Gregg D. Givens

Internet-based tele-audiometry system for the assessment of hearing: a pilot study.

The application of tele-audiology is in its infancy. Several systems have been developed to screen hearing, yet the application of real-time diagnostic audiology to a remote location is new. This paper describes a tele-audiometric system developed for the application of realtime diagnostic audiometry via the Internet. A pilot study evaluated 31 adult participants in a double-blind study of two different systems (i.e., conventional versus Internet-based) for assessing auditory thresholds. The threshold data show substantial agreement between the two systems. Mean thresholds varied by no more than 1.3 dB, well within established variability of audiometric testing. This pilot study demonstrated the feasibility of real-time Internet-based assessment of hearing. The system allows this remote assessment of hearing without an audiologist on site. Further investigation will assess of outcomes and costs.

Auditory temporal resolution in normal-hearing preschool children revealed by word recognition in continuous and interrupted noise.

The purpose of this study was to examine temporal resolution in normal-hearing preschool children. Word recognition was evaluated in quiet and in spectrally identical continuous and interrupted noise at signal-to-noise ratios (S/Ns) of 10, 0, and -10 dB. Sixteen children 4 to 5 years of age and eight adults participated. Performance decreased with decreasing S/N. At poorer S/Ns, participants demonstrated superior performance or a release from masking in the interrupted noise. Adults performed better than children, yet the release from masking was equivalent. Collectively these findings are consistent with the notion that preschool children suffer from poorer processing efficiency rather than temporal resolution per se.

Word retrieval following mild TBI: Implications for categorical deficits

Background: Theories on the organisation and structure of semantic knowledge of nouns and verbs have been based on findings with aphasic patients with focal lesions. Populations with diffuse lesions, such as mild traumatic brain injury (MTBI), may offer additional information relative to lexical access of nouns and verbs. Aims: The purpose of this study was to investigate possible dissociation between noun and verb retrieval after MTBI using the Test of Adolescent Adult Word Finding (TAWF). Methods & Procedures: Two groups, 10 MTBI and 10 non‐brain‐damaged (NBD) persons, who had normal vision and hearing, and no history of developmental disabilities, previous head injury, or substance abuse, were participants. Criteria for MTBI included: loss of consciousness <30 minutes and/or PTA<24 hours, GCS 13–15, and negative CT scan. The experimental task was the TAWF, focusing on differences in accuracy and response time for noun and verb naming. Outcomes & Results: Paired sample t‐tests comparing nouns and verbs on accuracy and response time revealed no significant differences for the MTBI group; for the NBD group, there were significant differences for response time only. One‐tailed independent sample t‐tests revealed significant group differences for accuracy and response time on combined nouns and only response time for verbs. Paired sample t‐tests revealed significant differences for naming living and nonliving items only for the MTBI group. Conclusions: No significant accuracy differences were found for either group between nouns and verbs. However, the NBD group named nouns significantly faster than verbs, whereas the MTBI group showed no significant difference. The MTBI group was significantly slower and less accurate than the NBD group for noun naming but only significantly slower for verbs. The MTBI group exhibited higher accuracy in naming living items as compared to nonliving. Therefore, response times appeared to be more sensitive than accuracy in identifying group differences.

Audiology Telepractice in a Clinical Environment: A Communication Perspective

Access to adequate hearing health care is an obstacle that many individuals face worldwide. The prospect of providing audiology services via the Internet is an attractive and viable alternative to traditional face-to-face interaction between patients and audiologists, thus affording improved access to hearing health care for traditionally underserved populations. This article details our experience of using a web-based system with wireless audiometers and videoconferencing software to administer remote audiological assessments in an active medical practice. It discusses the technological infrastructure used and the pragmatic issues that arise when the Internet, Bluetooth wireless audiometers, and videoconferencing devices are converged into a clinical setting. Patients at a local office of otolaryngologists were recruited to participate in a study in which remote assessment results were compared to those collected from a traditional face-to-face assessment. Preliminary data demonstrated that the assessment results from the two sources were comparable. We conclude that remote hearing assessment over the Internet can be achieved through a distributed system synthesized with Internet, wireless communication, and videoconferencing technologies, supported by appropriate staff.

Measures of auditory processing in aphasia: Behavioural and electrophysiological analysis

Background: Lesions resulting in aphasia frequently involve areas associated with auditory processing. Investigations using psychoacoustics and/or electrophysiology to examine the auditory processing abilities of aphasic as well as non-brain-damaged individuals have revealed the influence of several variables on findings, including age, type of stimuli, task difficulty/instructions, response modality, and lesion site/size. It is unclear whether both methods of testing are examining similar components of auditory processing and furthermore, if the variables identified as affecting findings for the two testing methodologies influence results in a similar manner. An electrophysiological approach to auditory processing may assist in the objective evaluation of patients who have difficulty consistently providing accurate responses. Aims: The purpose of this investigation was to explore behavioural and electrophysiological CAP abilities of several aphasic individuals using a set of divided attention tasks and to investigate whether electrophysiological results were congruent with those obtained from behavioural testing. Methods and Procedures: Participants were two females and five males, age range 33-73, all suffering left cerebrovascular accidents, resulting in aphasia. Experimental testing included: speech-language evaluation via administration of the Western Aphasia Battery and the Token Test ; hearing evaluation using routine pure-tone audiometry, speech audiometry, and middle ear measurements; behavioural central auditory processing assessment using Pitch Pattern Sequence and Dichotic Digits ; and electrophysiology testing, consisting of evaluation of late auditory evoked potentials (N100, P200, P300) with and without distraction using an oddball paradigm. Outcomes and Results: Results are presented individually for each patient. Overall, patients showed unique results relative to ear advantage pattern and congruence between electrophysiological and behavioural testing. One patient showed inconclusive findings due to a hearing loss; one patient showed no clear ear advantage pattern on either behavioural or electrophysiological testing; one patient showed no ear advantage on dichotic testing but showed a clear pattern on electrophysiology; and one patient showed incongruence in ear advantage pattern between electrophysiological and behavioural testing. Three patients showed congruent ear advantage patterns across both behavioural and electrophysiological testing; however, one showed a right ear advantage and two showed a left ear advantage. Conclusions: Based on these findings, it is evident that the direct and/or statistical relationship between behavioural CAP and electrophysiological findings requires more in-depth exploration. The testing of additional patients is imperative prior to making decisions regarding the utility and value of such a statistical approach. Thus, the use of these and other CAP measures bears additional investigation as clinical and experimental tools in evaluating auditory processing capabilities of the aphasic patient.

Using web services to realize remote hearing assessment.

Background. Internet-based tele-audiology is expected to relieve the dilemma between the lack of resources and high demand of audiological care services. This paper presents a web services based, distributed pure-tone hearing assessment system that improves accessibility of traditionally underserved groups to audiology care. Methods. The system employs browser-server network architecture to connect patients to audiology specialists through a web server where all application software is hosted. Software on the server is designed with a three-tier approach which makes the system scalable to include other audiological services. Hearing test data are stored in a standard database and can potentially be integrated into established electronic medical records. On the remote patient side, off-the-shelf audiometers are adopted. The Internet connection of these audiometers can be flexibly configured either with or without a computer. Two aspects of the system were tested: (1) the clinical effectiveness of the system: double-blinded experiments were conducted to assess hearing ability of 30 subjects and paired t-tests were utilized to compare assessment results from the remote approach and the conventional setup; and (2) to analyze the system bandwidth requirements, data traffic among the server, the audiometer, and the audiologist terminal was examined with a network monitoring software (wireshark). Results. Paired t-test results have demonstrated that the remote hearing assessment is equivalent in effectiveness to its conventional counterparts at all tested frequencies (P values are in the range of [0.12, 0.94]), and the bandwidth required by the system is less than 1 Mbps, falling within the capacity of average commercial Internet service subscription. Conclusions. The project developed a remote hearing assessment system based on services on a web server. The system minimizes hardware and software requirements on the audiologist’s computer and can be realized with regular Internet service subscription. Patient operations involved in hearing assessment are simple; making hearing test services more accessible to those otherwise may not be able to obtain the desired hearing care.

Behavioural and electrophysiological measures of auditory attention in right hemisphere brain damage

Background: The right hemisphere (RH) has been found to play a major role in attention. However, most research has focused on the RHs role in visual attention associated with arousal, orienting, vigilance, and sustained and selective attention, and especially on the subsequent visuospatial deficits observed after RH brain damage. The RHs contribution to auditory attention and processing as well as the auditory abilities of the RH after brain damage has been explored to a lesser degree. Investigations using psychoacoustics and electrophysiology to examine the auditory processing abilities of non‐brain‐damaged and aphasic adults have been numerous and have revealed the influence of several variables on their findings including age, lesion site, lesion size, type of stimuli, etc. Investigations using these approaches to examine the auditory attention abilities of individuals with RH brain damage have been minimal. Furthermore, it is unclear whether both testing methods are examining similar components of auditory attention. Aims: The purpose of this investigation was to determine if electrophysiological testing provided additional information not available from behavioural central auditory processing evaluation for three patients with RH brain damage as the result of a stroke. Another purpose was to investigate whether electrophysiological findings were consistent with those obtained from the behavioural evaluation. Methods & Procedures: Participants were three males, aged 69, 71, and 78, all having suffered right hemisphere cerebro‐vascular accidents, resulting in mild cognitive‐communicative impairments. Experimental testing included: speech‐language evaluation through administration of the Western Aphasia Battery and the Token Test; hearing evaluation using routine pure tone audiometry, speech audiometry, and middle ear measurements; behavioural CAP assessment using the auditory attention measures of Pitch Pattern Sequence and Dichotic Digits; and electrophysiological testing, consisting of evaluation of late auditory evoked potentials (N100, P200, P300) with and without distraction using an oddball paradigm. Outcomes & Results: All three participants showed a consistent right ear advantage, with abnormal scores for the left ear on the behavioural central auditory attention tests. Electrophysiological testing revealed greater amplitudes for the right ear than the left ear for all three late auditory evoked potentials for the three participants. Furthermore, when auditory competition was introduced, the expected decrease in amplitude was observed for all three late auditory evoked potentials only for the right ear; all three participants exhibited this pattern. Conclusions: Thus, the electrophysiological findings were congruent with the behavioural central auditory processing results for the three participants, revealing a consistent right ear advantage for auditory attention. Based on these findings, it is evident that the direct relationship between behavioural central auditory attention skills and electrophysiology requires further investigation with other patients with right hemisphere brain damage.

AUDITORY PROCESSING SKILLS AND HEARING AID SATISFACTION IN A SAMPLE OF OLDER ADULTS

The present study investigated the relationship between central auditory processing skills and satisfaction with hearing aids in a hearing-impaired geriatric sample of 58 adult wearers of hearing aids who were between the ages of 65 and 91 years. Analysis suggests the importance of adding central auditory tasks such as compressed speech or dichotic listening tasks to the evaluation of candidacy for hearing aids. This could lead to the better understanding of satisfaction with amplification by the geriatric population.

Perception of time-altered monosyllables in a specific group of phonologically disordered children

Temporal auditory processing of open (e.g. pie) versus closed (e.g. pipe) syllables in a specific group of phonologically impaired children who deleted word-final consonants and normal phonologically developing children between the ages of 4 and 7 yr was investigated. The disordered group demonstrated significantly poorer discrimination at the faster but not slower rates of speech. Imitation of word-final consonants did not significantly increase in the disordered subjects when presented with time-expanded speech although certain individuals made noticeable improvements. Discussion of temporal auditory processing deficits from a neuropsychological perspective which suggests different etiologies is offered.

Revision behaviors of normal and hearing-impaired children.

Childrens response to communicative failure was evaluated in terms of linguistic and nonlinguistic behaviors. Six hearing-impaired and six normal-hearing children served as subjects. Each group was comprised of three children at each of Browns language stages I and 111. Each child was engaged in spontaneous play and received the communicative failure cue “What?” on 20 occasions. Videorecorded responses were scored as repetitions, revisions, or no responses. Revisions were analyzed and categorized into one of nine categories according to linguistic and nonlinguistic structures. Results revealed that both groups of subjects used linguistic and nonlinguistic information in this revision behavior. However, the two groups differed in their pattern of revision behaviors. The hearing-impaired subjects, unlike the normal-hearing subjects, used less linguistic revision behaviors regardless of language development. Findings showed that the nonlinguistic as well as linguistic information may be important considerations when evaluating language with the hearing impaired.