Test-Retest Reliability of Word Recognition Score Using Korean Standard Monosyllabic Word Lists for Adults as a Function of the Number of Test Words

A Comparative Study Using Vestibular Mapping in Sudden Sensorineural Hearing Loss With and Without Vertigo

OBJECTIVE

To investigate the impairment patterns in peripheral vestibular organs in sudden sensorineural hearing loss (SSNHL) with and without vertigo.

STUDY DESIGN

Retrospective study.

SETTING

Single tertiary medical center.

METHODS

Data from 165 SSNHL patients in a tertiary referral center from January 2017 to December 2022 were retrospectively analyzed. All patients underwent a video head impulse test, vestibular evoked myogenic potential test, and pure-tone audiometry. Hierarchical cluster analysis was performed to investigate vestibular impairment patterns. The prognosis of the hearing was determined using American Academy of Otolaryngology-Head and Neck Surgery recommendations.

RESULTS

After excluding patients with vestibular schwannoma and Meniere's disease, 152 patients were included in this study. A total of 73 of 152 patients were categorized as SSNHL with vertigo (SSNHL_V) and showed an independent merge of the posterior semicircular canal (PSCC) in cluster analysis. A total of 79 of 152 patients were categorized as SSNHL without vertigo (SSNHL_N) and showed an independent merge of saccule in cluster analysis. The PSCC (56.2%) and saccule (20.3%) were the most frequently impaired vestibular organs in SSNHL_V and SSNHL_N, respectively. In terms of prognosis, 106 of 152 patients had partial/no recovery and showed an independent merge of the PSCC in cluster analysis. A total of 46 of 152 patients had a complete recovery and showed an independent merge of the saccule in cluster analysis.

CONCLUSION

A tendency of isolated PSCC dysfunction was seen in SSNHL_V and partial/no recovery. A tendency of isolated saccular dysfunction was seen in SSNHL_N and complete recovery. Different treatments might be needed in SSNHL depending on the presence of vertigo.

A Greek Pediatric Word Recognition Test by Picture Identification

(1) Background: The study aimed to construct a clinically valuable closet-set WRS test with a picture identification task for young Greek-speaking children. (2) Methods: The test material was meticulously designed based on specific criteria. To determine which parts of speech are used more frequently by preschool children, a spontaneous speech sample (250 words per child) was acquired from three hundred children aged 3 to 6 years (M = 4.56, SD = 0.90). The study involved the development and application of two phonemically balanced 50-word lists suitable for young children, as well as the creation of picture representations for each response set. All testing was accomplished in an audiometric booth that exceeded the audiometric rooms' ambient noise level standards. The speech signal was routed from a laptop computer to a GSI 61 audiometer, and all test items were delivered from the audiometer to the subject. (3) Results: The results indicated that materials for a WRS test for young children are developed with high face validity and are applicable for children as young as three years old. The test satisfies the essential components needed for a WRS test. It consists of two phonemically balanced 50-word lists with low-redundancy bisyllabic words, with each list containing 227 phonemes. (5) Conclusions: This novel closed-set WRS test presents a valuable tool for assessing speech perception skills in young Greek-speaking children. The test results have various applications, including diagnosis, research, and (re)habilitation.

Assessment of Binaural Benefits in Hearing and Hearing-Impaired Listeners

PURPOSE

The purpose of this study was to (a) investigate which speech material is most appropriate as stimulus in head shadow effect (HSE) and binaural squelch (SQ) tests, (b) obtain normative values of both tests using the material decided to be optimal, and (c) explore the results in bilateral cochlear implant (CI) users.

METHOD

Study participants consisted of 30 normal-hearing (NH) persons and 34 bilateral CI users. This study consisted of three phases. In the first phase, three different speech materials (1) monosyllabic words, (2) spondee words, and (3) sentences were compared in terms of (a) effect size, (b) test-retest reliability, and (c) interindividual variability. In the second phase, the speech material selected in the first phase was used to test a further 24 NHs to obtain normative values for both tests. In the third phase, tests were administered to a further 23 bilateral CI users, together with localization test and the Speech, Spatial, and Qualities of Hearing scale.

RESULTS

The results of the first phase indicated that spondees and sentences were more robust materials compared with monosyllables. Although the effect size and interindividual variability were comparable for spondees and sentences, sentences had higher test-retest reliability in this sample of CI users. With sentences, the mean (± standard deviation) HSE and SQ in the NH group were 58 ± 14% and 22 ± 11%, respectively. In the CI group, the mean HSE and SQ were 49 ± 13% and 13 ± 14%, respectively. There were no statistically significant correlations between the test results and the interval between the implantations, the length of binaural listening experience, or the asymmetry between the ears.

CONCLUSIONS

Sentences are preferred as stimulus material in the binaural HSE and SQ tests. Normative data are given for HSE and SQ with the LiCoS (linguistically controlled sentences) test. HSE is present for all bilateral CI users, whereas SQ is present in approximately seven out of 10 cases.

Effects of face masks and acoustical environments on speech recognition by preschool children in an auralised classroom

The potential impact of mask-wearing specifically on early-childhood speech and language development in classrooms has not been widely reported yet, although face masks are compulsory even in educational settings during the COVID-19 pandemic. This study investigated the combined effects of face-mask usage (no mask, surgical and KF94 masks) and room acoustics (RT 0.6 s and 1.2 s, SNR 12 dB and 22 dB) on speech recognition (KS-MWL-P) in preschool children (N = 67) in realistic classroom-acoustic settings using the auralisation technique. The face mask and reverberation time affected pre-schoolers' speech recognition scores. Reducing RT in the classroom improved the pre-schoolers' speech recognition that was reduced by face masks. Children aged 4 and 5 years were affected by face masks and RT more significantly than children aged 6 years. Appropriate room acoustics for classrooms and clear speech of teachers are recommended for better speech recognition in preschool, where pre-schoolers' language and speech development usually occur.

Real-World Effectiveness of Wearable Augmented Reality Device for Patients With Hearing Loss: Prospective Study

Background

Hearing loss limits communication and social activity, and hearing aids (HAs) are an efficient rehabilitative option for improving oral communication and speech comprehension, as well as the psychosocial comfort of people with hearing loss. To overcome this problem, over-the-counter amplification devices including personal sound amplification products and wearable augmented reality devices (WARDs) have been introduced.

Objective

This study aimed to evaluate the clinical effectiveness of WARDs for patients with mild to moderate hearing loss.

Methods

A total of 40 patients (18 men and 22 women) with mild to moderate hearing loss were enrolled prospectively in this study. All participants were instructed to wear a WARD, Galaxy Buds Pro (Samsung Electronics), at least 4 hours a day for 2 weeks, for amplifying ambient sounds. Questionnaires including the Korean version of the abbreviated profile of hearing aid benefit (K-APHAB) and the Korean adaptation of the international outcome inventory for hearing aids (K-IOI-HA) were used to assess personal satisfaction in all participants. Audiologic tests, including sound field audiometry, sound field word recognition score (WRS), and the Korean version of hearing in noise test (K-HINT), were administered to 14 of 40 patients. The tests were performed under two conditions: unaided and aided with WARDs.

Results

The mean age of the participants was 55.4 (SD 10.7) years. After 2 weeks of the field trial, participants demonstrated a benefit of WARDs on the K-APHAB. Scores of 3 subscales of ease of communication, reverberation, and background noise were improved significantly (P<.001). However, scores regarding aversiveness were worse under the aided condition (P<.001). K-IOI-HA findings indicated high user satisfaction after the 2-week field trial. On audiologic evaluation, the K-HINT did not show significant differences between unaided and aided conditions (P=.97). However, the hearing threshold on sound field audiometry (P=.001) and the WRS (P=.002) showed significant improvements under the aided condition.

Conclusions

WARDs can be beneficial for patients with mild to moderate hearing loss as a cost-effective alternative to conventional hearing aids.

Heparin therapy as adjuvant treatment for profound idiopathic sudden sensorineural hearing loss

OBJECTIVES/HYPOTHESIS

This study aimed to provide evidence of whether unfractionated heparin used as adjuvant therapy in conjunction with systemic corticosteroid therapy improves hearing recovery in patients with profound idiopathic sudden sensorineural hearing loss (ISSNHL), and to compare the effect of this treatment with those of additional intratympanic corticosteroid therapy.

STUDY DESIGN

Retrospective chart review.

METHODS

Eighty-seven patients with profound ISSNHL (≥90 dB) and who had been admitted at a tertiary referral center between 2010 and 2018 were retrospectively reviewed, 67 patients for additional intratympanic corticosteroid injection (ITSI) (ITSI group) and 21 for adjuvant heparin therapy (heparin group). Hearing recovery was evaluated by grade assessment according to the American Academy of Otolaryngology-Head and Neck Surgery criteria.

RESULTS

Of the patients in the heparin group, 42.8% recovered serviceable hearing, which was significantly higher than the recovery rates (19.7%) of those in the ITSI group. Particularly, in patients with pretreatment hearing level of 90 to 100 dB, adjuvant heparin therapy enhanced therapeutic effects with a significant hearing recovery rate of 80%. However, in patients with initial hearing level >100 dB, the rates of significant hearing recovery in the two groups were roughly equal and remained unsatisfactory (8.1% in the ITSI group and 9.1% in the heparin group).

CONCLUSIONS

The results of this study suggest that the treatment of profound ISSNHL with adjuvant heparin therapy, in combination with systemic steroid therapy, results in higher hearing recovery rates when compared to combined local and systemic corticosteroid therapy, without serious complications.

LEVEL OF EVIDENCE

3b Laryngoscope, 130:1310-1315, 2020.

Predicting cochlear dead regions in patients with hearing loss through a machine learning-based approach: A preliminary study

We propose a machine learning (ML)-based model for predicting cochlear dead regions (DRs) in patients with hearing loss of various etiologies. Five hundred and fifty-five ears from 380 patients (3,770 test samples) diagnosed with sensorineural hearing loss (SNHL) were analyzed. A threshold-equalizing noise (TEN) test was applied to detect the presence of DRs. Data were collected on sex, age, side of the affected ear, hearing loss etiology, word recognition scores (WRS), and pure-tone thresholds at each frequency. According to the cause of hearing loss as diagnosed by the physician, we categorized the patients into six groups: 1) SNHL with unknown etiology; 2) sudden sensorineural hearing loss (SSNHL); 3) vestibular schwannoma (VS); 4) Meniere's disease (MD); 5) noise-induced hearing loss (NIHL); or 6) presbycusis or age-related hearing loss (ARHL). To develop a predictive model, we performed recursive partitioning and regression for classification, logistic regression, and random forest. The overall prevalence of one or more DRs in test ears was 20.36% (113 ears). Among the 3,770 test samples, the overall frequency-specific prevalence of DR was 6.7%. WRS, pure-tone thresholds at each frequency, disease type (VS or MD), and frequency information were useful for predicting DRs. Sex and age were not associated with detecting DRs. Based on these results, we suggest possible predictive factors for determining the presence of DRs. To improve the predictive power of the model, a more flexible model or more clinical features, such as the duration of hearing loss or risk factors for developing DRs, may be needed.

Association of Cardiovascular Comorbidities With Hearing Loss in the Older Old

Importance

In the United States, the population of individuals older than 80 years is expected to double in the next 40 years. Cardiovascular comorbidities are prevalent in this older old population, and their relationship with hearing loss has not been well characterized.

Objective

To investigate the association of cardiovascular disease (CVD)-related risk factors with auditory function among the older old (>80 years).

Design, Setting, and Participants

Audiological data and medical records from 2001 through 2014 of 433 patients aged 80 to 106 years at an academic medical center were analyzed in 2017.

Main Outcomes and Measures

The degree of low- and high-frequency hearing loss of participants with coronary artery disease, diabetes, hypertension, history of cerebrovascular accident, and smoking status was compared with that of disease-free individuals. Rate of hearing loss was also determined.

Results

Among the 433 patients (67% female; mean [SD] age, 89 [5.8] years), the presence of at least 1 cardiovascular morbidity was associated with elevated mean (SD) low-frequency pure-tone average (LFPTA) of 42.4 (1.6) vs 36.9 (3.5) decibels hearing loss (dB HL), a difference of 5.47 (95% CI, 4.15-9.49) dB HL. Among the 96 patients with 2 audiograms performed at age 80 years or older from which the rate of hearing loss could be calculated, 32 patients had CVD or related risk factors and 64 were healthy controls. Those with at least 1 disease had accelerated hearing loss. Patients with cardiovascular morbidity experienced a faster mean (SD) decline in LFPTA of 1.90 (0.27) vs 1.18 (0.42) dB HL/y, a difference of 0.72 (95% CI, 0.08-1.36) dB HL/y. Of the conditions studied, coronary artery disease had the highest association with audiometric thresholds and was associated with hearing loss at all frequencies tested and with poor word recognition score. Hearing loss was more strongly associated with CVD risk factors in men than in women.

Conclusions and Relevance

In this study of the older old, cardiovascular risk factors and disease were associated with worse hearing and a greater rate of hearing deterioration. Hearing loss in women was less associated with the presence of CVD, possibly owing to the cardioprotective effects of estrogen. The association of hearing with CVD severity and management remains to be determined.

Test-Retest Reliability of Word Recognition Score Using Korean Standard Monosyllabic Word Lists for Adults as a Function of the Number of Test Words

BACKGROUND AND OBJECTIVES

The purpose was to establish the test-retest reliability of word recognition score (WRS) using Korean standard monosyllabic word lists for adults (KS-MWL-A) recently developed based on the international standard for speech audiometry (ISO 8253-3:2012).

SUBJECTS AND METHODS

Subjects consisted of 159 adults aged to 18 to 25 years with normal hearing sensitivity. WRSs were obtained in 2 dB steps from the level of speech recognition thresholds to the level of 86% correct responses or greater. After one or two weeks, retest was performed. Correlation, confidence interval (CI) and prediction interval (PI) were calculated for the reliability.

RESULTS

Correlation coefficients were 0.88 for 50 test words, 0.76 for 25 and 0.61 for 10 words. Results also showed that 95% CIs and PIs were narrower for 25 and 50 test words than those for 10 test words.

CONCLUSIONS

Korean WRS using the KS-MWL-A has high reliability for 25 and 50 test words, but relatively low for 10 words. It suggested that 95% CIs for each test words would be criteria for significant differences in WRS for groups and 95% PIs at each score of WRS could be utilized for a considerable difference for each individual at retest.