Ross J. Roeser

Clinical experience with tinnitus maskers

Results from tinnitus evaluations and follow-up questionnaires were used in an effort to assess the efficacy of tinnitus masking units as a means of providing active and/or passive relief for patients experiencing problematical tinnitus. Nine of 34 patients (26%) who were felt to be candidates for masking units reported that they were receiving some form of relief from their tinnitus.

Evaluating changes in the communication skills of deaf children using vibrotactile stimulation

Results of a 9-mo longitudinal study designed to evaluate the efficacy of a vibrotactile aid, the SRA-l o, with four profoundly deaf preschool children are reported. During the study the subjects were enrolled in 30-min triweekly language therapy sessions, and changes in communication skills in connected discourse (vocalization only, sign language only, and vocalization PIUS sign language) were measured using a computer-based observation system. Changes in structural and semantic aspects of language were also measured. The four subjects were evaluated during one 16-week phase in which the aid was used (aid-on condition) and another 8 weeks in duration in which the aid was not used (aid-off condition). Communication skills improved in the aid-on condition and decreased in the aid-off condition. The changes were found to be significant for the communication involving the vocalization plus sign language (Total Communication) measure, indicating that the vibrotactile stimulation was Positively associated with the communicative act.

What Audiologists Must Know About Cerumen and Cerumen Management.

The Legislative Council of the American Speech-Language-Hearing Association recently accepted several scope of practice statements, including one concerned with external auditory canal examination and cerumen management by audiologists (Asha, 1992). Now that cerumen management is encompassed within the scope of practice of audiology, audiologists must know about cerumen-its physiology and pathophysiology, its effect on the practice of audiology, and its management. The purpose of this paper is to review the physiology and pathophysiology of cerumen production and to describe a procedure proven safe and effective for managing cerumen.

Dichotic consonant-vowel (CV) perception in normal and learning-impaired children.

Two experiments were performed using dichotic presentation of the consonant-vowel (CV) syllables /pa/, /ba/, /ta/, /da/, /ka/, and /ga/. The stimuli were constructed with no temporal offsets between channels (±2 msec) and with temporal offsets of 30, 60, and 90 msec between channels. Data were analyzed for ear asymmetry (right ear advantage), doublecorrect responses (auditory capacity), and the effects of temporal offsets (the lag effect). In experiment 1, 32 normal children (mean age at entry = 6 yrs 6 mos) were evaluated once each year over a 4-yr period. Results showed no significant change in ear laterality over the 4 yrs. However, there was a significant, age-related increase in auditory capacity. None of the subject groups showed a significant lag effect. In experiment 2 results from 17 children (mean age = 9.3 yrs) enrolled in a school for learning disability who were identified as having significant auditory processing problems were compared to age- and sex-matched normal controls. Results failed to show a significant group difference for ear asymmetry, auditory capacity, or the lag effect. Case studies are presented comparing two learning-disabled children with two normal children matched for age and sex to illustrate the results for the learning-impaired population. Overall, findings indicate that the dichotic CV syllables test has limited prognostic value in identifying auditory processing dysfunction in children classified as having “learning disability.”

A modified polymer foam earplug for the hearing aid evaluation

Functional gain was compared with 12 subjects using three earmold conditions: an E-A-R polymer foam earplug modified for use with a hearing aid, a personal custom earmold, and a best-fit receiver-type stock earmold. Functional gain was equivalent between the modified E-A-R earplug and the custom earmold conditions. The stock earmold condition resulted in a significant shunting of low-frequency amplification. The gain control of the personal hearing aids could be adjusted to the user comfort level gain setting without resulting in acoustic feedback in only the modified E-A-R earplug and custom earmold conditions. These findings are discussed relative to the hearing aid evaluation.

The use and misuse of ‘America’ and the JCR impact factor

When she was accepted into the U.S. Peace Corps, my daughter was assigned to Ecuador, South America. She immediately began studying Spanish and South American culture, and one day came home and asked me, ‘‘How many American families do you think speak Spanish as their primary language in their homes?’’ My answer was certainly no more than 6 8%, or possibly even less. However, I was astonished when I found out that the number is more like 85 90%! You see, we in the USA think of ‘America’ as the continental United States*we seem to forget that in addition to North America, Central and South America are a significant part of America. The USA makes up only a small portion of the land area of the Americas. To put it into perspective, the land area of the entire continental United States can fit within the South American country of Brazil. Over the years, those of us living in the USA have used the term ‘America’ very specifically to refer only to the USA, ignoring our fellow North American, Central, and South American neighbors. I have pledged sensitivity to this issue and remind my fellow colleagues of the proper use of the term whenever needed. So, how does the misuse of ‘America’ relate to the Journal Citation Reports (JCR) impact factor? The JCR impact factor was first reported in 1963 as a method of counting references as a simple means of rating scientific journals (Garfield, 1999). The idea was to provide a straightforward useful index of a journal’s ability to attract the best papers. Unfortunately, like so many other measures that try to quantify complex issues with a single number, the significance of the JCR impact factor has been over interpreted. It is now used for multiple reasons, some of which are inappropriate. An interpretation of the quality of an author’s work, or whether research funding should be provided, or promotion and tenure decisions for a university faculty may sometimes be based on the impact factors of the journals where an author has published. This seems to me to be highly inappropriate. Providing evidence on the impact factor to support my opinion needs only a quick bit of math. The impact factor is a simple ratio obtained from dividing citations received in one year by papers published in the two previous years IN THE SAME JOURNAL. IJA’s impact factor for 2005 was 0.896, which was derived using the following data:

Moderate-to-severe hearing loss with an island of normal hearing.

A case study is presented illustrating an island of hearing sensitivity within the range of normal limits, between 1000 and 2000 Hz, in a child with an otherwise moderately severe flat sensorineural hearing loss. The area of near normal hearing sensitivity was first detected at age 8 yr, 11 mo. Before the discovery, the discrepancies between pure-tone and speech audiometry, in the hearing aid evaluation and the childs speech and language skills, had created significant confusion resulting in multiple reevaluations and significant misdiagnosis by several clinicians.

Pure tone audiometry in noise with auraldomes.

Pure tone thresholds were obtained using a TDH-39 driver mounted in a standard (MX-41/AR) cushion and an Auraldome (AR-100-R) circumaural enclosure. Thresholds were recorded in quiet and in the presence of broad band sound field noise at 50, 60, and 70 dB SPL. No significant differences were observed between the two earphone conditions in the presence of any of the ambient broad band noise levels. However, thresholds were found to be statistically different in the quiet condition. These results raise questions regarding the calibration of intensity for Auraldomes and indicate that this particular circumaural cushion provides no advantage over standard cushions in the presence of ambient noise above 50 dB SPL.

The audiogram: Upside down?

In this issue Dr. Jim Jerger provides us with an historical perspective on one of the most often used and valued diagnostic tools in audiology: The audiogram. In his article, Dr. Jerger describes the beginnings of the development of the audiogram and, based on traditional scientifi c graphics, it became backwards, or upside down. Before reading Dr. Jerger ’ s thought provoking contribution I personally never questioned the way the data on the audiogram appears, because this is the way it was presented to me from the fi rst I was introduced to audiometry and the audiogram — it never occurred to me to think that it is was backwards. But, based on conventional logic, Dr. Jerger makes the point clear that the audiogram truly can be considered upside down. Along these lines, one thing that has always been confusing is the terms used to describe results from pure-tone threshold audiometry. Some use “ higher ” and “ lower ” to represent how the symbols that appear on the audiogram form, so that higher means poorer hearing and lower means better hearing. However, psycho acousticians use the term “ lower ” to mean better hearing and “ higher ” to mean poorer hearing. As a result, one can totally miss the meaning of information that uses higher or lower when describing audiometric thresholds. When such terms are used, it is always best to ask for clarifi cation. Otherwise, the audiologist who is pleased to know that a patient ’ s thresholds are higher will be disappointed to learn that hearing has worsened, rather than improved. Better yet, to prevent confusion on these terms, the convention should be to avoid using them, and refer to either better or poorer hearing or thresholds. That way, there is no confusion about the intended meaning. No matter how we view the audiogram, even with its known limitations, it is considered the “ gold standard ” for audiological diagnosis. Virtually every patient undergoing diagnostic audiological testing has pure-tone threshold audiometry, and data are displayed on the audiogram. Dr. Jerger ’ s article now gives us a clear historical understanding of how the audiogram is the way it is, and makes us think more carefully about how it is displayed.

Discussion papers to present editorial/author comments

The International Journal of Audiology ’s peer review process for submitted manuscripts involves obtaining comments from two to four seasoned reviewers to determine their suitability for publication. While the process is relatively well-defined, it can be quite involved, sometimes requiring a paper to be sent to reviewers and authors for numerous substantive and structural revisions. The outcome (whether to accept the paper or not) is always unpredictable from the start, but for the most part there is general agreement among the reviewers regarding the suitability of the material so that a decision can be made by the assigned editor in concert with the Editor-in-Chief. On occasion, the decision on a submission can become quite controversial, based on philosophical differences and/or technical perspectives. For these occasional papers, the manuscript represents a high quality contribution that adds significantly to the scientific and clinical literature, but reviewers differ significantly regarding the appropriateness of the material due to different orientations. No one is ‘‘right’’ or ‘‘wrong’’. A solution for manuscripts falling into this category is to publish them, but also to allow the reviewers who have differing opinions to express them, and the author(s) to respond. In some journals, such dialogue might appear as a ‘‘Letter to the Editor’’ in subsequent issues of the journal. However, only readers who are diligent in reading each issue are exposed to the dialogue following the initial publication*/some may never see it. In this issue, IJA will begin publishing ‘‘Discussion Papers’’. For this type of paper, reviewers who have valid philosophical differences with high quality papers covering controversial issues will provide their points of view, and the submitting author(s) will respond*/in the same issue of the journal following the paper. As readers will see, Dr Debbie Moncrieff presents data on the topic of auditory processing disorders, and Dr Robert Keith offers his differing views. What better topic than auditory processing disorders to launch this new type of paper? Readers’ views on this new type of format would be most welcomed.