Jennifer B. Shinn

Gin (gaps-in-noise) Test Performance In Subjects With Confirmed Central Auditory Nervous System Involvement

Objective: The purpose of the present study was to investigate the value of a new gap detection procedure called Gaps-In-Noise (GIN) for assessment of temporal resolution in a clinical population. Design: The test consists of 0 to 3 silent intervals ranging from 2 to 20 msec embedded in 6-sec segments of white noise. The location, number, and duration of the gaps per noise segment vary throughout the test for a total of 60 gaps presented in each of four lists. The GIN procedure was administered to 50 normal-hearing listeners (group I) and 18 subjects with confirmed neurological involvement of the central auditory nervous system (group II). Results: Results showed mean approximated gap detection thresholds of 4.8 msec for the left ear and 4.9 msec for the right ear for group I. In comparison, results for group II demonstrated a statistically significant increase in gap detection thresholds, with approximated thresholds of 7.8 msec and 8.5 msec being noted for the left and right ears, respectively. Significant mean differences were also observed in the overall performance scores (i.e., the identification of the presence of the gaps within the noise segments) of the two groups of subjects. Finally, psychometric functions, although similar for short and long duration gaps, were highly different for gaps in the 4- to 10-msec range for the two groups. Conclusions: A variety of psychoacoustic procedures are available to assess temporal resolution; however, the clinical use of these procedures is minimal at best. Results of the present study show that the GIN test holds promise as a clinically useful tool in the assessment of temporal resolution in the clinical arena.

Current epidemiology and management trends in acoustic neuroma

Objective: The objective of this study was to assess the epidemiology of acoustic neuroma and determine current trends in therapy using tumor registry techniques. Study Design: Analysis of a national database. Subjects and Methods: The Surveillance Epidemiology and End Results (SEER) database is a national tumor registry that began to identify and abstract benign and borderline tumors of the brain and central nervous system in the year 2004. Coding for International Classification of Diseases for Oncology (ICD-O-3) codes for schwannoma (9560/0) with collaborative staging (CS) coding for acoustic nerve (72.4) was used to identify acoustic neuromas. Demographic data, tumor size, and treatment data were analyzed. Results: A total of 1621 patients with acoustic neuroma were identified, for an incidence rate of 1.1/100,000. Mean age was 53.1 years. Tumors were equally distributed across gender and tumor laterality, with the majority (84%) occurring in Caucasians. Nine hundred sixty-four patients (59.5%) were treated with surgery, whereas 341 (21.0%) were treated with radiation. A total of 1.6 percent received combined therapy over the study period, with the remaining patients receiving either no treatment or unknown therapy. Of tumors less than 2 cm, 27.2 percent were treated with radiotherapy. Statistically significant associations were observed with the increased use of radiotherapy for small (< 2 cm) tumors (P = 0.0001). Conclusion: Unlike data from single series, which usually represent individual treatment preferences and techniques, use of SEER data allows for the assessment of demographics and treatment trends at the national level. The results and potential applications are discussed.

Delays in Diagnosis of Congenital Hearing Loss in Rural Children

OBJECTIVE To examine the incidence of pediatric congenital hearing loss and the timing of diagnosis in a rural region of hearing healthcare disparity. STUDY DESIGN Data from the Kentucky newborn hearing-screening program was accessed to determine the incidence of congenital hearing loss in Kentucky, both in the extremely rural region of Appalachia and non-Appalachian region of Kentucky. We also performed a retrospective review of records of children with congenital hearing loss at our institution to determine the timing of diagnostic testing. RESULTS In Kentucky, during 2009-2011, there were 6970 newborns who failed hearing screening; the incidence of newborn hearing loss was 1.71 per 1000 births (1.28/1000 in Appalachia and 1.87/1000 in non-Appalachia); 23.8% of Appalachian newborns compared with 17.3% of non-Appalachian children failed to obtain follow-up diagnostic testing. Children from Appalachia were significantly delayed in obtaining a final diagnosis of hearing loss compared with children from non-Appalachian regions (P = .04). CONCLUSION Congenital hearing loss in children from rural regions with hearing healthcare disparities is a common problem, and these children are at risk for a delay in the timing of diagnosis, which has the potential to limit language and social development. It is important to further assess the causative factors and develop interventions that can address this hearing healthcare disparity issue.

Assessment of Appalachian region pediatric hearing healthcare disparities and delays.

The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity.

Long-term hearing results in gamma knife radiosurgery for acoustic neuromas.

Objectives: There are many studies that have examined functional outcomes following Gamma Knife treatment; however, few have reported long‐term audiometric data. This study analyzed the long‐term hearing results of Gamma Knife radiosurgery in the treatment of acoustic neuromas.

Rural barriers to early diagnosis and treatment of infant hearing loss in Appalachia.

Objective The purpose of this study was to assess regional parental barriers in the diagnostic and therapeutic process after abnormal newborn hearing screening (NHS) testing. Study design Cross-sectional questionnaire study. Setting Tertiary medical center. Patients Parents of infants who failed NHS in Kentucky from January 2009 to February 2012. Main outcome measure Demographic information, county of origin, attitudes and perceptions regarding NHS, and barriers in the NHS diagnostic process. Results There were 460 participants in the study, which included 25.4% of parents from the Appalachian region. Twenty-one percent of Appalachian parents found the process on newborn hearing testing difficult. Appalachian parents were more likely to have no more than 12 years of education (odds ratio [OR], 1.7; p = 0.02) and Medicaid insurance (OR, 2.3; p < 0.001) compared with non-Appalachian parents. A higher percentage of Appalachian parents were unaware of the NHS results at the time of hospital discharge than non-Appalachians (14% versus 7%, p = 0.03). Distance from the diagnostic/therapeutic center represented was a significant barrier for Appalachian parents (OR, 2.8; p = 0.001). Compared with urban parents, a greater percentage of rural parents had never heard of a cochlear implant (p = 0.01). Appalachian parents expressed a strong interest in telemedicine and a desire for closer services. Conclusion Multiple barriers including education, distance, accessibility, and socioeconomic factors can affect timely diagnosis and treatment of congenital hearing loss for children residing in rural areas. Educational and telemedicine programs may benefit parents in Appalachia as well as parents in other rural areas.

Factors involved in access and utilization of adult hearing healthcare: A systematic review

Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare.

Perspectives on the Pure-Tone Audiogram

BACKGROUND The pure-tone audiogram, though fundamental to audiology, presents limitations, especially in the case of central auditory involvement. Advances in auditory neuroscience underscore the considerably larger role of the central auditory nervous system (CANS) in hearing and related disorders. Given the availability of behavioral audiological tests and electrophysiological procedures that can provide better insights as to the function of the various components of the auditory system, this perspective piece reviews the limitations of the pure-tone audiogram and notes some of the advantages of other tests and procedures used in tandem with the pure-tone threshold measurement. PURPOSE To review and synthesize the literature regarding the utility and limitations of the pure-tone audiogram in determining dysfunction of peripheral sensory and neural systems, as well as the CANS, and to identify other tests and procedures that can supplement pure-tone thresholds and provide enhanced diagnostic insight, especially regarding problems of the central auditory system. RESEARCH DESIGN A systematic review and synthesis of the literature. DATA COLLECTION AND ANALYSIS The authors independently searched and reviewed literature (journal articles, book chapters) pertaining to the limitations of the pure-tone audiogram. RESULTS The pure-tone audiogram provides information as to hearing sensitivity across a selected frequency range. Normal or near-normal pure-tone thresholds sometimes are observed despite cochlear damage. There are a surprising number of patients with acoustic neuromas who have essentially normal pure-tone thresholds. In cases of central deafness, depressed pure-tone thresholds may not accurately reflect the status of the peripheral auditory system. Listening difficulties are seen in the presence of normal pure-tone thresholds. Suprathreshold procedures and a variety of other tests can provide information regarding other and often more central functions of the auditory system. CONCLUSIONS The audiogram is a primary tool for determining type, degree, and configuration of hearing loss; however, it provides the clinician with information regarding only hearing sensitivity, and no information about central auditory processing or the auditory processing of real-world signals (i.e., speech, music). The pure-tone audiogram offers limited insight into functional hearing and should be viewed only as a test of hearing sensitivity. Given the limitations of the pure-tone audiogram, a brief overview is provided of available behavioral tests and electrophysiological procedures that are sensitive to the function and integrity of the central auditory system, which provide better diagnostic and rehabilitative information to the clinician and patient.

Timing Discrepancies of Early Intervention Hearing Services in Urban and Rural Cochlear Implant Recipients

Objective The purpose of this study was to examine the timing of early intervention diagnostic and therapeutic services in cochlear implant recipients from rural and urban areas. Study Design Retrospective case series review. Setting Tertiary referral center. Patients Cochlear implant recipients from a single comprehensive hearing institute born with severe congenital sensorineural hearing loss were examined. Timing of diagnostic and therapeutic services was examined. Intervention(s) Diagnosis, amplification, and eventual cochlear implantation for all patients in the study. Main Outcome Measure(s) Time points of definitive diagnosis, amplification, and cochlear implantation for children from urban and rural regions were examined. Correlation analysis of distance to testing center and timing of services was also assessed. Results Forty children born with congenital hearing loss were included in the study and were diagnosed at a median age of 13 weeks after birth. Children from rural regions obtained amplification at a median age of 47.7 weeks after birth, whereas urban children were amplified at 26 weeks after birth. Cochlear implantation was performed at a median age of 182 weeks after birth in those from rural areas and at 104 weeks after birth in urban-dwelling patients. A linear relationship was identified between distance to the implant center and timing of hearing aid amplification (r = 0.5, p = 0.033) and cochlear implantation (r = 0.5, p = 0.016). Conclusion Children residing outside of metro areas may be at higher risk of delayed rehabilitative services and cochlear implantation than those residing in urban areas that may be closer to tertiary care centers.

Hot or Cold? Is Monothermal Caloric Testing Useful and Cost-Effective?

Objectives: Videonystagmography (VNG) is used widely in the assessment of balance dysfunction. The full test battery can be time-consuming and can induce patient discomfort. The purpose of this study was to examine the value of monothermal caloric testing in predicting unilateral caloric weakness, as well as abnormal VNG vestibular and nonvestibular eye movement, while considering the time and reimbursement associated with these tests. Methods: In a retrospective review of 645 patients who completed a comprehensive VNG test battery with bithermal caloric testing, we calculated the specificity, sensitivity, and predictive values of monothermal caloric testing in relation to bithermal caloric results and noncaloric VNG results. Results: With unilateral vestibular weakness (UVW) defined as a 25% interear difference, warm-air monothermal caloric testing yielded a sensitivity of 87% and a negative predictive value of 90% for predicting UVW. With a 10% UVW definition, the warm-air caloric testing sensitivity increased to 95% and the negative predictive value to 92%. Warm-air monothermal caloric testing had a positive predictive value of 85% and a negative predictive value of 18% for predicting noncaloric VNG findings; cold-air monothermal and bithermal testing displayed similar results. Conclusions: Isolated monothermal testing is a sensitive screening tool for detecting UVW, but is not adequate for predicting noncaloric VNG results.