Publications by Type: Journal Article

OBJECTIVE: Age-related deficits in selective attention are hypothesized to result from decrements in inhibition of task-irrelevant information. Speed of processing (SOP) training is an adaptive cognitive intervention designed to enhance processing speed for attention tasks. The effectiveness of SOP training to improve cognitive and everyday functional performance is well documented. However, underlying mechanisms of these training benefits are unknown.

METHODS: Participants completed a visual search task evaluated using event-related potentials (ERPs) before and after 10 weeks of SOP training or no contact. N2pc and P3b components were evaluated to determine SOP training effects on attentional resource allocation and capacity.

RESULTS: Selective attention to a target was enhanced after SOP training compared to no training. N2pc and P3b amplitudes increased after training, reflecting attentional allocation and capacity enhancement, consistent with previous studies demonstrating behavioral improvements in selective attention following SOP training.

CONCLUSIONS: Changes in ERPs related to attention allocation and capacity following SOP training support the idea that training leads to cognitive enhancement. Specifically, we provide electrophysiological evidence that SOP training may be successful in counteracting age-related declines in selective attention.

SIGNIFICANCE: This study provides important evidence of the underlying mechanisms by which SOP training improves cognitive function in older adults.

BACKGROUND: Despite evidence suggesting inaccuracy in the default fittings provided by hearing aid manufacturers, the use of probe-microphone measures for the verification of fitting accuracy is routinely used by fewer than half of practicing audiologists.

PURPOSE: The present study examined whether self-perception of hearing aid benefit, as measured through the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), differed as a function of hearing aid fitting method, specifically, manufacturer's initial-fit approach versus a verified prescription. The prescriptive fit began at NAL-NL1 targets, with adjustments based on participant request. Each of the two fittings included probe-microphone measurement.

RESEARCH DESIGN: A counterbalanced, cross-over, repeated-measures, single-blinded design was utilized to address the research objectives.

STUDY SAMPLE: Twenty-two experienced hearing aid users from the general Bay Pines VA Healthcare System audiology clinic population were randomized into one of two intervention groups.

INTERVENTION: At the first visit, half of the participants were fit with new hearing aids via the manufacturer's initial fit while the second half were fit to a verified prescription using probe-microphone measurement. After a wear period of 4-6 wk, the participants' hearing aids were refit via the alternate method and worn for an additional 4-6 wk. Participants were blinded to the method of fitting by utilizing probe-microphone measures with both approaches.

DATA COLLECTION AND ANALYSIS: The APHAB was administered at baseline and at the end of each intervention trial. At the end of the second trial period, the participants were asked to identify which hearing aid fitting was "preferred." The APHAB data were subjected to a general linear model repeated-measures analysis of variance.

RESULTS: For the three APHAB communication subscales (i.e., Ease of Communication, Reverberation, and Background Noise) mean scores obtained with the verified prescription were higher than those obtained with the initial-fit approach, indicating greater benefit with the former. The main effect of hearing aid fitting method was statistically significant [F (1, 21) = 4.69, p = 0.042] and accounted for 18% of the variance in the data (partial eta squared = 0.183). Although the mean benefit score for the APHAB Aversiveness subscale was also better (i.e., lower) for the verified prescription than the initial-fit approach, the difference was not statistically significant. Of the 22 participants, 7 preferred their hearing aids programmed to initial-fit settings and 15 preferred their hearing aids programmed to the verified prescription.

CONCLUSIONS: The data support the conclusion that hearing aids fit to experienced hearing aid wearers using a verified prescription are more likely to yield better self-perceived benefit as measured by the APHAB than if fit using the manufacturer's initial-fit approach.

BACKGROUND: The decision to fit one or two hearing aids in individuals with binaural hearing loss has been debated for years. Although some 78% of U.S. hearing aid fittings are binaural (Kochkin , 2010), Walden and Walden (2005) presented data showing that 82% (23 of 28 patients) of their sample obtained significantly better speech recognition in noise scores when wearing one hearing aid as opposed to two.

PURPOSE: To conduct two new experiments to fuel the monaural/binaural debate. The first experiment was a replication of Walden and Walden (2005), whereas the second experiment examined the use of binaural cues to improve speech recognition in noise.

RESEARCH DESIGN: A repeated measures experimental design.

STUDY SAMPLE: Twenty veterans (aged 59-85 yr), with mild to moderately severe binaurally symmetrical hearing loss who wore binaural hearing aids were recruited from the Audiology Department at the Bay Pines VA Healthcare System.

DATA COLLECTION AND ANALYSIS: Experiment 1 followed the procedures of the Walden and Walden study, where signal-to-noise ratio (SNR) loss was measured using the Quick Speech-in-Noise (QuickSIN) test on participants who were aided with their current hearing aids. Signal and noise were presented in the sound booth at 0° azimuth under five test conditions: (1) right ear aided, (2) left ear aided, (3) both ears aided, (4) right ear aided, left ear plugged, and (5) unaided. The opposite ear in (1) and (2) was left open. In Experiment 2, binaural Knowles Electronics Manikin for Acoustic Research (KEMAR) manikin recordings made in Lou Malnati's pizza restaurant during a busy period provided a typical real-world noise, while prerecorded target sentences were presented through a small loudspeaker located in front of the KEMAR manikin. Subjects listened to the resulting binaural recordings through insert earphones under the following four conditions: (1) binaural, (2) diotic, (3) monaural left, and (4) monaural right.

RESULTS: Results of repeated measures ANOVAs demonstrated that the best speech recognition in noise performance was obtained by most participants with both ears aided in Experiment 1 and in the binaural condition in Experiment 2.

CONCLUSIONS: In both experiments, only 20% of our subjects did better in noise with a single ear, roughly similar to the earlier Jerger et al (1993) finding that 8-10% of elderly hearing aid users preferred one hearing aid.

BACKGROUND: Patients with single-sided deafness (SSD), where one ear has an unaidable hearing loss and the other ear has normal or aidable hearing, often complain of difficulties understanding speech and localizing sound sources, and report a higher self-perceived hearing disability. Patients with SSD may benefit from using contralateral routing of signal (CROS) or bilateral contralateral routing of the signal (BiCROS) amplification. Dissatisfaction of previously available (Bi)CROS devices has been reported, such as, interfering transmissions, low-fidelity sound quality, poor "user-friendly" set-up, and a bulky and cosmetically cumbersome appearance.

PURPOSE: Recent advances in hearing aid technology have improved (Bi)CROS hearing aids; however, these devices have not been experimentally evaluated. We hypothesized that newer technology with reports of improved digital signal processing, wireless transmission, and physical design would be as good, or better than, our participants' previous-generation BiCROS systems.

RESEARCH DESIGN: A within-subjects, pretest-posttest design was executed.

STUDY SAMPLE: Thirty-nine veterans (one female, 38 males; mean age = 74 yr, range = 49-85 yr) from the Audiology Section of the Bay Pines Veterans Affair Healthcare System participated. All participants were previously experienced BiCROS hearing aid users with varying degrees of sensorinerual hearing impairment in their better ear.

INTERVENTION: Participants were provided at least 4 wk of consistent use with the new BiCROS. DATA COLLECTION AND ANALYSES: Participants completed three research visits. At Visit 1, with their previous BiCROS, and at Visit 3, with their new BiCROS, the following objective and subjective measures were obtained: (1) soundfield speech-in-noise testing using the Words-In-Noise (WIN) test; (2) speech, spatial, and qualities of the hearing scale (SSQ) questionnaire; (3) selected questions from the MarkeTrak questionnaire; and, (4) three open-ended questions. Data were analyzed using parametric and nonparametric statistics.

RESULTS: Overall, the objective (WIN) and subjective (SSQ, MarkeTrak, and open-ended questions) measures indicated that the new BiCROS provided better outcomes than the previous BiCROS system. In addition, an overlap of favorable results was seen across measures.

CONCLUSIONS: Of the 39 participants, 95% reported improvements with the new BiCROS and chose to utilize the device regularly. The favorable objective and subjective outcomes indicate that the new BiCROS system is as good, or better than, what was previously utilized by our sample of veterans.

PURPOSE: To review the current literature on help seeking for hearing health care among older adults.

METHOD: The authors conducted a literature review regarding help seeking for hearing-related communication difficulties as well as for other chronic medical conditions.

RESULTS: Untreated hearing loss can lead to numerous negative secondary consequences; uptake and use of hearing aids remain low, despite the fact that hearing aids provide an effective treatment option for older adults with hearing loss. The authors describe models relevant to understanding the help-seeking and decision-making behaviors of older adults with hearing loss and discuss recommendations for future research.

CONCLUSION: Because of the considerable overlap in factors associated with help-seeking behaviors across chronic medical conditions and because help-seeking behaviors are complex, help seeking should be examined within the framework of a multifactorial model, such as the health belief model or the transtheoretical stages of change model.

PURPOSE: To briefly summarize existing data on effects of aging on auditory processing and cognition.

METHOD: A narrative review summarized previously reported data on age-related changes in auditory processing and in cognitive processes with a focus on spoken language comprehension and memory. In addition, recent data on effects of lifestyle engagement on cognitive processes are reviewed.

RESULTS: There is substantial evidence for age-related declines in both auditory processes and cognitive abilities. Accumulating evidence supports the idea that the perceptual burden associated with hearing loss impacts the processing resources available for good comprehension and memory for spoken language, particularly in older adults with limited resources. However, many language abilities are well preserved in old age, and there is considerable variability among individuals in cognitive performance across the life span. The authors discuss how lifestyle factors and socioemotional engagement can help to offset declining abilities.

CONCLUSIONS: It is clear that spoken language processing in adulthood and old age is affected by changes in perceptual, cognitive, and socioemotional processes as well as by interactions among these changes. Recommendations for further research include studying speech comprehension in complex conditions, including meaningful-connection spoken language, and tailoring clinical interventions based on patients' auditory processing and cognitive abilities along with their individual socioemotional demands.

BACKGROUND: Patients with single-sided deafness (SSD), where one ear has an unaidable hearing loss and the other ear has normal or aidable hearing, often complain of difficulties understanding speech and localizing sound sources, and report a higher self-perceived hearing disability. Patients with SSD may benefit from using contralateral routing of signal (CROS) or bilateral contralateral routing of the signal (BiCROS) amplification. Dissatisfaction of previously available (Bi)CROS devices has been reported, such as, interfering transmissions, low-fidelity sound quality, poor "user-friendly" set-up, and a bulky and cosmetically cumbersome appearance.

PURPOSE: Recent advances in hearing aid technology have improved (Bi)CROS hearing aids; however, these devices have not been experimentally evaluated. We hypothesized that newer technology with reports of improved digital signal processing, wireless transmission, and physical design would be as good, or better than, our participants' previous-generation BiCROS systems.

RESEARCH DESIGN: A within-subjects, pretest-posttest design was executed.

STUDY SAMPLE: Thirty-nine veterans (one female, 38 males; mean age = 74 yr, range = 49-85 yr) from the Audiology Section of the Bay Pines Veterans Affair Healthcare System participated. All participants were previously experienced BiCROS hearing aid users with varying degrees of sensorinerual hearing impairment in their better ear.

INTERVENTION: Participants were provided at least 4 wk of consistent use with the new BiCROS. DATA COLLECTION AND ANALYSES: Participants completed three research visits. At Visit 1, with their previous BiCROS, and at Visit 3, with their new BiCROS, the following objective and subjective measures were obtained: (1) soundfield speech-in-noise testing using the Words-In-Noise (WIN) test; (2) speech, spatial, and qualities of the hearing scale (SSQ) questionnaire; (3) selected questions from the MarkeTrak questionnaire; and, (4) three open-ended questions. Data were analyzed using parametric and nonparametric statistics.

RESULTS: Overall, the objective (WIN) and subjective (SSQ, MarkeTrak, and open-ended questions) measures indicated that the new BiCROS provided better outcomes than the previous BiCROS system. In addition, an overlap of favorable results was seen across measures.

CONCLUSIONS: Of the 39 participants, 95% reported improvements with the new BiCROS and chose to utilize the device regularly. The favorable objective and subjective outcomes indicate that the new BiCROS system is as good, or better than, what was previously utilized by our sample of veterans.

BACKGROUND: The most common complaint of adults with hearing loss is understanding speech in noise. One class of masker that may be particularly useful in the assessment of speech-in-noise abilities is interrupted noise. Interrupted noise usually is a continuous noise that has been multiplied by a square wave that produces alternating intervals of noise and silence. Wilson and Carhart found that spondaic word thresholds for listeners with normal hearing were 28 dB lower in an interrupted noise than in a continuous noise, whereas listeners with hearing loss experienced only an 11 dB difference.

PURPOSE: The purpose of this series of experiments was to determine if a speech-in-interrupted-noise paradigm differentiates better (1) between listeners with normal hearing and listeners with hearing loss and (2) among listeners with hearing loss than do traditional speech-in-continuous-noise tasks.

RESEARCH DESIGN: Four descriptive/quasi-experimental studies were conducted.

STUDY SAMPLE: Sixty young adults with normal hearing and 144 older adults with pure-tone hearing losses participated.

DATA COLLECTION AND ANALYSIS: A 4.3 sec sample of speech-spectrum noise was constructed digitally to form the 0 interruptions per second (ips; continuous) noise and the 5, 10, and 20 ips noises with 50% duty cycles. The noise samples were mixed digitally with the Northwestern University Auditory Test No. 6 words at selected signal-to-noise ratios and recorded on CD. The materials were presented through an earphone, and the responses were recorded and analyzed at the word level. Similar techniques were used for the stimuli in the remaining experiments.

RESULTS: In Experiment 1, using 0 ips as the reference condition, the listeners with normal hearing achieved 34.0, 30.2, and 28.4 dB escape from masking for 5, 10, and 20 ips, respectively. In contrast, the listeners with hearing loss only achieved 2.1 to 2.4 dB escape from masking. Experiment 2 studied the 0 and 5 ips conditions on 72 older listeners with hearing loss, who were on average 13 yr younger and more varied in their hearing loss than the listeners in Experiment 1. The mean escape from masking in Experiment 2 was 7dB, which is 20-25 dB less than the escape achieved by listeners with normal hearing. Experiment 3 examined the effects that duty cycle (0-100% in 10% steps) had on recognition performance in the 5 and 10 ips conditions. On the 12 young listeners with normal hearing, (1) the 50% correct point increased almost linearly between the 0 and 60% duty cycles (slope = 4.2 dB per 10% increase in duty cycle), (2) the slope of the function was steeper between 60 and 80% duty cycles, and (3) about the same masking was achieved for the 80-100% duty cycles. The data from the listeners with hearing loss were inconclusive. Experiment 4 varied the interburst ratios (0, -6, -12, -24, -48, and -infinity dB) of 5 ips noise and evaluated recognition performance by 24 young adults. The 50% points were described by a linear regression (R2 = 0.98) with a slope of 0.55 dB/dB.

CONCLUSION: The current data indicate that interrupted noise does provide a better differentiation both between listeners with normal hearing and listeners with hearing loss and among listeners with hearing loss than is provided by continuous noise.

OBJECTIVES: Comparing the effects of different disorders and interventions on health-related quality of life (HRQoL) is important for healthcare policy and accountability. There are two basic approaches to measure HRQoL: questionnaires derived from psychometrics and preference-based measures or utilities derived from econometrics. While disease-specific HRQoL questionnaires, such as the Dizziness Handicap Inventory (DHI), are important because they focus on the impact of a specific problem and its treatments (i.e., vestibular disorders), economic comparisons of the impacts of diseases/disorders and their treatments are typically based on utility assessment. The utility measures for audiology application (UMAA) were developed to measure utilities for various audiologic conditions using a standard computer. The purpose of this study was to determine if the UMAA provides stable, valid, and sensitive utility measures of the effects of benign paroxysmal positional vertigo (BPPV) and its treatment on HRQoL. It was hypothesized that utilities, as measured by the UMAA, would indicate improvement in HRQoL post-treatment for BPPV comparable to a disease-specific health status measure (DHI).

DESIGN: The UMAA incorporates three techniques to measure utility: rating scale, standard gamble, and time tradeoff. A utility is a cardinal measure of strength of preference and is measured on a continuum basis from 0.0 (incapacitating dizziness) to 1.0 (no dizziness). Fifty-two adults with BPPV of the posterior semicircular canal completed the UMAA and DHI before treatment and again post-treatment. A subgroup of 15 participants completed the UMAA on two occasions before treatment to assess test-retest stability and to establish critical difference values.

RESULTS: Results from this investigation demonstrate that utilities as measured through the UMAA are stable, valid, and comparable to the DHI. Post-treatment utilities were also significantly higher than pretreatment utilities, indicating that the utilities, as measured through the UMAA, are sensitive to improvement in HRQoL after BPPV treatment.

CONCLUSIONS: Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.