Tools for telehealth: A correlational analysis of app-based hearing testing

Objective

Telehealth evaluation of hearing is rapidly evolving; however, the lack of consensus on the most accurate remote hearing test application has made hearing evaluation complicated. The objective of this study was to evaluate the correlation between the pure tone audiometry results obtained from app-based hearing testing programs and a traditional audiogram.

Methods

A prospective within-subject and between-subject study design was used to correlate audiogram results between app-based hearing programs and a traditional audiogram. All participants completed a traditional audiogram, 1 commercial app-based test (ShoeBox), 2 consumer app-based tests (EarTrumpet and Hearing Test and Ear Age Test [HTEAT]), and a Hearing Handicap Inventory screening version (HHI-S). Testing was conducted in an acoustically controlled environment (traditional) and a quiet room (app-based hearing tests).

Results

A total of 39 participants were enrolled in the study (21 with normal hearing and 18 with hearing loss). In patients with normal hearing, only the commercial hearing testing app (ShoeBox) had a statistically significant pure tone average correlation in both ears with traditional audiometry (Right ear-r = 0.7, p = .005, Left ear-r = 0.66, p = .001). Both consumer and commercial apps had statistically significant correlations with both ears in patients with hearing loss (ranging from r = 0.62 to r = 0.9). Regarding accuracy within 10 dB of the pure tone average of the traditional audiogram of all tested ears, the commercial app-based test was accurate in 94% for all ears (normal and hearing loss), while consumer app-based tests were between 14% and 36% for all ears. The HHI-S indicated no hearing impairment in 95% of those with normal hearing and indicated hearing impairment in 89% of those with hearing loss.

Conclusion

Commercial-grade app-based pure tone audiometry demonstrates overall strong correlation and accuracy with traditional audiometry. The HHI-S assessment remains a valid and useful tool to predict normal hearing and hearing impairment.

Level of Evidence

2.

Behavioral and Hemodynamic Changes Following Dichotic Training in Patients with Neurological Deficits of the Auditory Nervous System: A Case Series

BACKGROUND

 Dichotic listening occurs when one attends to different acoustical messages presented simultaneously to both ears. This is important for understanding speech in compromised listening situations, such as background noise. Deficits in dichotic listening can be remediated by participating in auditory training. We present two patients with binaural integration deficits who underwent dichotic interaural intensity difference (DIID) training.

PURPOSE

 The purpose of this investigation is to demonstrate improvement of dichotic listening deficits following DIID training in neurological patients seen clinically for hearing issues.

RESEARCH DESIGN

 This was a case series utilizing a pre- and posttreatment design.

STUDY SAMPLE

 This case series utilized two female participants who demonstrated binaural integration deficits during an auditory processing evaluation.

INTERVENTION

 The participants underwent a pretraining auditory processing evaluation and functional magnetic resonance imaging (fMRI). Participants then underwent 12, 30-minute DIID training sessions followed by posttreatment auditory processing evaluations and fMRI.

DATA COLLECTION AND ANALYSIS

 Data was collected at the pretreatment appointment and then immediately following the completion of the training.

RESULTS

 Each patient demonstrated varying degrees of improvement on the posttreatment assessment. Case 1 showed significant improvement on the Speech-in-Noise-Revised (SPIN-R) test. fMRI showed changes in activation patterns following training. Case 2 demonstrated improved scores on the Dichotic Digits Test and SPIN-R and increased activation of the calcarine sulcus following training.

CONCLUSION

 Dichotic training can be an efficacious treatment for binaural integration deficits and may show evidence of improving speech understanding in noise. This case series demonstrates a promising therapy to help patients improve auditory function by improving dichotic listening skills.

Hormones and Hearing: Central Auditory Processing in Women

BACKGROUND

Estrogen has been identified as playing a key role in many organ systems. Recently, estrogen has been found to be produced in the human brain and is believed contribute to central auditory processing. After menopause, a low estrogen state, many women report hearing loss but demonstrate no deficits in peripheral hearing sensitivity, which support the notion that estrogen plays an effect on central auditory processing. Although animal research on estrogen and hearing loss is extensive, there is little in the literature on the human model.

PURPOSE

The aim of this study was to evaluate relationships between hormonal changes and hearing as it relates to higher auditory function in pre- and postmenopausal (Post-M) females.

RESEARCH DESIGN

A prospective, group comparison study.

STUDY SAMPLE

Twenty eight women between the ages of 18 and 70 at the University of Kentucky were recruited.

DATA COLLECTION AND ANALYSIS

Participants were separated into premenopausal and peri-/Post-M groups. Participants had normal peripheral hearing sensitivity and underwent a behavioral auditory processing battery and electrophysiological evaluation. An analysis of variance was performed to address the aims of the study.

RESULTS

Results from the study demonstrated statistically significant difference between groups, where Post-M females had difficulties in spatial hearing abilities as reflected on the Listening in Spatialized Noise Test-Sentences test. In addition, measures on the auditory brainstem response and the middle latency response reflected statistically significant differences between groups with Post-M females having longer latencies.

CONCLUSIONS

Results from the present study demonstrated significant differences between groups, particularly listening in noise. Females who present with auditory complaints in spite of normal hearing thresholds should have a more extensive audiological evaluation to further evaluate possible central deficits.

Search for gravitational waves associated with γ-ray bursts detected by the interplanetary network

We present the results of a search for gravitational waves associated with 223 γ-ray bursts (GRBs) detected by the InterPlanetary Network (IPN) in 2005-2010 during LIGO's fifth and sixth science runs and Virgo's first, second, and third science runs. The IPN satellites provide accurate times of the bursts and sky localizations that vary significantly from degree scale to hundreds of square degrees. We search for both a well-modeled binary coalescence signal, the favored progenitor model for short GRBs, and for generic, unmodeled gravitational wave bursts. Both searches use the event time and sky localization to improve the gravitational wave search sensitivity as compared to corresponding all-time, all-sky searches. We find no evidence of a gravitational wave signal associated with any of the IPN GRBs in the sample, nor do we find evidence for a population of weak gravitational wave signals associated with the GRBs. For all IPN-detected GRBs, for which a sufficient duration of quality gravitational wave data are available, we place lower bounds on the distance to the source in accordance with an optimistic assumption of gravitational wave emission energy of 10(-2)M⊙c(2) at 150 Hz, and find a median of 13 Mpc. For the 27 short-hard GRBs we place 90% confidence exclusion distances to two source models: a binary neutron star coalescence, with a median distance of 12 Mpc, or the coalescence of a neutron star and black hole, with a median distance of 22 Mpc. Finally, we combine this search with previously published results to provide a population statement for GRB searches in first-generation LIGO and Virgo gravitational wave detectors and a resulting examination of prospects for the advanced gravitational wave detectors.

Search for gravitational waves associated with γ-ray bursts detected by the interplanetary network

We present the results of a search for gravitational waves associated with 223 γ-ray bursts (GRBs) detected by the InterPlanetary Network (IPN) in 2005-2010 during LIGO's fifth and sixth science runs and Virgo's first, second, and third science runs. The IPN satellites provide accurate times of the bursts and sky localizations that vary significantly from degree scale to hundreds of square degrees. We search for both a well-modeled binary coalescence signal, the favored progenitor model for short GRBs, and for generic, unmodeled gravitational wave bursts. Both searches use the event time and sky localization to improve the gravitational wave search sensitivity as compared to corresponding all-time, all-sky searches. We find no evidence of a gravitational wave signal associated with any of the IPN GRBs in the sample, nor do we find evidence for a population of weak gravitational wave signals associated with the GRBs. For all IPN-detected GRBs, for which a sufficient duration of quality gravitational wave data are available, we place lower bounds on the distance to the source in accordance with an optimistic assumption of gravitational wave emission energy of 10(-2)M⊙c(2) at 150 Hz, and find a median of 13 Mpc. For the 27 short-hard GRBs we place 90% confidence exclusion distances to two source models: a binary neutron star coalescence, with a median distance of 12 Mpc, or the coalescence of a neutron star and black hole, with a median distance of 22 Mpc. Finally, we combine this search with previously published results to provide a population statement for GRB searches in first-generation LIGO and Virgo gravitational wave detectors and a resulting examination of prospects for the advanced gravitational wave detectors.

Early warnings of regime shifts: a whole-ecosystem experiment

Catastrophic ecological regime shifts may be announced in advance by statistical early warning signals such as slowing return rates from perturbation and rising variance. The theoretical background for these indicators is rich, but real-world tests are rare, especially for whole ecosystems. We tested the hypothesis that these statistics would be early warning signals for an experimentally induced regime shift in an aquatic food web. We gradually added top predators to a lake over 3 years to destabilize its food web. An adjacent lake was monitored simultaneously as a reference ecosystem. Warning signals of a regime shift were evident in the manipulated lake during reorganization of the food web more than a year before the food web transition was complete, corroborating theory for leading indicators of ecological regime shifts.

An exceptionally bright flare from SGR 1806–20 and the origins of short-duration γ-ray bursts

Soft-gamma-ray repeaters (SGRs) are galactic X-ray stars that emit numerous short-duration (about 0.1 s) bursts of hard X-rays during sporadic active periods. They are thought to be magnetars: strongly magnetized neutron stars with emissions powered by the dissipation of magnetic energy. Here we report the detection of a long (380 s) giant flare from SGR 1806-20, which was much more luminous than any previous transient event observed in our Galaxy. (In the first 0.2 s, the flare released as much energy as the Sun radiates in a quarter of a million years.) Its power can be explained by a catastrophic instability involving global crust failure and magnetic reconnection on a magnetar, with possible large-scale untwisting of magnetic field lines outside the star. From a great distance this event would appear to be a short-duration, hard-spectrum cosmic gamma-ray burst. At least a significant fraction of the mysterious short-duration gamma-ray bursts may therefore come from extragalactic magnetars.

Development of reading proficiency in English by bilingual children and their monolingual peers

The semantic, syntactic, and graphophonic cueing techniques employed by 55 bilingual children and 39 monolingual peers when reading aloud in English were identified through miscue analysis. In contrast to earlier research in 1999 by Cline and Cozens no significant differences were found between the two groups on any of the techniques. Both bilingual and monolingual readers consistently used more graphophonic cues than syntactic or semantic cues but not significantly so. The authors discuss possible extraneous variables which may account in part for this unexpected result.

Interplanetary Network Localization of GRB 991208 and the Discovery of its Afterglow

The extremely energetic ( approximately 10-4 ergs cm-2) gamma-ray burst (GRB) of 1999 December 8 was triangulated to an approximately 14 arcmin2 error box approximately 1.8 days after its arrival at Earth with the third interplanetary network (IPN), which consists of the Ulysses, Near-Earth Asteroid Rendezvous, and Wind spacecraft. Radio observations with the Very Large Array approximately 2.7 days after the burst revealed a bright fading counterpart whose position is consistent with that of an optical transient source with a redshift of 0.707. We present the time history, peak flux, fluence, and refined 1.3 arcmin2 error box of this event and discuss its energetics. This is the first time that a counterpart has been found for a GRB localized only by the IPN.

Prompt Optical Observations of Gamma-Ray Bursts

The Robotic Optical Transient Search Experiment (ROTSE) seeks to measure simultaneous and early afterglow optical emission from gamma-ray bursts (GRBs). A search for optical counterparts to six GRBs with localization errors of 1 deg2 or better produced no detections. The earliest limiting sensitivity is mROTSE>13.1 at 10.85 s (5 s exposure) after the gamma-ray rise, and the best limit is mROTSE>16.0 at 62 minutes (897 s exposure). These are the most stringent limits obtained for the GRB optical counterpart brightness in the first hour after the burst. Consideration of the gamma-ray fluence and peak flux for these bursts and for GRB 990123 indicates that there is not a strong positive correlation between optical flux and gamma-ray emission.

Multilingualism and dyslexia: challenges for research and practice

Over the last two decades there has been an expansion of activity and substantial progress in research on dyslexia and research on bilingualism and multilingualism. But the study of dyslexia has generally focused on monolingual learners and the study of bilingualism has tended to focus on speakers who do not have special educational needs. This paper will review the strands of research to date that have a bearing on multilingualism and dyslexia and attempt to identify the major challenges that face researchers and teachers. A satisfactory response cannot be developed without a full understanding of the impact that dyslexia has on language learning and the impact that multilingualism has on literacy learning.

The impact of gender on primary teachers' evaluations of children's difficulties in school

BACKGROUND

More boys than girls receive provision to meet special educational needs. It has been suggested that teachers' evaluations of children's difficulties in school may be subject to gender bias. But the evidence is inconsistent, and the methodology of some work that reported bias has been criticised because the type of rating task that was used may have encouraged stereotypic thinking (Langfeldt, 1993).

AIMS

This study investigated whether gender of child would still have an influence on teacher's judgments if a fuller context was provided for the stimulus and there was a more realistic rating task.

SAMPLES

The sample comprised 523 teachers in 79 primary schools in London, the home counties and the North-West of England.

METHODS

Participants completed questionnaires on what action might be required in their school for children with difficulties who were described in short vignettes. The children's gender was varied systematically. The construct of 'seriousness', which had generally been left vague in earlier research, was given a concrete definition.

RESULTS

It was found that, when the experimental task was contextualised in this way, the gender-of-child effect disappeared. Teacher characteristics such as gender did not influence the results.

CONCLUSIONS

These findings should be treated with some caution as they relate to the small and restricted range of types of difficulty that were included in the study and to a sample of primary schools in one society. However, they give support to an emphasis on 'realism' in the method of investigation that is used for exploring teachers' judgments.

Clinical judgement in context: a review of situational factors in person perception during clinical interviews

The literature on the clinical interview and clinical judgement has generally tended to ignore relevant research in social psychology. It is argued that the basic psychological processes involved in clinical judgement can be compared with those involved in everyday social judgement. This review summarises evidence on the sophistication and complexity of clinical judgement and on the likely impact on it of a number of factors: the judge's personality, the stimulus background, institutional norms, objectives in the interview, and the interaction process as influenced by situational factors. It is suggested that a model of clinical judgement is required that can encompass, interpret and find value in the artifacts of the clinician's situation.

Temperature-sensitive mutants of bioluminescent bacteria

Mutants of a marine luminous bacterium, in which the ability to emit light is conditional upon temperature, have been isolated. The mutants obtained fall into three classes, which are readily distinguishable by both in vivo and in vitro criteria. In one class an altered, more temperature-sensitive luciferase is produced; in a second, the luciferase is actually not produced at the higher temperature. The third is defective in the production of an aldehyde-like factor that is a known requirement in the in vitro reaction.