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Hearing Disorders: HELP
Articles by Michael Valente
Based on 11 articles published since 2009
(Why 11 articles?)
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Between 2009 and 2019, Michael Valente wrote the following 11 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 Guideline Clinical practice guideline: sudden hearing loss. 2012

Stachler, Robert J / Chandrasekhar, Sujana S / Archer, Sanford M / Rosenfeld, Richard M / Schwartz, Seth R / Barrs, David M / Brown, Steven R / Fife, Terry D / Ford, Peg / Ganiats, Theodore G / Hollingsworth, Deena B / Lewandowski, Christopher A / Montano, Joseph J / Saunders, James E / Tucci, Debara L / Valente, Michael / Warren, Barbara E / Yaremchuk, Kathleen L / Robertson, Peter J / Anonymous4970719. ·Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan 48202, USA. rstachl1@hfhs.org ·Otolaryngol Head Neck Surg · Pubmed #22383545.

ABSTRACT: OBJECTIVE: Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. PURPOSE: The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. RESULTS: The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.

2 Review What defines asymmetric sensorineural hearing loss? 2019

Durakovic, Nedim / Valente, Michael / Goebel, Joel A / Wick, Cameron C. ·Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A. ·Laryngoscope · Pubmed #30408187.

ABSTRACT: -- No abstract --

3 Article Differences in Word and Phoneme Recognition in Quiet, Sentence Recognition in Noise, and Subjective Outcomes between Manufacturer First-Fit and Hearing Aids Programmed to NAL-NL2 Using Real-Ear Measures. 2018

Valente, Michael / Oeding, Kristi / Brockmeyer, Alison / Smith, Steven / Kallogjeri, Dorina. ·Department of Otolaryngology - Head and Neck Surgery, Division of Adult Audiology, Washington University in St. Louis School of Medicine, St. Louis, MO. ·J Am Acad Audiol · Pubmed #30222541.

ABSTRACT: BACKGROUND: The American Speech-Language-Hearing Association (ASHA) and American Academy of Audiology (AAA) have created Best Practice Guidelines for fitting hearing aids to adult patients. These guidelines recommend using real-ear measures (REM) to verify that measured output/gain of hearing aid(s) match a validated prescriptive target. Unfortunately, approximately 70-80% of audiologists do not routinely use REM when fitting hearing aids, instead relying on a manufacturer default "first-fit" setting. This is problematic because numerous studies report significant differences in REM between manufacturer first-fit and the same hearing aids using a REM or programmed-fit. These studies reported decreased prescribed gain/output in the higher frequencies for the first-fit compared with the programmed fit, which are important for recognizing speech. Currently, there is little research in peer-reviewed journals reporting if differences between hearing aids fitted using a manufacturer first-fit versus a programmed-fit result in significant differences in speech recognition in quiet, noise, and subjective outcomes. PURPOSE: To examine if significant differences were present in monosyllabic word and phoneme recognition (consonant-nucleus-consonant; CNC) in quiet, sentence recognition in noise (Hearing in Noise Test; HINT), and subjective outcomes using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Speech, Spatial and Qualities of Hearing (SSQ) questionnaires between hearing aids fit using one manufacturer's first-fit and the same hearing aids with a programmed-fit using REM to National Acoustic Laboratories Nonlinear Version 2 (NAL-NL2) prescriptive target. RESEARCH DESIGN: A double-blind randomized crossover design was used. Throughout the study, one investigator performed all REM whereas a second investigator measured speech recognition in quiet, noise, and scored subjective outcome measures. STUDY SAMPLE: Twenty-four adults with bilateral normal sloping to moderately severe sensorineural hearing loss with no prior experience with amplification. DATA COLLECTION AND ANALYSIS: The hearing aids were fit using the proprietary manufacturer default first-fit and a programmed-fit to NAL-NL2 using real-ear insertion gain measures. The order of the two fittings was randomly assigned and counterbalanced. Participants acclimatized to each setting for four weeks and returned for assessment of performance via the revised CNC word lists, HINT, APHAB, and SSQ for the respective fitting. RESULTS: (1) A significant median advantage of 15% (p < 0.001; 95% CI: 9.7-24.3%) for words and 7.7% (p < 0.001; 95% CI: 5.9-10.9%) for phonemes for the programmed-fit compared with first-fit at 50 dB sound pressure level (SPL) and 4% (p < 0.01; 95% CI: 1.7-6.3%) for words at 65 dB SPL; (2) No significant differences for the HINT reception threshold for sentences (RTS); (3) A significant median advantage of 4.2% [p < 0.04; 95% confidence interval (CI): -0.6-13.2%] for the programmed-fit compared with the first-fit for the background noise subscale problem score for the APHAB; (4) No significant differences on the SSQ. CONCLUSIONS: Improved word and phoneme recognition for soft and words for average speech in quiet were reported for the programmed-fit. Seventy-nine percent of the participants preferred the programmed-fitting versus first-fit. Hearing aids, therefore, should be verified and programmed using REM to a prescriptive target versus no verification using a first-fit.

4 Article Evaluation of a BICROS System with a Directional Microphone in the Receiver and Transmitter. 2015

Valente, Michael / Oeding, Kristi. ·Division of Adult Audiology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO. ·J Am Acad Audiol · Pubmed #26554490.

ABSTRACT: BACKGROUND: The bilateral contralateral routing of signals (BICROS) system has provided limited benefit for speech recognition in noise for patients with asymmetric sensorineural hearing loss, even when an automatic adaptive multichannel directional microphone (DM) is in the receiver (Rx) and an omnidirectional microphone (OM) is in the transmitter (Tx). A recent BICROS system was introduced that can be programmed with a DM in the Rx and an OM or a DM in the Tx. PURPOSE: To examine if significant differences in sentence recognition in noise and subjective preferences are present between an OM and an adaptive broadband DM programmed in the Tx of a BICROS system with an automatic adaptive multichannel DM programmed in the Rx. RESEARCH DESIGN: A randomized crossover single-blind design was used to assess differences between the OM and DM programmed in the Tx. STUDY SAMPLE: Eighteen adult experienced BICROS system users were recruited. DATA COLLECTION AND ANALYSIS: The BICROS system was fit using real-ear insertion gain measures. The Tx was programmed with an OM and a DM and the Rx was always programmed with an automatic adaptive multichannel DM. The order of microphone condition in the Tx was counterbalanced. Participants acclimatized to the BICROS system for 4 weeks and returned and completed the Abbreviated Profile of Hearing Aid Benefit (APHAB) for the respective microphone condition. The Tx was then programmed with the other microphone condition and participants acclimatized for another four weeks. At the final visit, the APHAB was completed for the respective microphone condition. After eight weeks of acclimatization, Hearing in Noise Test sentences were presented in the R-Space™ system with the Tx in either the OM or DM condition for three listening conditions: (1) speech from 90° to the Rx and noise from 0°, 90°, and 180° to the Tx (Sp Rx/N Tx), (2) speech from 90° to the Tx and noise from 0°, 90°, and 180° to the Rx (Sp Tx/N Rx), and (3) speech from 0° and noise from eight surrounding loudspeakers separated by 45° (diffuse). RESULTS: A two-factor repeated measures analysis of variance revealed no significant differences between the OM and DM microphone conditions for Sp Rx/N Tx listening condition. A significant mean disadvantage of 1.9 dB (p < 0.01) was revealed for the DM compared to the OM for Sp Tx/N Rx listening condition and a mean advantage of 2.6 dB (p < 0.001) for the DM compared to the OM in a diffuse listening condition. There were no significant differences in the APHAB aided problem and resulting benefit scores between the OM and DM for the following subscales: ease of communication, background noise, reverberation, and aversiveness of sounds. CONCLUSIONS: No significant differences were revealed between OM and DM for Sp Rx/N Tx. The DM performed significantly poorer than OM for the Sp Tx/N Rx listening condition. Results revealed significant benefit for the DM compared to OM for the diffuse listening condition. No significant differences were revealed between the OM and DM on the APHAB.

5 Article The Effect of a High Upper Input Limiting Level on Word Recognition in Noise, Sound Quality Preferences, and Subjective Ratings of Real-World Performance. 2015

Oeding, Kristi / Valente, Michael. ·Division of Adult Audiology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO. ·J Am Acad Audiol · Pubmed #26134722.

ABSTRACT: BACKGROUND: One important factor that plays a role in front-end processing is the analog-to-digital converter within current hearing aids. The average input dynamic range of hearing aids is 96 dB SPL with an upper input limiting level (UILL) of 95-105 dB SPL. The UILL of standard hearing aids could distort loud signals, such as loud speech or music, which have root-mean-square values of 90 and 105 dB SPL with crest factors of 12 dB SPL to 14-20 dB SPL, respectively. This indicates that these loud sounds could create a distorted signal for patients when the input limiting level is reached. PURPOSE: To examine if significant differences in word recognition in noise, sound quality preferences, and subjective ratings of real-world performance exist between conventional and high UILL hearing aids. RESEARCH DESIGN: Words in noise and sound quality preferences were assessed using recordings on a Knowles Electronic Manikin for Acoustic Research with conventional and high UILL hearing aids, different microphone modes, and listening conditions. Participants wore the hearing aids for 2 mo and completed questionnaires on subjective performance. STUDY SAMPLE: Ten adults with bilateral slight to moderately severe sensorineural hearing loss were recruited. RESULTS: A four-factor repeated-measures analysis of variance (ANOVA) revealed significant differences between the conventional and high UILL across microphone modes and listening conditions for words in noise [F(2, 18) = 6.0; p < 0.05]. A three-factor repeated-measures ANOVA for sound quality preferences revealed a significant difference only for presentation level [F(1, 9) = 81.0; p < 0.001]. A one-factor ANOVA did not reveal significant differences between the conventional and high UILL on subjective ratings of real-world performance. CONCLUSIONS: Word recognition and sound quality preferences revealed significant differences between the conventional and high UILL; however, there were no differences in subjective ratings of real-world performance. One participant preferred the conventional UILL, two the high UILL, and seven thought performance was equal, which may be due to the listening environments participants encountered, as evidenced by datalogging.

6 Article Sentence recognition in noise and perceived benefit of noise reduction on the receiver and transmitter sides of a BICROS hearing aid. 2013

Oeding, Kristi / Valente, Michael. ·Department of Otolaryngology-Head and Neck Surgery, Division of Adult Audiology, Washington University in St. Louis School of Medicine. ·J Am Acad Audiol · Pubmed #24384083.

ABSTRACT: BACKGROUND: In the past, bilateral contralateral routing of signals (BICROS) amplification incorporated omnidirectional microphones on the transmitter and receiver sides and some models utilized noise reduction (NR) on the receiver side. Little research has examined the performance of BICROS amplification in background noise. However, previous studies examining contralateral routing of signals (CROS) amplification have reported that the presence of background noise on the transmitter side negatively affected speech recognition. Recently, NR was introduced as a feature on the receiver and transmitter sides of BICROS amplification, which has the potential to decrease the impact of noise on the wanted speech signal by decreasing unwanted noise directed to the transmitter side. PURPOSE: The primary goal of this study was to examine differences in the reception threshold for sentences (RTS in dB) using the Hearing in Noise Test (HINT) in a diffuse listening environment between unaided and three aided BICROS conditions (no NR, mild NR, and maximum NR) in the Tandem 16 BICROS. A secondary goal was to examine real-world subjective impressions of the Tandem 16 BICROS compared to unaided. RESEARCH DESIGN: A randomized block repeated measures single blind design was used to assess differences between no NR, mild NR, and maximum NR listening conditions. STUDY SAMPLE: Twenty-one adult participants with asymmetric sensorineural hearing loss (ASNHL) and experience with BICROS amplification were recruited from Washington University in St. Louis School of Medicine. DATA COLLECTION AND ANALYSIS: Participants were fit with the National Acoustic Laboratories' Nonlinear version 1 prescriptive target (NAL-NL1) with the Tandem 16 BICROS at the initial visit and then verified using real-ear insertion gain (REIG) measures. Participants acclimatized to the Tandem 16 BICROS for 4 wk before returning for final testing. Participants were tested utilizing HINT sentences examining differences in RTS between unaided and three aided listening conditions. Subjective benefit was determined via the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire between the Tandem 16 BICROS and unaided. A repeated measures analysis of variance (ANOVA) was utilized to analyze the results of the HINT and APHAB. RESULTS: Results revealed no significant differences in the RTS between unaided, no NR, mild NR, and maximum NR. Subjective impressions using the APHAB revealed statistically and clinically significant benefit with the Tandem 16 BICROS compared to unaided for the Ease of Communication (EC), Background Noise (BN), and Reverberation (RV) subscales. CONCLUSIONS: The RTS was not significantly different between unaided, no NR, mild NR, and maximum NR. None of the three aided listening conditions were significantly different from unaided performance as has been reported for previous studies examining CROS hearing aids. Further, based on comments from participants and previous research studies with conventional hearing aids, manufacturers of BICROS amplification should consider incorporating directional microphones and independent volume controls on the receiver and transmitter sides to potentially provide further improvement in signal-to-noise ratio (SNR) for patients with ASNHL.

7 Article The effectiveness of the directional microphone in the Oticon Medical Ponto Pro in participants with unilateral sensorineural hearing loss. 2013

Oeding, Kristi / Valente, Michael. ·Division of Adult Audiology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine. ·J Am Acad Audiol · Pubmed #24131606.

ABSTRACT: BACKGROUND: Current bone anchored hearing solutions (BAHSs) have incorporated automatic adaptive multichannel directional microphones (DMs). Previous fixed single-channel hypercardioid DMs in BAHSs have provided benefit in a diffuse listening environment, but little data are available on the performance of adaptive multichannel DMs in BAHSs for persons with unilateral sensorineural hearing loss (USNHL). PURPOSE: The primary goal was to determine if statistically significant differences existed in the mean Reception Threshold for Sentences (RTS in dB) in diffuse uncorrelated restaurant noise between unaided, an omnidirectional microphone (OM), split DM (SDM), and full DM (FDM) in the Oticon Medical Ponto Pro. A second goal was to assess subjective benefit using the Abbreviated Profile of Hearing Aid Benefit (APHAB) comparing the Ponto Pro to the participant's current BAHS, and the Ponto Pro and participant's own BAHS to unaided. The third goal was to compare RTS data of the Ponto Pro to data from an identical study examining Cochlear Americas' Divino. RESEARCH DESIGN: A randomized repeated measures, single blind design was used to measure an RTS for each participant for unaided, OM, SDM, and FDM. STUDY SAMPLE: Fifteen BAHS users with USNHL were recruited from Washington University in St. Louis and the surrounding area. DATA COLLECTION AND ANALYSIS: The Ponto Pro was fit by measuring in-situ bone conduction thresholds and was worn for 4 wk. An RTS was obtained utilizing Hearing in Noise Test (HINT) sentences in uncorrelated restaurant noise from an eight loudspeaker array, and subjective benefit was determined utilizing the APHAB. Analysis of variance (ANOVA) was used to analyze the results of the Ponto Pro HINT and APHAB data, and comparisons between the Ponto Pro and previous Divino data. RESULTS: No statistically significant differences existed in mean RTS between unaided, the Ponto Pro's OM, SDM, or FDM (p = 0.10). The Ponto Pro provided statistically significant benefit for the Background Noise (BN) (p < 0.01) and Reverberation (RV) (p < 0.05) subscales compared to the participant's own BAHS. The Ponto Pro (Ease of Communication [EC] [p < 0.01], BN [p < 0.001], and RV [p < 0.01] subscales) and participant's own BAHS (BN [p < 0.01] and RV [p < 0.01] subscales) overall provided statistically significant benefit compared to unaided. Clinically significant benefit of 5% was present for the Ponto Pro compared to the participant's own BAHS and 10% for the Ponto Pro and the participant's own BAHS compared to unaided. The Ponto Pro's OM (p = 0.05), SDM (p = 0.05), and FDM (p < 0.01) were statistically significantly better than the Divino's OM. No significant differences existed between the Ponto Pro's OM, SDM, and FDM compared to the Divino's DM. CONCLUSIONS: No statistically significant differences existed between unaided, OM, SDM, or FDM. Participants preferred the Ponto Pro compared to the participant's own BAHS and the Ponto Pro and participant's own BAHS compared to unaided. The RTS of the Ponto Pro's adaptive multichannel DM was similar to the Divino's fixed hypercardioid DM, but the Ponto Pro's OM was statistically significantly better than the Divino's OM.

8 Article Differences in sensation level between the Widex Soundtracker and two real-ear analyzers. 2013

Oeding, Kristi / Valente, Michael. ·Division of Adult Audiology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine. ·J Am Acad Audiol · Pubmed #24131602.

ABSTRACT: BACKGROUND: SoundTracker is an algorithm in Widex's Compass fitting software that could potentially be used to estimate a patient's aided sensation level (SL). SoundTracker's accuracy of estimating a patient's SL has never been verified in comparison to SL measured with commercially available real-ear analyzers. PURPOSE: Determine whether statistically significant differences are present between the estimated SL of the Widex SoundTracker software application and the measured SL of the Audioscan Verifit and Frye 6500 real-ear analyzers at 500, 1000, 2000, and 4000 Hz. RESEARCH DESIGN: This study used a randomized repeated measures design to determine differences in SL between SoundTracker and the Verifit and 6500. STUDY SAMPLE: Ten subjects (N = 20 ears) were recruited who were experienced users of behind-the-ear hearing aids with conventional vented earmolds and had bilateral sensorineural hearing loss that was >30 dB HL below 1000 Hz and ≤70 dB HL to 4000 Hz. DATA COLLECTION AND ANALYSIS: Real-ear in-situ thresholds (dB sound pressure level [SPL]) and real-ear aided responses (REAR; dB SPL) were measured at 500, 1000, 2000, and 4000 Hz to determine differences in SL between SoundTracker, Verifit, and 6500. A three-factor repeated measures analysis of variance (ANOVA) was utilized to determine differences between method (real-ear analyzers and SoundTracker), analyzer (Verifit and 6500), and frequency (500, 1000, 2000, and 4000 Hz). RESULTS: Mean differences in measured SL for the Verifit and 6500 were ≤2 dB when compared to the estimated SL using SoundTracker. A statistically significant difference in SL was present between the Verifit and SoundTracker at 2000 Hz (p < 0.01), but no significant differences were present at 500, 1000, and 4000 Hz. A statistically significant difference in SL was present between the 6500 and SoundTracker at 4000 Hz (p < 0.01), but no significant differences were present at 500, 1000, and 2000 Hz. Mean differences in measured SL between the real-ear analyzers (difference of SoundTracker SL minus Verifit SL compared to the difference of SoundTracker SL minus 6500 SL) were ≤2 dB with a statistically significant difference present at 2000 Hz (p < 0.01), but no statistically significant differences were present at 500, 1000, or 4000 Hz. CONCLUSIONS: Nearly 85% of the differences between the estimated SoundTracker SL and the measured SLs of the Verifit and 6500 were ≤2 dB. Despite some limitations of this study, SoundTracker could be useful as a counseling tool to illustrate to patients which sounds are audible or inaudible when unaided and aided.

9 Article Difference between the default telecoil (t-coil) and programmed microphone frequency response in behind-the-ear (BTE) hearing aids. 2012

Putterman, Daniel B / Valente, Michael. ·Program in Audiology and Communication Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. Daniel.Putterman@va.gov ·J Am Acad Audiol · Pubmed #22533979.

ABSTRACT: BACKGROUND: A telecoil (t-coil) is essential for hearing aid users when listening on the telephone because using the hearing aid microphone when communicating on the telephone can cause feedback due to telephone handset proximity to the hearing aid microphone. Clinicians may overlook the role of the t-coil due to a primary concern of matching the microphone frequency response to a valid prescriptive target. Little has been published to support the idea that the t-coil frequency response should match the microphone frequency response to provide "seamless" and perhaps optimal performance on the telephone. If the clinical goal were to match both frequency responses, it would be useful to know the relative differences, if any, that currently exist between these two transducers. PURPOSE: The primary purpose of this study was to determine if statistically significant differences were present between the mean output (in dB SPL) of the programmed microphone program and the hearing aid manufacturer's default t-coil program as a function of discrete test frequencies. In addition, pilot data are presented on the feasibility of measuring the microphone and t-coil frequency response with real-ear measures using a digital speech-weighted noise. RESEARCH DESIGN: A repeated-measures design was utilized for a 2-cc coupler measurement condition. Independent variables were the transducer (microphone, t-coil) and 11 discrete test frequencies (15 discrete frequencies in the real-ear pilot condition). STUDY SAMPLE: The study sample was comprised of behind-the-ear (BTE) hearing aids from one manufacturer. Fifty-two hearing aids were measured in a coupler condition, 39 of which were measured in the real-ear pilot condition. Hearing aids were previously programmed and verified using real-ear measures to the NAL-NL1 (National Acoustic Laboratories-Non-linear 1) prescriptive target by a licensed audiologist. DATA COLLECTION AND ANALYSIS: Hearing aid output was measured with a Fonix 7000 hearing aid analyzer (Frye Electronics, Inc.) in a HA-2 2-cc coupler condition using a pure-tone sweep at an input level of 60 dB SPL with the hearing aid in the microphone program and 31.6 mA/M in the t-coil program. A digital speech weighted noise input signal presented at additional input levels was used in the real-ear pilot condition. A mixed-model repeated-measures analysis of variance (ANOVA) and the Tukey Honestly Significant Difference (HSD) post hoc test were utilized to determine if significant differences were present in performance across treatment levels. RESULTS: There was no significant difference between mean overall t-coil and microphone output averaged across 11 discrete frequencies (F(1,102) = 0, p < 0.98). A mixed-model repeated-measures ANOVA revealed a significant transducer by frequency interaction (F(10,102) = 13.0, p < 0.0001). Significant differences were present at 200 and 400 Hz where the mean t-coil output was less than the mean microphone output, and at 4000, 5000, and 6300 Hz where the mean t-coil output was greater than the mean microphone output. CONCLUSIONS: The mean t-coil output was significantly lower than the mean microphone output at 400 Hz, a frequency that lies within the typical telephone bandwidth of 300-3300 Hz. This difference may partially help to explain why some patients often complain the t-coil fails to provide sufficient loudness for telephone communication.

10 Article Challenges in fitting a hearing aid to a severely collapsed ear canal and mixed hearing loss. 2012

Oeding, Kristi / Valente, Michael / Chole, Richard. ·Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, MO, USA. oedingk@ent.wustl.edu ·J Am Acad Audiol · Pubmed #22463941.

ABSTRACT: BACKGROUND: Collapsed ear canals typically occur when an outside force, such as a headset for audiometric testing, is present. However, when a collapsed ear canal occurs without external pressure, this creates a challenge not only for performing audiometric testing but also for coupling a hearing aid to the ear canal. PURPOSE: This case report highlights the challenges associated with fitting a hearing aid on a patient with a severe anterior-posterior collapsed ear canal with a mixed hearing loss. RESEARCH DESIGN: A 67-yr-old female originally presented to Washington University in St. Louis School of Medicine in 1996 with a long-standing history of bilateral otosclerosis. She had chronic ear infections in the right ear and a severely collapsed ear canal in the left ear and was fit with a bone anchored hearing aid (BAHA®) on the right side in 2003. However, benefit from the BAHA started to decrease due to changes in hearing, and a different hearing solution was needed. It was proposed that a hearing aid be fit to her collapsed left ear canal; however, trying to couple a hearing aid to the collapsed ear canal required unique noncustom earmold solutions. CONCLUSIONS: This case study highlights some of the obstacles and potential solutions for coupling a hearing aid to a severely collapsed ear canal.

11 Article Effectiveness of the directional microphone in the Baha® Divino™. 2010

Oeding, Kristi / Valente, Michael / Kerckhoff, Jessica. ·Program in Audiology and Communication Sciences, Washington University School of Medicine in St. Louis, USA. oedingk@ent.wustl.edu ·J Am Acad Audiol · Pubmed #21034701.

ABSTRACT: BACKGROUND: Patients with unilateral sensorineural hearing loss (USNHL) experience great difficulty listening to speech in noisy environments. A directional microphone (DM) could potentially improve speech recognition in this difficult listening environment. It is well known that DMs in behind-the-ear (BTE) and custom hearing aids can provide a greater signal-to-noise ratio (SNR) in comparison to an omnidirectional microphone (OM) to improve speech recognition in noise for persons with hearing impairment. Studies examining the DM in bone anchored auditory osseointegrated implants (Baha), however, have been mixed, with little to no benefit reported for the DM compared to an OM. PURPOSE: The primary purpose of this study was to determine if there are statistically significant differences in the mean reception threshold for sentences (RTS in dB) in noise between the OM and DM in the Baha® Divino™. The RTS of these two microphone modes was measured utilizing two loudspeaker arrays (speech from 0° and noise from 180° or a diffuse eight-loudspeaker array) and with the better ear open or closed with an earmold impression and noise attenuating earmuff. Subjective benefit was assessed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) to compare unaided and aided (Divino OM and DM combined) problem scores. RESEARCH DESIGN: A repeated measures design was utilized, with each subject counterbalanced to each of the eight treatment levels for three independent variables: (1) microphone (OM and DM), (2) loudspeaker array (180° and diffuse), and (3) better ear (open and closed). STUDY SAMPLE: Sixteen subjects with USNHL currently utilizing the Baha were recruited from Washington University's Center for Advanced Medicine and the surrounding area. DATA COLLECTION AND ANALYSIS: Subjects were tested at the initial visit if they entered the study wearing the Divino or after at least four weeks of acclimatization to a loaner Divino. The RTS was determined utilizing Hearing in Noise Test (HINT) sentences in the R-Space™ system, and subjective benefit was determined utilizing the APHAB. A three-way repeated measures analysis of variance (ANOVA) and a paired samples t-test were utilized to analyze results of the HINT and APHAB, respectively. RESULTS: Results revealed statistically significant differences within microphone (p < 0.001; directional advantage of 3.2 dB), loudspeaker array (p = 0.046; 180° advantage of 1.1 dB), and better ear conditions (p < 0.001; open ear advantage of 4.9 dB). Results from the APHAB revealed statistically and clinically significant benefit for the Divino relative to unaided on the subscales of Ease of Communication (EC) (p = 0.037), Background Noise (BN) (p < 0.001), and Reverberation (RV) (p = 0.005). CONCLUSIONS: The Divino's DM provides a statistically significant improvement in speech recognition in noise compared to the OM for subjects with USNHL. Therefore, it is recommended that audiologists consider selecting a Baha with a DM to provide improved speech recognition performance in noisy listening environments.