Introdução: Embora alucinações auditivas sejam consideradas manifestações psicopatológicas, a alucinação musical vem sendo descrita em indivíduos sem antecedentes de psicose e com sintomas otológicos. Assim como ocorre com o zumbido, acredita-se que a perda auditiva seja o principal fator predisponente para o aparecimento da alucinação musical. Até o momento, a alucinação musical tem-se mostrado refratária aos tratamentos usualmente propostos na literatura. Objetivos: 1. Primário: avaliar o efeito do uso de aparelho de amplificação sonora individual, pelo período de um ano, em pacientes com zumbido e alucinação musical, associados à perda auditiva; 2. Secundários: a. avaliar a coexistência de doenças otológicas, neurológicas e psiquiátricas; b. verificar associação entre a melhora do zumbido e a da alucinação musical com uso de aparelho de amplificação sonora individual. Métodos: pela raridade do fenômeno, realizou-se um ensaio clínico não-randomizado que incluiu os primeiros 14 pacientes com zumbido e alucinação musical matriculados no Grupo de Pesquisa em Zumbido do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, adultos, de ambos os gêneros. Todos foram submetidos à avaliação multidisciplinar pela mesma equipe de otorrinolaringologistas, neurologistas e psiquiatras. Todos pacientes tinham critério audiológico para uso de aparelho de amplificação sonora individual e não haviam melhorado dos sintomas com abordagem medicamentosa. O grupo experimental contou com 9 participantes que receberam orientação sobre seus três sintomas auditivos e adaptaram o aparelho de amplificação sonora individual, enquanto o grupo controle contou com 5 participantes que receberam a mesma orientação sobre os sintomas, mas recusaram-se a submeter-se à adaptação do aparelho de amplificação sonora individual. O zumbido foi avaliado antes e após um ano pelo Tinnitus Handicap Inventory e a alucinação musical, pela escala numérica. Resultados: O grau de perda auditiva mostrou-se adequadamente pareado em ambos os grupos, sendo severo a profundo em cerca de 80% dos casos. A avaliação cognitiva mostrou déficit de atenção leve em 33,3% (grupo experimental) e 20% (grupo controle). Atividade epileptiforme esteve presente em 11,1% (grupo experimental) e 20% (grupo controle). A avaliação psiquiátrica evidenciou episódio depressivo em 66,6% (grupo experimental) e 80% (grupo controle), ansiedade generalizada em 11,1% (grupo experimental) e 0% (grupo controle) e ausência de diagnóstico psiquiátrico em 22% (grupo experimental) e 20% (grupo controle). Após um ano, pacientes de ambos os grupos apresentaram melhora do grau de incômodo do zumbido, porém a melhora no grupo experimental foi significativamente maior do que no grupo controle e somente os indivíduos do grupo experimental apresentaram melhora do incômodo com a alucinação musical. Não houve associação entre a melhora do zumbido e da alucinação musical. Conclusão: A alucinação musical, nesta amostra, apresentou-se expressivamente associada ao sexo feminino, aos idosos e à presença dos transtornos de humor. A avaliação multidisciplinar (otológica, psiquiátrica e neurológica) deve ser oferecida a pacientes que apresentem alucinação musical para refinar o diagnóstico. Após um ano de acompanhamento, a amplificação sonora promovida pelo uso de aparelho de amplificação sonora individual, associada à orientação específica sobre zumbido, alucinação musical e perda auditiva foi mais efetiva no controle do zumbido e da alucinação musical que a orientação isolada / Introduction: Although auditory hallucinations are considered psychopathological phenomena, musical hallucinations have been reported in individuals without history of psychosis but with otologic symptoms. As is the case for tinnitus, hearing loss is thought to be the main predisposing factor for the emergence of musical hallucinations. To date, musical hallucinations have remained refractory to the treatment approaches typically recommended in the literature. Objectives: 1. Primary: to assess the effect of one year of hearing aid use in patients with both tinnitus and musical hallucinations associated with hearing loss; 2. Secondary: a. to investigate the coexistence of otologic, neurologic and psychiatric diseases; b. to verify the association between improvement of tinnitus and musical hallucinations using hearing aid. Methods: given the rareness of the phenomenon, a nonrandomized clinical trial was conducted including the first 14 consecutive adult patients of both genders with tinnitus and musical hallucinations enrolled at the Tinnitus Research Group of the Clinicas Hospital of the University of São Paulo School of Medicine. All patients were assessed by the same multidisciplinary team of ENT specialists, neurologists and psychiatrists. All patients met audiologic criteria for use of a hearing aid and had shown no improvement in symptoms after treatment with medications. The experimental group comprised 9 participants who were given counseling on their three auditory symptoms and fitted with hearing aids. The control group comprised 5 subjects given the same counseling but who declined to have hearing aids fitted. Tinnitus was assessed at baseline and again at 1- year follow-up using the Tinnitus Handicap Inventory whereas musical hallucinations were assessed by a numeric scale. Results: The two groups proved suitably matched for deafness, with 80% of the both groups presenting with severe to profound hearing loss. The cognitive assessment revealed mild attention deficit in 33.3% (experimental group) and 20%(control group). Epileptiform activity was detected in 11.1% (experimental group) and 20% (control group). The psychiatric assessment revealed depressive episodes in 66.6% (experimental group) and 80% (control group). Generalized anxiety was found in 11.1% (experimental group) and 0% (control group) and absence of psychiatric diagnoses in 22% (experimental group) and 20% (control group). Patients from both groups showed improved tinnitus handicap grades at 1-year follow-up, although experimental group subjects had a significantly greater improvement than control group subjects. Only individuals from the experimental group improved on musical hallucination handicap. No correlation was found between improvement in tinnitus and improvement in musical hallucinations. Conclusion: In the sample studied, musical hallucination was found in females and elderly adults and was associated with mood disorders. Patients presenting with musical hallucinations should be submitted to a multidisciplinary assessment (otologic, psychiatric and neurologic) to refine the diagnosis. Sound amplification using a hearing aid, combined with specific counseling on tinnitus, musical hallucinations and hearing loss, proved more effective for controlling tinnitus and musical hallucinations after one year than specific counseling alone

A vida de milhões de pessoas é afetada por problemas de deficiência auditiva, incapacitando-as de ouvirem os sons naturalmente. O uso de aparelhos de auxílio auditivo minimiza o efeito das deficiências, pois possibilita tratamento dos sinais auditivos através de sofisticados algoritmos que eliminam ruídos e amplificam os sinais de interesse. Este trabalho propõem a especificação de um sistema integrado, otimizado em termos de consumo de potência, para realizar o processamento de sinais digitais em aparelhos de auxílio auditivo digital. Foram desenvolvidos dois blocos para processamento hardwired, que substituem o processamento realizado por software, cuja finalidade é filtrar os sinais sonoros digitalizados com menor consumo. Um dos blocos, um filtro FIR de até 128 coeficientes, pode ser utilizado como filtro do tipo passa baixa ou passa altas frequências. O outro bloco, para executar o algoritmo ALE, é utilizado para eliminar ruídos periódicos. Os blocos desenvolvidos e implementados foram compilados e simulados para comprovar a funcionalidade. Os resultados das simulações mostraram que eles atendem as especificações de funcionalidade. Os blocos foram também sintetizados em uma tecnologia CMOS de 0,35 &#956m, três níveis de metal, para assim se ter as estimativas de área do circuito e de consumo de potência. A área do layout final foi de 14 mm². O consumo de potência estimado é de 0,30 mW para frequência de clock de 300 kHz (o que permite que um filtro FIR processe uma amostra a cada 240 &#956s, no pior caso, e o ALE, uma a cada 36 &#956s), e de 5,06 mW para frequência de clock de 5,0 MHz (filtro FIR processa uma amostra a cada 14,4 &#956s e o ALE, uma a cada 2,2 &#956s). As estimativas de consumo foram feitas considerando os dois blocos operando simultaneamente e com tensão de alimentação de 1,8 V. Para todo o sistema integrado proposto, obtive-se, com um cenário específico, o consumo de potência de 1,1 mW, considerando dois Filtros Configuráveis, um Filtro ALE e um DSP. / The live of millions of people are affected by hearing problems, disabling them from hearing the sounds naturally. The use of hearing aids devices minimizes the effect of deficiencies, since it allows processing of auditory signals through sophisticated algorithms that eliminate noise and amplify the signals of interest. This work proposes the specification of an integrated system, optimized in terms of power consumption, to perform digital signal processing in digital hearing aid devices. Were developed two blocks of hardwired processing, replacing software processing, whose purposes are to filter the digitized audio signals with lower consumption. One of the blocks, an FIR filter up to 128 coefficients can be used as a low pass or high pass filter. The other block, to run the ALE algorithm, is used to eliminate periodic noises. The blocks developed and implemented were compiled and simulated to demonstrate their functionality. The simulation results show that they meet the specifications of functionality. The blocks were also synthesized in a 0.35 &#956m CMOS technolog, three metal levels, in order to have estimatives of circuit area and power consumption. The area of the final layout was 14,0 mm². The estimated power consumption is 0.30 mW for clock frequency of 300 kHz (which allows a FIR filter to process one sample every 240 &#956s in the worst case, and ALE, one every 36 &#956s), and 5.06 mW for clock frequency of 5.0 MHz (FIR filter processing one sample every 14.4 &#956s, and ALE, one every 2.2 &#956s). Consumption estimates were made considering the two blocks operating simultaneously and supply voltage of 1.8 V. For all the proposed integrated system, it was found, for a specific scenario, the power consumption of 1.1 mW, considering two configurable filters, one filter ALE and one DSP.

To determine the amount of importance audiologists place on various items related to their selection of a preferred hearing aid brand manufacturer. Three hundred forty-three hearing aid-dispensing audiologists rated a total of 32 randomized items by survey methodology. Principle component analysis identified seven orthogonal statistical factors of importance. In rank order, these factors were Aptitude of the Brand, Image, Cost, Sales and Speed of Delivery, Exposure, Colleague Recommendations, and Contracts and Incentives. While it was hypothesized that differences among audiologists in the importance ratings of these factors would dictate their preference for a given brand, that was not our finding. Specifically, mean ratings for the six most important factors did not differ among audiologists preferring different brands. A statistically significant difference among audiologists preferring different brands was present, however, for one factor: Contracts and Incentives. Its assigned importance, though, was always lower than that for the other six factors. Although most audiologists have a preferred hearing aid brand, differences in the perceived importance of common factors attributed to brands do not largely determine preference for a particular brand.

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Although hearing loss is among the most common chronic conditions in the U.S., many individuals never speak to a healthcare provider about it. Thus, evaluation and rehabilitation services remain underutilized. Even mild hearing loss may result in decreased quality of life, social isolation, and decreased selfsufficiency. The purpose of this study was to assess factors that influence hearing healthcare access and hearing aid acquisition by individuals in Southern Appalachia. The identification of barriers to hearing healthcare access may help audiologists tailor care to this group‘s specific needs. The Hearing Handicap Inventory for Adults (HHIA), a questionnaire assessing self-perceived hearing handicap (a major determinant in help-seeking behaviors in people with hearing loss), was administered along with a researcher-designed survey. The researcher-designed survey was comprised of two forms. Form A asked questions specific to unaided individuals, with half pertaining to individuals with normal hearing, and the other half pertaining to individuals with unaided hearing loss. Form B asked questions specific to hearing aid users. Both forms collected demographic information. Survey participants were recruited from the Remote Area Medical (RAM) clinic held in Bristol, TN on May 1-3, 2015. HHIAs and surveys were obtained from 127 individuals. Two major barriers to hearing healthcare were identified: financial barriers and transportation-related barriers. 62% of respondents reported a household income of $20,000 or less, with an average household size of 2.6 members. Because hearing aids must often be purchased out of pocket, individuals in this income bracket may not be able to afford assistive devices. Some individuals in Southern Appalachia live far from the urban centers where audiologists tend to be located. Although the unaided individuals surveyed indicated they could travel some distance for hearing healthcare services, more than half indicated that they would be unable to travel more than an hour. In contrast, more than half of the aided group indicated that they were required to travel more than an hour for services. Since rural areas often lack public transportation, costs associated with traveling a long distance using personal transportation may present a barrier to hearing healthcare access. These barriers may be at least partially remediated by financial aid programs, telehealth services, and self-help/support group initiatives. The Bristol RAM clinic, in partnership with ETSU‘s audiology department, attempts to overcome these barriers by providing free hearing screenings and low-cost amplification options to individuals with hearing loss living in rural areas.

Let's talk beer for a moment. Beginning back in the mid-90s, at the Sandlot microbrewery located within Coors Field in Downtown Denver, a fairly tasty Belgian-style witbier called Bellyslide (a baseball term) was available in small batches. It was a favorite of a few, but ignored by most, and even scorned by some (it was unfiltered). But then, about 6 years ago, Coors gave it a new name— Blue Moon—started producing it in bulk, and rolled it out across the U.S. It became the top-performing beer brand in 2007, and today Blue Moon is closing in on making the top ten list of all domestic beers sold. Why is it so popular? The taste of course, right? Maybe. How about the pretty blue label? Or the fact that it's usually served with an orange slice? Or that Coors disguises it as a “craft beer”? Or, maybe it's just more fun to say “Blue Moon” than “Bud.” As with beer, people also make brand purchase decisions about hearing aids. But there's a difference. In the case of hearing aids, the consumer usually does not select the brand. His or her dispenser does. It's not uncommon to sit down with four different people in private practice and discover that each has a different favorite hearing aid brand. And interestingly, all of them say they picked this particular brand because it is the best. But how can all four brands be the best? Or are they all just the same? Only a few audiologists have conducted research on hearing aid brand preferences. One of them is Earl Johnson, AuD, PhD, an audiologist at Mountain Home, TN, Veterans Affairs Medical Center and assistant professor at East Tennessee State University. While obtaining his PhD at Vanderbilt University with a focus on hearing aid research, Dr. Johnson also studied consumer behavior at Vanderbilt's Owen business school—an unusual combination that has led to much of his research. You've probably also noted his recent book chapters and journal publications related to modern hearing aid technology and hearing aid selection. While this is his debut on Page Ten, Earl is not a new contributor to the Journal. For many years he assisted with HJ'sdispenser surveys and contributed articles on these findings. I'm not sure if Earl drinks Blue Moon because of the orange slice, but I'm quite certain he can provide you some interesting insights on why you have a hearing aid brand preference.

Excerpt: How do audiologists decide which manufacturing brand they will use when dispensing hearing aids to patients? Based on ideology and methodology from the field of consumer behavior, this article offers insight into the decision-making processes used by clinical audiologists in today's field of practice. To begin, it is necessary to briefly review recent and relevant trends in this area.

Hearing loss affects millions of Americans each year, especially targeting older Americans. Elders aged 65-75 years are affected as much as 38% and those numbers rapidly rise to over 42% affected by the time a person is 75 years of age. The rise in the numbers of older persons in the United States makes hearing loss the third most common chronic illness in the US today. Of these persons approximately 30% chose to purchase hearing aids, but an astounding 47.2% of these individuals are able to adjust to the hearing aids in order to wear them daily. Ambient sounds and physical discomfort, from the presence of the device in the ear cause individuals either to never wear the devices or stop wearing them after a short time. This dissertation focused on an intervention to assist those older persons who have purchased hearing aids, but are not wearing them, in adjusting to those aids; in order to improve hearing aid satisfaction and hours of hearing aid use. A one group pre/posttest design was implemented on a group of individuals who had previously failed to adjust to hearing aids between the ages of 65-75 years of age. The Glasgow Hearing Aid Benefit Profile (GHABP) and hours of hearing aid use time were the primary outcome variables. This intervention study occurred over a four week period of time, with weekly face-to-face meetings with participants. Findings demonstrated that the intervention was feasible to administer in a group of community dwelling older persons (aged 65-75 years). All 15 participants completed the entire intervention, meeting each of 4 times with the researcher over a four week period. 40% of volunteers later declined to participate and 48% were turned away due to the small sample size of this study. An overall increase of hearing aid use time was between 1-9 hours per day. A Wilcoxin signed rank test was performed with a result of 60 (p=<0.0001). Participants who increased their hearing aid use time >4 hours equaled 53% while 46.7% increase their hearing aid use time <4 hours. Hearing aid satisfaction as measured by the GHABP improved between 1-5 with a median of 4. The Wilcoxin signed rank test result was 22.5 with a p value of 0.0039. These results deem the intervention not only feasible, but statistically significant in improving both hearing aid use time and hearing aid satisfaction. Future studies should be aimed at advanced statistical analysis, randomized clinical trial with larger numbers to improve power, and expanding the age criteria for study inclusion. Implications for future research are great, improving communication in older persons, but also perhaps impacting third party reimbursement of hearing aids, as well as decreasing the biopsychosocial effects hearing loss has on the population as a whole.

Hearing loss can significantly hinder an individual's ability to engage socially and, when left untreated, can lead to anxiety, depression, and even dementia. The most common type of hearing loss is sensor-neural hearing loss that is treated using hearing aids (HAs). However, a significant fraction of individuals that may benefit from using HA do not use them and, the satisfaction of those that do, is only around 60%. Today, we have only a limited understanding regarding the factors that contribute to the low adoption and satisfaction rates. This is a limitation of existing laboratory-based assessment methods that cannot accurately predict the performance of HAs in the real-world as they do not fully reproduce the complexities of real-world environments. There four core contributions of my PhD thesis: i) the development new computer-based methods for assessing HAs in the real-world. Our approach is based on the insight that HA performance is intrinsically dependent on the context in which a HA is used. A context includes characteristics of the listening activity, social context, and acoustic environment. To evaluate this hypothesis, we have developed AudioSense, a system that uses mobile phones to jointly characterize the context of users and the performance of HAs. ii) We provide the first instance of characterization of the auditory lifestyle of hearing aid users, and the relationships that exist between the context and hearing aid outcomes. iii) We utilize the subjective data collected using AudioSense to build novel models that can predict the success of hearing aid prescriptions for new and experienced users. We also quantitatively prove the importance of collecting contextual information for evaluating hearing aids. iv) We use the objective audio data collected with AudioSense to predict contextual information like acoustic activity and noise level. This provides us a way to intelligently infer contextual information automatically and reduce the burden on the study participants.

Frequency-lowering signal processing in hearing aids has re-emerged as an option to improve audibility of the high frequencies by expanding the input bandwidth. However, few studies have investigated the usefulness of the scheme as a bimodal option for cochlear implant users. In this study, that question was posed. It was hypothesized that, following fitting and a period of adjustment to a frequency-compression hearing aid, sound localization and speech perception would be improved compared to conventional amplification. More specifically, more high-frequency cues would be perceived in the hearing aid ear using frequency compression, thereby providing better sensitivity to interaural level differences when a cochlear implant is used contralaterally. There were two experiments in this study. In the first experiment, the goal was to determine if frequency compression was a better bimodal option than conventional amplification. Performance was assessed on tests of sound localization, speech perception in a background of noise, and using questionnaires. Ten subjects with a cochlear implant plus hearing aid participated in experiment one. In the second experiment, the goal was to determine the impact of frequency compression on speech perception in quiet. Consonant and vowel perception in quiet was assessed using the frequency-compression and conventional hearing aid. Seventeen adult subjects participated in the second experiment. In both experiments, subjects alternated daily between a frequency-compression and conventional hearing aid for two months. The parameters of frequency compression were set individually for each subject and audibility was measured for the frequency compression and conventional hearing aid programs by comparing estimations of the Speech Intelligibility Index (SII) using a modified algorithm (Bentler, R., Cole, B., Wu, Y-H. (2011, March). Deriving an audibility index for frequency-lowered hearing aids. Poster session presented at the meeting of the American Auditory Society, Scottsdale, AZ). In both experiments, the outcome measures were administered following the hearing aid fitting to establish baseline performance and after two months of use. Results revealed no significant difference between the frequency-compression and conventional hearing aid on tests of localization and consonant recognition. Spondee-in-noise and vowel perception scores were significantly higher with the conventional hearing aid compared to the frequency-compression hearing aid after two months of use. These results suggest that, for the subjects in this study, frequency compression is not a better bimodal option than conventional amplification. In addition, speech perception may be negatively influenced by frequency compression because formant frequencies are too severely compressed and can no longer be distinguished.