Beyond the audiogram: application of models of auditory fitness for duty to assess communication in the real world

Dubno, Judy R.

doi:10.1080/14992027.2018.1439677

Cited by 4 publications

(2 citation statements)

References 2 publications

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“…Thus, a necessary precursor to obtaining a full picture of the effect of blast exposure will be to develop more reliable ways to assess the blast and noise exposure history of SMs, either through the deployment of blast and noise exposure sensors or through the use of more sophisticated noise exposure surveys, especially those that include questions regarding TTS (Hecht et al 2019). Once differences in blast exposure are assessed, it will be necessary to deploy a more extensive battery of behavioral and objective tests that look at the damaged auditory periphery beyond the audiogram (Kujawa & Liberman 2009;Gallun et al 2012a;Dubno 2018;Kubli et al 2018), possible higher-level auditory processing deficits (Koerner et al 2020;Tepe et al 2020), and cognitive-processing deficits (Gallun et al 2012b(Gallun et al , 2016Hoover et al 2017). Understanding the primary nature of the problem, whether it is mostly a peripheral suprathreshold distortion propagating in a bottom-up manner, or a cognitive deficit (e.g., language, attention, working memory, temporal processing speed) influencing performance in a top-down manner, will help determine the best rehabilitation approaches to help these SMs and Veterans (e.g., FM systems, low-gain signal-processing hearing aids, or auditory and cognitive training).…”

Section: Clinical Applicationmentioning

confidence: 99%

Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds

et al. 2021

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Objectives: Over the past decade, U.S. Department of Defense and Veterans Affairs audiologists have reported large numbers of relatively young adult patients who have normal to near-normal audiometric thresholds but who report difficulty understanding speech in noisy environments. Many of these service members also reported having experienced exposure to explosive blasts as part of their military service. Recent studies suggest that some blast-exposed patients with normal to near-normal-hearing thresholds not only have an awareness of increased hearing difficulties, but also poor performance on various auditory tasks (sound source localization, speech recognition in noise, binaural integration, gap detection in noise, etc.). The purpose of this study was to determine the prevalence of functional hearing and communication deficits (FHCD) among healthy Active-Duty service men and women with normal to near-normal audiometric thresholds. Design:To estimate the prevalence of such FHCD in the overall military population, performance of roughly 3400 Active-Duty service members with hearing thresholds mostly within the normal range were measured on 4 hearing tests and a brief 6-question survey to assess FHCD. Subjects were subdivided into 6 groups depending on the severity of the blast exposure (3 levels: none, far away, or close enough to feel heat or pressure) and hearing thresholds (2 levels: audiometric thresholds of 20 dB HL or better, slight elevation in 1 or more thresholds between 500 and 4000 Hz in either ear).Results: While the probability of having hearing difficulty was low (≈4.2%) for the overall population tested, that probability increased by 2 to 3 times if the service member was blast-exposed from a close distance or had slightly elevated hearing thresholds (>20 dB HL). Service members having both blast exposure and mildly elevated hearing thresholds exhibited up to 4 times higher risk for performing abnormally on auditory tasks and more than 5 times higher risk for reporting abnormally low ratings on the subjective questionnaire, compared with service members with no history of blast exposure and audiometric thresholds ≤20 dB HL. Blast-exposed listeners were roughly 2.5 times more likely to experience subjective or objective hearing deficits than those with noblast history.Conclusions: These elevated rates of abnormal performance suggest that roughly 33.6% of Active-Duty service members (or approximately 423,000) with normal to near-normal-hearing thresholds (i.e., H1 profile) are at some risk for FHCD, and about 5.7% (approximately 72,000) are at high risk, but are currently untested and undetected within the current fitness-for-duty standards. Service members identified as "at risk" for FHCD according to the metrics used in the present study, in spite of their excellent hearing thresholds, require further testing to determine whether they have sustained damage to peripheral and early-stage auditory processing (bottom-up processing), damage to cognitive processes for speech (top-down processing), or bo...

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Section: Clinical Applicationmentioning

confidence: 99%

Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds

et al. 2021

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“…The exclusive or even primary use of conventional audiometry to index hearing impairment is currently being challenged by several emerging discoveries and constructs including unexplained difficulty hearing speech-innoise (Pienkowski 2017), 'hidden' hearing loss (e.g. cochlear synaptopathy; Liberman 2015), 'extended frequency' hearing loss (tones > 8 kHz; Monson et al 2014), and 'hearing critical tasks' (Dubno 2018;Soli et al 2018). The data presented provide another challenge in the form of novel, objective support for a 15 dB HL 'entry level' for hearing loss in children.…”

Section: Further Directionsmentioning

confidence: 99%

Minimal and mild hearing loss in children: Association with auditory perception, cognition, and communication problems

Moore

Zobay

Ferguson

2019

Preprint

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Objectives: 'Minimal' and 'mild' hearing loss are the most common but least understood forms of hearing loss in children. Children with better ear hearing level as low as 30 dB HL have a global language impairment and, according to the World Health Organization, a "disabling level of hearing loss". We examined in a population of 6 -11 year olds how hearing level ≤ 40.0 dB HL (1 and 4 kHz pure tone average, PTA, threshold) related to auditory perception, cognition and communication. Design: School children (n=1638) were recruited in four centres across the UK. They completed a battery of hearing (audiometry, filter width, temporal envelope, speech-in-noise) and cognitive (IQ, attention, verbal memory, receptive language, reading) tests. Caregivers assessed their children's communication and listening skills. Children included in this study (702 male; 752 female) had four reliable tone thresholds (1, 4 kHz each ear), and no caregiver reported medical or intellectual disorder. Normal hearing children (n=1124, 77.1%) had all four thresholds and PTA < 15 dB HL. Children with ≥ 15 dB HL for at least one threshold, and PTA < 20 dB (n=245, 16.8%) had Minimal hearing loss. Children with 20 ≤ PTA < 40 dB HL (n=88, 6.0%) had Mild hearing loss. Interaural Asymmetric hearing loss (|Left PTA -Right PTA| ≥ 10 dB) was found in 28.9% of those with Minimal and 39.8% of those with Mild hearing loss. Results: Speech perception in noise, indexed by VCV pseudoword repetition in speech modulated noise, was impaired in children with Minimal and Mild hearing loss, relative to Normal hearing children. Effect size was largest (d=0.63) in Asymmetric Mild hearing loss and smallest (d=0.21) in Symmetric Minimal hearing loss.Spectral (filter width) and temporal (backward masking) perception were impaired in children with both forms of hearing loss, but supra-threshold perception generally related only weakly to PTA. Speech-in-noise (nonsense syllables) and language (pseudoword repetition) were also impaired in both forms of hearing loss and correlated more strongly with PTA. Children with Mild hearing loss were additionally impaired in working memory (digit span) and reading, and generally performed more poorly than those with Minimal loss. Asymmetric hearing loss produced as much impairment overall on both auditory and cognitive tasks as Symmetric hearing loss. Nonverbal IQ, attention and caregiver-rated listening and communication were not significantly impaired in children with hearing loss. Modelling suggested that 15 dB HL is objectively an appropriate lower audibility limit for diagnosis of hearing loss. Conclusions:Hearing loss between 15 -30 dB PTA is, at ~20%, much more prevalent in 6-11 y.o. children than most current estimates. Key aspects of auditory and cognitive skills are impaired in both symmetric and asymmetric minimal and mild hearing loss. Hearing loss < 30 dB HL is most closely related to speech perception in noise, and to cognitive abilities underpinning language and reading. The results suggest wider use of speech-innoise...

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A study on the association of functional hearing behaviors with semantics, morphology and syntax in cochlear-implanted preschool children

Kutlu

Özkan

Yücel

2021

International Journal of Pediatric Otorhinolaryngology

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Beyond the audiogram: application of models of auditory fitness for duty to assess communication in the real world

Cited by 4 publications

References 2 publications

Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds

Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds

Minimal and mild hearing loss in children: Association with auditory perception, cognition, and communication problems

A study on the association of functional hearing behaviors with semantics, morphology and syntax in cochlear-implanted preschool children

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