Objectives: Diagnosis of hearing loss and prescription of amplification for infants and young children require accurate estimates of ear- and frequency-specific behavioral thresholds based on auditory brainstem response measurements. Although the overall relationship between ABR and behavioral thresholds has been demonstrated, the agreement is imperfect, and the accuracy of predictions of behavioral threshold based on ABR may depend on degree of hearing loss. Behavioral thresholds are lower than ABR thresholds, at least in part due to differences in calibration interacting with the effects of temporal integration, which are manifest in behavioral measurements but not ABR measurements and depend on behavioral threshold. Listeners with sensory hearing loss exhibit reduced or absent temporal integration, which could impact the relationship between ABR and behavioral thresholds as degree of hearing loss increases. The current study evaluated the relationship between ABR and behavioral thresholds in infants and children over a range of hearing thresholds, and tested an approach for adjusting the correction factor based on degree of hearing loss as estimated by ABR measurements. Design: A retrospective review of clinical records was completed for 309 ears of 177 children with hearing thresholds ranging from normal to profound hearing loss and for whom both ABR and behavioral thresholds were available. Children were required to have the same middle-ear status at both evaluations. The relationship between ABR and behavioral thresholds was examined. Factors that potentially could affect the relationship between ABR and behavioral thresholds were analyzed, including degree of hearing loss observed on the ABR, behavioral test method (visual reinforcement, conditioned play or conventional audiometry), the length of time between ABR and behavioral assessments, and clinician-reported reliability of the behavioral assessment. Predictive accuracy of a correction factor based on the difference between ABR and behavioral thresholds as a function of ABR threshold was compared to the predictive accuracy achieved by two other correction approaches in current clinical use. Results: As expected, ABR threshold was a significant predictor of behavioral threshold. The relationship between ABR and behavioral thresholds varied as a function of degree of hearing loss. The test method, length of time between assessments and reported reliability of the behavioral test results were not related to the difference between ABR and behavioral thresholds. A correction factor based on the linear relationship between the differences in ABR and behavioral thresholds as a function of ABR threshold resulted in more accurately predicted behavioral thresholds than other correction factors in clinical use. Conclusions: ABR is a valid predictor of behavioral threshold in infants and children. A correction factor that accounts for the effect of degree of hearing loss on the difference between ABR and behavioral thresholds resulted in more accurate pred...

Objective: Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is a type of otoacoustic emission (OAE) that is calculated as a transfer function between forward pressure and reflected pressure. The purpose of this study was to compare wideband CR to distortion-product (DP) OAEs in two ways: (1) in a clinical-screening paradigm where the task is to determine whether an ear is normal or has hearing loss and (2) in the prediction of audiometric thresholds. The goal of the study was to assess the clinical utility of CR.Design: Data were collected from 32 normal-hearing and 124 hearing-impaired participants. A wideband noise stimulus presented at three stimulus levels (30, 40, 50 dB SPL) was used to elicit the CR. DPOAEs were elicited using primary tones spanning a wide frequency range (1-16 kHz). Predictions of auditory status (i.e., hearing-threshold category) and predictions of audiometric threshold were based on regression analysis. Test performance (identification of normal vs. impaired hearing) was evaluated using clinical decision theory.Results: When regressions were based only on physiological measurements near the audiometric frequency, the accuracy of CR predictions of auditory status and audiometric threshold was less than reported in previous studies using DPOAE measurements. CR predictions were improved when regressions were based on measurements obtained at many frequencies. CR predictions were further improved when regressions were performed on males and females separately. Conclusion:Compared to CR measurements, DPOAE measurements have the advantages in a screening paradigm of better test performance and shorter test time. The full potential of CR measurements to predict audiometric thresholds may require further improvements in signalprocessing methods to increase its signal-to-noise ratio. CR measurements have theoretical significance in revealing the number of cycles of delay at each frequency that is most sensitive to hearing loss.

The practice area of clinical supervision has recently acknowledged a demand for efficacious and accessible supervision training opportunities. As with any area of clinical practice, effective supervision requires prior training. Those who engage in supervision practices must be well-trained to adequately support the advancement of evidence-based clinicians. This article will discuss the upcoming changes in supervision training requirements and how embracing these changes will ultimately transform the fields of audiology and speech language pathology.

Subjective cognitive decline (SCD) impacts quality-of-life, healthcare utilization and predicts dementia. If hearing loss is associated with SCD is unknown. We estimated the cross-sectional association between hearing loss and SCD in 2,536 participants (79.3±4.4 years, 60% female, 20% Black) in the Atherosclerosis Risk in Communities Neurocognitive Study. SCD was defined as self-reported persistent decline in memory (yes/no) among adults with normal cognition. Hearing was measured using pure tone better-ear thresholds (0.5-4 kHz), speech-in-noise, and self-report. Using Poisson models with robust standard errors, after adjustment for demographic and clinical covariates, self-reported moderate or greater trouble hearing (vs. excellent/good) was associated with a 30% increase in the prevalence of SCD (95%CI:1.12,1.51). Audiometric hearing and speech-in-noise performance were not associated. Use of self-report to approximate audiometric hearing warrants caution, particularly when the outcome is also self-reported; our findings suggest the association between self-reported hearing and SCD may be due to correlated measurement error.