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Hearing Disorders: HELP
Articles by Vijayalakshmi Easwar
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, Vijayalakshmi Easwar wrote the following 11 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 Review Binaural integration: a challenge to overcome for children with hearing loss. 2017

Gordon, Karen A / Cushing, Sharon L / Easwar, Vijayalakshmi / Polonenko, Melissa J / Papsin, Blake C. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada. ·Curr Opin Otolaryngol Head Neck Surg · Pubmed #29049038.

ABSTRACT: PURPOSE OF REVIEW: Access to bilateral hearing can be provided to children with hearing loss by fitting appropriate hearing devices to each affected ear. It is not clear, however, that bilateral input is properly integrated through hearing devices to promote binaural hearing. In the present review, we examine evidence indicating that abnormal binaural hearing continues to be a challenge for children with hearing loss despite early access to bilateral input. RECENT FINDINGS: Behavioral responses and electrophysiological data in children, combined with data from developing animal models, reveal that deafness in early life disrupts binaural hearing and that present hearing devices are unable to reverse these changes and/or promote expected development. Possible limitations of hearing devices include mismatches in binaural place, level, and timing of stimulation. Such mismatches could be common in children with hearing loss. One potential solution is to modify present device fitting beyond providing audibility to each ear by implementing binaural fitting targets. SUMMARY: Efforts to better integrate bilateral input could improve spatial hearing in children with hearing loss.

2 Article Impact of Consistency in Daily Device Use on Speech Perception Abilities in Children with Cochlear Implants: Datalogging Evidence. 2018

Easwar, Vijayalakshmi / Sanfilippo, Joseph / Papsin, Blake / Gordon, Karen. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada. · Collaborative Program in Neuroscience, The University of Toronto, Toronto, ON, Canada. · Otolaryngology, The Hospital for Sick Children, Toronto, Toronto, ON, Canada. · Otolaryngology, The University of Toronto, Toronto, Toronto, ON, Canada. ·J Am Acad Audiol · Pubmed #30278868.

ABSTRACT: BACKGROUND: Cochlear implants (CIs) give children with severe to profound hearing loss access to sound. There appears to be a dose effect of sound exposure on speech perception abilities as shown by the positive influence of early implantation and CI experience. The consistency in device use per day could also affect sound dose, potentially affecting perceptual abilities in children with CIs. PURPOSE: The objectives of the present study were to identify the impact of consistency in device use on: (1) speech perception abilities and (2) asymmetry in speech perception abilities between bilateral CIs. RESEARCH DESIGN: Retrospective analysis. STUDY SAMPLE: To achieve the first objective, data from 65 children (age range at speech test: 1.91-18.05 yrs) with one (unilaterally implanted or bimodal) or two CIs (sequentially or simultaneously implanted) were included. A subset of data from 40 children with bilateral CIs was included to achieve the second objective. Of the 40 children with two CIs, 15 received their CIs sequentially. DATA COLLECTION AND ANALYSIS: Device use information was extracted from datalogs stored in personal speech processors using custom software. Speech perception scores per CI collected in quiet were also evaluated. Multiple regression was used to assess the impact of daily CI use, while controlling for factors previously identified to affect speech perception: age at speech test, length of pre-CI (acoustic) hearing experience, length of CI hearing experience, and order of CI for the first objective, and CI category (simultaneous/sequential implantation), interimplant delay, and length of CI experience for the second objective. RESULTS: On average, children wore their CIs for 11.59 ± 2.86 hours/day and, with one CI, exhibited 65.07 ± 22.64% accuracy on speech perception tests. Higher monaural speech perception scores were associated with longer everyday CI use and CI experience (p < 0.05). Among children with bilateral CIs, those with simultaneously implanted CIs and similar bilateral hearing experience demonstrated a small but significant right ear advantage with higher speech perception scores when using the right rather than left CI (mean difference = 4.55 ± 9.83%). The asymmetry in speech perception between CIs was larger and more variable in children who received their CIs sequentially (mean difference CI1-CI2 = 27.48 ± 24.87%). These asymmetries decreased with longer/consistent everyday use of the newer CI (p < 0.05). Yet, despite consistent everyday device use of the second CI (>12 hours/day), only a small proportion of children implanted sequentially (one out of seven children) achieved symmetrical function similar to children with simultaneously received bilateral CIs. CONCLUSIONS: Consistent everyday CI use contributes to higher speech perception scores. Although consistent CI use can help reduce the asymmetry in speech perception abilities of children with sequentially implanted CIs subsequent to interimplant delay, residual asymmetry often persists.

3 Article Cortical Processing of Level Cues for Spatial Hearing is Impaired in Children with Prelingual Deafness Despite Early Bilateral Access to Sound. 2018

Easwar, Vijayalakshmi / Yamazaki, Hiroshi / Deighton, Michael / Papsin, Blake / Gordon, Karen. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Room 6D08, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. veaswar@nca.uwo.ca. · Collaborative Program in Neuroscience, University of Toronto, Toronto, Canada. veaswar@nca.uwo.ca. · Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Room 6D08, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. · Department of Otolaryngology, University of Toronto, Toronto, Canada. · Department of Otolaryngology, The Hospital for Sick Children, Toronto, Canada. ·Brain Topogr · Pubmed #29119311.

ABSTRACT: Bilateral cochlear implantation aims to restore binaural hearing, important for spatial hearing, to children who are deaf. Improvements over unilateral implant use are attributed largely to the detection of interaural level differences (ILDs) but emerging evidence of impaired sound localization and binaural fusion suggest that these binaural cues are abnormally coded by the auditory system. We used multichannel electroencephalography (EEG) to assess cortical responses to ILDs in two groups: 13 children who received early bilateral cochlear implants (CIs) simultaneously, known to protect the developing auditory cortices from unilaterally driven reorganization, and 15 age matched peers with normal hearing. EEG source analyses indicated a dominance of right auditory cortex in both groups. Expected reductions in activity to ipsilaterally weighted ILDs were evident in the right hemisphere of children with normal hearing. By contrast, cortical activity in children with CIs showed: (1) limited ILD sensitivity in either cortical hemisphere, (2) limited correlation with reliable behavioral right-left lateralization of ILDs (in 10/12 CI users), and (3) deficits in parieto-occipital areas and the cerebellum. Thus, expected cortical ILD coding develops with normal hearing but is affected by developmental deafness despite early and simultaneous bilateral implantation. Findings suggest that impoverished fidelity of ILDs in independently functioning CIs may be impeding development of cortical ILD sensitivity in children who are deaf but do not altogether limit benefits of listening with bilateral CIs. Future efforts to provide consistent/accurate ILDs through auditory prostheses including CIs could improve binaural hearing for children with hearing loss.

4 Article The Participation Scale: psychometric properties of a South Indian translation with hearing-impaired respondents. 2018

Thammaiah, Spoorthi / Manchaiah, Vinaya / Easwar, Vijayalakshmi / Krishna, Rajalakshmi / McPherson, Bradley. ·a Department of Speech and Hearing Sciences , Lamar University , Beaumont , TX , USA. · b Audiology India , Mysore , Karnataka , India. · c Department of Behavioral Science and Learning, The Swedish Institute for Disability Research , Linköping University , Linköping , Sweden. · d Department of Speech and Hearing, School of Allied Health Sciences , Manipal University , Manipal , Karnataka , India. · e National Centre for Audiology Western University , London , ON , Canada. · f All India Institute of Speech and Hearing , University of Mysore , Mysore , Karnataka , India. · g Division of Speech and Hearing Sciences, Faculty of Education , The University of Hong Kong , Hong Kong , China. ·Disabil Rehabil · Pubmed #28687058.

ABSTRACT: AIMS: The Participation Scale (P-Scale) is a widely used generic self-report measure designed to assess an individual's participation restriction consequent to any disease condition. The present study aimed to evaluate the validity and reliability of a south Indian (Kannada language) version of the P-Scale for use with adults with hearing loss. This study is a part of an ongoing research program on the assessment of outcomes of hearing health rehabilitation with hearing aids involving Indian client groups. METHODS: One hundred and three adults with hearing loss completed the original English and the newly translated-adapted Kannada P-Scale questionnaire. Nearly half of the participants completed repeat testing of the Kannada version 15 days after the initial assessment. Along with the P-Scale, Kannada versions of the Hearing Handicap Questionnaire (HHQ) and the Assessment of Quality of Life - 4 Dimensions Questionnaire (AQoL-4D) were also administered. Based on predefined quality criteria, five different psychometric properties of the P-Scale were evaluated, together with an analysis of the Kannada P-Scale's factor structure. The psychometric properties assessed included internal consistency, test-retest reliability, convergent validity, discriminant validity, and floor-ceiling effects. RESULTS: Principal component analysis indicated a four-factor complex structure, which explained 69.78% of the variance in the Kannada P-Scale. High internal consistency (Cronbach's alpha = 0.90) and test-retest reliability (internal consistency coefficient  >0.90) were obtained. Comparisons with the HHQ (ρ = 0.52) and AQoL-4 D (ρ = 0.76) indicated good convergent validity. Discriminant validity among the P-Scale questions was acceptable (inter-item correlation  <0.60). Floor and ceiling effects were not evident in the Kannada P-Scale. CONCLUSIONS: The psychometric characteristics of the Kannada P-scale were found to be sufficient for use with the participant group (literate, Kannada-speaking adults with hearing loss) who were assessed in this study. Further research is required to determine generalizability of the Kannada P-Scale among other Kannada-speaking communities. Implications for Rehabilitation The Kannada version of the Participation Scale (P-Scale) can be validly used with Kannada speaking adults with hearing loss. The Kannada P-Scale can be used for clinical/research purposes to assess outcome (specifically, change in participation restriction) before, during, and after the hearing rehabilitation process. However, education and socioeconomic status may have an effect of the Kannada P-Scale results and these factors need to be further investigated prior to wider clinical use.

5 Article Simultaneous bilateral cochlear implants: Developmental advances do not yet achieve normal cortical processing. 2017

Easwar, Vijayalakshmi / Yamazaki, Hiroshi / Deighton, Michael / Papsin, Blake / Gordon, Karen. ·Archie's Cochlear Implant Laboratory The Hospital for Sick Children Toronto ON Canada. · Collaborative Program in Neuroscience The University of Toronto Toronto ON Canada. · Otolaryngology The University of Toronto Toronto ON Canada. · Otolaryngology The Hospital for Sick Children Toronto ON Canada. ·Brain Behav · Pubmed #28413698.

ABSTRACT: BACKGROUND: Simultaneous bilateral cochlear implantation promotes symmetric development of bilateral auditory pathways but binaural hearing remains abnormal. To evaluate whether bilateral cortical processing remains impaired in such children, cortical activity to unilateral and bilateral stimuli was assessed in a unique cohort of 16 children who received bilateral cochlear implants (CIs) simultaneously at 1.97 ± 0.86 years of age and had ~4 years of CI experience, providing the first opportunity to assess electrically driven cortical development in the absence of reorganized asymmetries from sequential implantation. METHODS: Cortical activity to unilateral and bilateral stimuli was measured using multichannel electro-encephalography. Cortical processing in children with bilateral CIs was compared with click-elicited activity in 13 normal hearing children matched for time-in-sound. Source activity was localized using the Time Restricted, Artefact and Coherence source Suppression (TRACS) beamformer method. RESULTS: Consistent with dominant crossed auditory pathways, normal P1 activity (~100 ms) was weaker to ipsilateral stimuli relative to contralateral and bilateral stimuli and both auditory cortices preferentially responded to the contralateral ear. Right hemisphere dominance was evident overall. Children with bilateral CIs maintained the expected right dominance but differences from normal included: (i) minimal changes between ipsilateral, contralateral and bilateral stimuli, (ii) weaker than normal contralateral stimulus preference, (iii) symmetric activity to bilateral stimuli, and (iv) increased occipital lobe recruitment during bilateral relative to unilateral stimulation. Between-group contrasts demonstrated lower than normal activity in the inferior parieto-occipital lobe (suggesting deficits in sensory integration) and greater than normal left frontal lobe activity (suggesting increased attention), even during passive listening. CONCLUSIONS: Together, findings suggest that early simultaneous bilateral cochlear implantation promotes normal-like auditory symmetry but that abnormalities in cortical processing consequent to deafness and/or electrical stimulation through two independent speech processors persist.

6 Article Cortical Representation of Interaural Time Difference Is Impaired by Deafness in Development: Evidence from Children with Early Long-term Access to Sound through Bilateral Cochlear Implants Provided Simultaneously. 2017

Easwar, Vijayalakshmi / Yamazaki, Hiroshi / Deighton, Michael / Papsin, Blake / Gordon, Karen. ·Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada, v.easwar@utoronto.ca. · Collaborative Program in Neuroscience, University of Toronto, Toronto, Ontario M5S 1A8, Canada. · Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada. · Department of Otolaryngology, University of Toronto, Toronto, Ontario M5G 2N2, Canada, and. · Department of Otolaryngology, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada. ·J Neurosci · Pubmed #28123078.

ABSTRACT: Accurate use of interaural time differences (ITDs) for spatial hearing may require access to bilateral auditory input during sensitive periods in human development. Providing bilateral cochlear implants (CIs) simultaneously promotes symmetrical development of bilateral auditory pathways but does not support normal ITD sensitivity. Thus, although binaural interactions are established by bilateral CIs in the auditory brainstem, potential deficits in cortical processing of ITDs remain. Cortical ITD processing in children with simultaneous bilateral CIs and normal hearing with similar time-in-sound was explored in the present study. Cortical activity evoked by bilateral stimuli with varying ITDs (0, ±0.4, ±1 ms) was recorded using multichannel electroencephalography. Source analyses indicated dominant activity in the right auditory cortex in both groups but limited ITD processing in children with bilateral CIs. In normal-hearing children, adult-like processing patterns were found underlying the immature P1 (∼100 ms) response peak with reduced activity in the auditory cortex ipsilateral to the leading ITD. Further, the left cortex showed a stronger preference than the right cortex for stimuli leading from the contralateral hemifield. By contrast, children with CIs demonstrated reduced ITD-related changes in both auditory cortices. Decreased parieto-occipital activity, possibly involved in spatial processing, was also revealed in children with CIs. Thus, simultaneous bilateral implantation in young children maintains right cortical dominance during binaural processing but does not fully overcome effects of deafness using present CI devices. Protection of bilateral pathways through simultaneous implantation might be capitalized for ITD processing with signal processing advances, which more consistently represent binaural timing cues.

7 Article Psychometric properties of the hearing handicap questionnaire: a Kannada (South-Indian) translation. 2017

Thammaiah, Spoorthi / Manchaiah, Vinaya / Easwar, Vijayalakshmi / Krishna, Rajalakshmi / McPherson, Bradley. ·a Department of Speech and Hearing Sciences , Lamar University , Beaumont , TX , USA. · b Audiology India , Mysore , Karnataka , India. · c Department of Behavioral Science and Learning, The Swedish Institute for Disability Research, Linköping University , Linköping , Sweden. · d Department of Communication Sciences and Disorders , Western University , Ontario , Canada. · e All India Institute of Speech and Hearing, University of Mysore , Mysore , India , and. · f Division of Speech and Hearing Sciences , The University of Hong Kong , Hong Kong , China. ·Int J Audiol · Pubmed #27809619.

ABSTRACT: OBJECTIVE: To assess the psychometric properties of the Hearing Handicap Questionnaire (HHQ) in Kannada (a South-Indian language) among adults with hearing loss. DESIGN: The study involved a cross-sectional survey design. Participants provided demographic details and completed the Kannada and English (original) version of the HHQ questionnaire. To evaluate test-retest reliability, ∼50% of the participants completed the Kannada version for the second time after 15 days. STUDY SAMPLE: The sample comprised 103 adults with hearing loss recruited from local audiology clinics. RESULTS: Exploratory factor analysis indicated a one-factor structure, which explained 71% of the variance in Kannada-HHQ scores. The internal consistency measured with Cronbach's alpha was 0.96. The test-retest reliability correlations of the Kannada version with the English and with the same Kannada version re-administered after 15 days were 0.96 and 0.91, respectively. Convergent validity of the scale was confirmed by significant correlations with the Participation Scale and the Assessment of Quality of Life scales. Discriminant validity was found to be low as all the Kannada-HHQ questions were highly correlated with each other (r> 0.60). No floor and ceiling effects were identified. CONCLUSIONS: The psychometric properties of the Kannada-HHQ scale are considered to be adequate for clinical or research use.

8 Article Factors Affecting Daily Cochlear Implant Use in Children: Datalogging Evidence. 2016

Easwar, Vijayalakshmi / Sanfilippo, Joseph / Papsin, Blake / Gordon, Karen. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada. · Collaborative Program in Neuroscience, The University of Toronto, Toronto, ON, Canada. · Otolaryngology, The University of Toronto, Toronto, ON, Canada. · Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada. ·J Am Acad Audiol · Pubmed #27885978.

ABSTRACT: BACKGROUND: Children with profound hearing loss can gain access to sound through cochlear implants (CIs), but these devices must be worn consistently to promote auditory development. Although subjective parent reports have identified several factors limiting long-term CI use in children, it is also important to understand the day-to-day issues which may preclude consistent device use. In the present study, objective measures gathered through datalogging software were used to quantify the following in children: (1) number of hours of CI use per day, (2) practical concerns including repeated disconnections between the external transmission coil and the internal device (termed "coil-offs"), and (3) listening environments experienced during daily use. PURPOSE: This study aimed to (1) objectively measure daily CI use and factors influencing consistent device use in children using one or two CIs and (2) evaluate the intensity levels and types of listening environments children are exposed to during daily CI use. RESEARCH DESIGN: Retrospective analysis. STUDY SAMPLE: Measures of daily CI use were obtained from 146 pediatric users of Cochlear Nucleus 6 speech processors. The sample included 5 unilateral, 40 bimodal, and 101 bilateral CI users (77 simultaneously and 24 sequentially implanted). DATA COLLECTION AND ANALYSIS: Daily CI use, duration, and frequency of coil-offs per day, and the time spent in multiple intensity ranges and environment types were extracted from the datalog saved during clinic appointments. Multiple regression analyses were completed to predict daily CI use based on child-related demographic variables, and to evaluate the effects of age on coil-offs and environment acoustics. RESULTS: Children used their CIs for 9.86 ± 3.43 hr on average on a daily basis, with use exceeding 9 hr per day in ∼64% of the children. Daily CI use reduced significantly with increasing durations of coil-off (p = 0.027) and increased significantly with longer CI experience (p < 0.001) and pre-CI acoustic experience (p < 0.001), when controlled for the child's age. Total time in sound (sum of CI and pre-CI experience) was positively correlated with CI use (r = 0.72, p < 0.001). Longer durations of coil-off were associated with higher frequency of coil-offs (p < 0.001). The frequency of coil-offs ranged from 0.99 to 594.10 times per day and decreased significantly with age (p < 0.001). Daily CI use and frequency of coil-offs did not vary significantly across known etiologies. Listening environments of all children typically ranged between 50 and 70 dBA. Children of all ages were exposed to speech in noisy environments. Environment classified as "music" was identified more often in younger children. CONCLUSIONS: The majority of children use their CIs consistently, even during the first year of implantation. The frequency of coil-offs is a practical challenge in infants and young children, and demonstrates the need for improved coil retention methods for pediatric use. Longer hearing experience and shorter coil-off time facilitates consistent CI use. Children are listening to speech in noisy environments most often, thereby indicating a need for better access to binaural cues, signal processing, and stimulation strategies to aid listening. Study findings could be useful in parent counseling of young and/or new CI users.

9 Article Effect of Stimulus Level and Bandwidth on Speech-Evoked Envelope Following Responses in Adults With Normal Hearing. 2015

Easwar, Vijayalakshmi / Purcell, David W / Aiken, Steven J / Parsa, Vijay / Scollie, Susan D. ·1National Centre for Audiology, Western University, London, Ontario, Canada; 2School of Communication Sciences and Disorders, Western University, London, Ontario, Canada; and 3School of Human Communication Disorders, Dalhousie University, Halifax, Nova Scotia, Canada. ·Ear Hear · Pubmed #26226607.

ABSTRACT: OBJECTIVE: The use of auditory evoked potentials as an objective outcome measure in infants fitted with hearing aids has gained interest in recent years. This article proposes a test paradigm using speech-evoked envelope following responses (EFRs) for use as an objective-aided outcome measure. The method uses a running speech-like, naturally spoken stimulus token /susa∫i/ (fundamental frequency [f0] = 98 Hz; duration 2.05 sec), to elicit EFRs by eight carriers representing low, mid, and high frequencies. Each vowel elicited two EFRs simultaneously, one from the region of formant one (F1) and one from the higher formants region (F2+). The simultaneous recording of two EFRs was enabled by lowering f0 in the region of F1 alone. Fricatives were amplitude modulated to enable recording of EFRs from high-frequency spectral regions. The present study aimed to evaluate the effect of level and bandwidth on speech-evoked EFRs in adults with normal hearing. As well, the study aimed to test convergent validity of the EFR paradigm by comparing it with changes in behavioral tasks due to bandwidth. DESIGN: Single-channel electroencephalogram was recorded from the vertex to the nape of the neck over 300 sweeps in two polarities from 20 young adults with normal hearing. To evaluate the effects of level in experiment I, EFRs were recorded at test levels of 50 and 65 dB SPL. To evaluate the effects of bandwidth in experiment II, EFRs were elicited by /susa∫i/ low-pass filtered at 1, 2, and 4 kHz, presented at 65 dB SPL. The 65 dB SPL condition from experiment I represented the full bandwidth condition. EFRs were averaged across the two polarities and estimated using a Fourier analyzer. An F test was used to determine whether an EFR was detected. Speech discrimination using the University of Western Ontario Distinctive Feature Differences test and sound quality rating using the Multiple Stimulus Hidden Reference and Anchors paradigm were measured in identical bandwidth conditions. RESULTS: In experiment I, the increase in level resulted in a significant increase in response amplitudes for all eight carriers (mean increase of 14 to 50 nV) and the number of detections (mean increase of 1.4 detections). In experiment II, an increase in bandwidth resulted in a significant increase in the number of EFRs detected until the low-pass filtered 4 kHz condition and carrier-specific changes in response amplitude until the full bandwidth condition. Scores in both behavioral tasks increased with bandwidth up to the full bandwidth condition. The number of detections and composite amplitude (sum of all eight EFR amplitudes) significantly correlated with changes in behavioral test scores. CONCLUSIONS: Results suggest that the EFR paradigm is sensitive to changes in level and audible bandwidth. This may be a useful tool as an objective-aided outcome measure considering its running speech-like stimulus, representation of spectral regions important for speech understanding, level and bandwidth sensitivity, and clinically feasible test times. This paradigm requires further validation in individuals with hearing loss, with and without hearing aids.

10 Article Evaluation of Speech-Evoked Envelope Following Responses as an Objective Aided Outcome Measure: Effect of Stimulus Level, Bandwidth, and Amplification in Adults With Hearing Loss. 2015

Easwar, Vijayalakshmi / Purcell, David W / Aiken, Steven J / Parsa, Vijay / Scollie, Susan D. ·1National Centre for Audiology, Western University, London, Ontario, Canada; 2School of Communication Sciences and Disorders, Western University, London, Ontario, Canada; and 3School of Human Communication Disorders, Dalhousie University, Halifax, Nova Scotia, Canada. ·Ear Hear · Pubmed #26226606.

ABSTRACT: OBJECTIVES: The present study evaluated a novel test paradigm based on speech-evoked envelope following responses (EFRs) as an objective aided outcome measure for individuals fitted with hearing aids. Although intended for use in infants with hearing loss, this study evaluated the paradigm in adults with hearing loss, as a precursor to further evaluation in infants. The test stimulus was a naturally male-spoken token /susa∫i/, modified to enable recording of eight individual EFRs, two from each vowel for different formants and one from each fricative. In experiment I, sensitivity of the paradigm to changes in audibility due to varying stimulus level and use of hearing aids was tested. In experiment II, sensitivity of the paradigm to changes in aided audible bandwidth was evaluated. As well, experiment II aimed to test convergent validity of the EFR paradigm by comparing the effect of bandwidth on EFRs and behavioral outcome measures of hearing aid fitting. DESIGN: Twenty-one adult hearing aid users with mild to moderately severe sensorineural hearing loss participated in the study. To evaluate the effects of level and amplification in experiment I, the stimulus was presented at 50 and 65 dB SPL through an ER-2 insert earphone in unaided conditions and through individually verified hearing aids in aided conditions. Behavioral thresholds of EFR carriers were obtained using an ER-2 insert earphone to estimate sensation level of EFR carriers. To evaluate the effect of aided audible bandwidth in experiment II, EFRs were elicited by /susa∫i/ low-pass filtered at 1, 2, and 4 kHz and presented through the programmed hearing aid. EFRs recorded in the 65 dB SPL aided condition in experiment I represented the full bandwidth condition. EEG was recorded from the vertex to the nape of the neck over 300 sweeps. Speech discrimination using the University of Western Ontario Distinctive Feature Differences test and sound quality rating using the Multiple-Stimulus Hidden Reference and Anchor paradigm were measured in the same bandwidth conditions. RESULTS: In experiment I, an increase in stimulus level above threshold and the use of amplification resulted in a significant increase in the number of EFRs detected per condition. At positive sensation levels, an increase in level demonstrated a significant increase in response amplitude in unaided and aided conditions. At 50 and 65 dB SPL, the use of amplification led to a significant increase in response amplitude for the majority of carriers. In experiment II, the number of EFR detections and the combined response amplitude of all eight EFRs improved with an increase in bandwidth up to 4 kHz. In contrast, behavioral measures continued to improve at wider bandwidths. Further change in EFR parameters was possibly limited by the hearing aid bandwidth. Significant positive correlations were found between EFR parameters and behavioral test scores in experiment II. CONCLUSIONS: The EFR paradigm demonstrates sensitivity to changes in audibility due to a change in stimulus level, bandwidth, and use of amplification in clinically feasible test times. The paradigm may thus have potential applications as an objective aided outcome measure. Further investigations exploring stimulus-response relationships in aided conditions and validation studies in children are warranted.

11 Article The Ling 6(HL) test: typical pediatric performance data and clinical use evaluation. 2014

Glista, Danielle / Scollie, Susan / Moodie, Sheila / Easwar, Vijayalakshmi / Anonymous3650815. ·National Centre for Audiology and School of Communications Sciences and Disorders, Western University, London, ON Canada. · National Centre for Audiology and School of Health and Rehabilitation Sciences, Western University, London, ON Canada. ·J Am Acad Audiol · Pubmed #25514453.

ABSTRACT: BACKGROUND: The Ling 6(HL) test offers a calibrated version of naturally produced speech sounds in dB HL for evaluation of detection thresholds. Aided performance has been previously characterized in adults. PURPOSE: The purpose of this work was to evaluate and refine the Ling 6(HL) test for use in pediatric hearing aid outcome measurement. RESEARCH DESIGN: This work is presented across two studies incorporating an integrated knowledge translation approach in the characterization of normative and typical performance, and in the evaluation of clinical feasibility, utility, acceptability, and implementation. STUDY SAMPLE: A total of 57 children, 28 normally hearing and 29 with binaural sensorineural hearing loss, were included in Study 1. Children wore their own hearing aids fitted using Desired Sensation Level v5.0. Nine clinicians from The Network of Pediatric Audiologists participated in Study 2. DATA COLLECTION AND ANALYSIS: A CD-based test format was used in the collection of unaided and aided detection thresholds in laboratory and clinical settings; thresholds were measured clinically as part of routine clinical care. Confidence intervals were derived to characterize normal performance and typical aided performance according to hearing loss severity. Unaided-aided performance was analyzed using a repeated-measures analysis of variance. The audiologists completed an online questionnaire evaluating the quality, feasibility/executability, utility/comparative value/relative advantage, acceptability/applicability, and interpretability, in addition to recommendation and general comments sections. RESULTS: Ling 6(HL) thresholds were reliably measured with children 3-18 yr old. Normative and typical performance ranges were translated into a scoring tool for use in pediatric outcome measurement. In general, questionnaire respondents generally agreed that the Ling 6(HL) test was a high-quality outcome evaluation tool that can be implemented successfully in clinical settings. CONCLUSIONS: By actively collaborating with pediatric audiologists and using an integrated knowledge translation framework, this work supported the creation of an evidence-based clinical tool that has the potential to be implemented in, and useful to, clinical practice. More research is needed to characterize performance in alternative listening conditions to facilitate use with infants, for example. Future efforts focused on monitoring the use of the Ling 6(HL) test in daily clinical practice may help describe whether clinical use has been maintained across time and if any additional adaptations are necessary to facilitate clinical uptake.