cognitive decline in this population, in which sensory compensation may not be sufficient.

The purpose of this critical essay is two-fold. First, the essay presents a detailed critical analysis of my original composition, Blueline Concerto for bass trombone and wind ensemble. Second, using Blueline Concerto, the essay presents preliminary findings of my study to develop an approach to composing that takes into account the musicians' health, specifically regarding noise induced hearing loss (NIHL). Through various hypothesized composition- and orchestral-based approaches, I test effectiveness on changes in NIHL risk while also noting that artistic merit and compositional integrity is preserved.

Background. Internationally, infectious diseases remain the greatest cause of morbidity among young children. Infectious disease burden is particularly high in low-to-mid income countries (LMIC). South Africa has a high prevalence of bacterial meningitis (BM), especially in children under the age of five. BM is also one of the commonest causes of acquired hearing loss in children. Given the fluctuating and transient nature of BM-related hearing loss, there is a need for an effective audiological protocol to facilitate timeous and appropriate audiological management. There is currently no universally accepted protocol for the audiological referral and management of children diagnosed with BM. Consequently, there is a need for an evidence-based protocol that will ensure timely referral and audiological testing of all children diagnosed with BM. Early identification of BM-related hearing loss in children will allow for timeous, appropriate audiological management and associated benefits, such as an option for placement in mainstream schooling. Objectives. This study aimed to explore the audiological management of children diagnosed with BM at a tertiary hospital in the Western Cape, South Africa, with reference to: patterns of referral for audiological assessment following a diagnosis of BM; current audiological protocols for the management of children diagnosed with BM. It was anticipated that this study would generate evidence that could potentially be used to develop appropriate protocols for the audiological management of children diagnosed with BM in LMICs, specifically South Africa. Methods. A retrospective record review was conducted using patient folders of children between 0 and 6 years who were treated for BM between May 2016 and May 2018. Data collection took place at Red Cross War Memorial Children's Hospital, which has a paediatric infectious diseases unit and an audiology department. Demographic and audiological data were recorded on a self-developed data abstraction form and data were analysed descriptively. Results. A total of 291 patient folders were accessed for review in this study. Of those, 40 (13.7%) met the inclusion criteria for the study and were selected for review. The majority of excluded folders were for patients not referred for audiological testing post-BM diagnosis. For those children referred to audiology, average referral time was 15 days (SD = 24 days) and each patient attended an average of only 2 audiology appointments. Otoacoustic emissions testing and tympanometry were the most commonly performed audiological tests in all children. BM-related hearing loss developed in 2/19 of these patients. All patients who were diagnosed with BM-related hearing loss were subsequently fitted with hearing aids – one of whom was fitted unilaterally with a hearing aid and the other, a cochlear implant candidate, was lost to follow-up. Conclusions. The key challenge experienced in this study was low referral rates to audiology (16%), which was followed by poor adherence to follow-up appointments – both of which were found to impede effective audiological management. Effective management and prevention of BM-related hearing loss pose challenges in LMICs. This study highlights the need for a well-defined referral pathway and an evidence-based protocol for the audiological management of children with BM within the South African health care setting. If this could be achieved, the early identification of hearing loss in these children has the potential to provide them with developmental, scholastic, and working opportunities in line with those of children with normal hearing.

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