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Journal: International journal of audiology


Abstract Children with listening difficulties, but normal audiometry, may be diagnosed with APD. The diagnosis is typically based on poor performance on tests of perception of both non-speech and speech stimuli. However, non-speech test results correlate only weakly with evaluations of speech-in-noise processing, cognitive skills, and caregiver evaluations of listening ability. The interpretation of speech test results is confounded by the involvement of language processing mechanisms. Overall, listening ability is associated more with higher-level, cognitive and analytic processing than with lower-level sensory processing. Current diagnosis of a child with APD, rather than another problem (e.g. language impairment, LI), is determined more by the referral route than by the symptoms. Co-occurrence with other learning problems suggests that APD may be a symptom of a more varied neurodevelopmental disorder. Alternately, APD has been proposed as a cause of language-based disorders, but there is no one-to-one mapping between listening and language among individuals. Screening for APD may be most appropriately based on a well-validated, caregiver questionnaire that captures the fundamental problem of listening difficulties and identifies areas for further assessment and management. This approach has proved successful for LI, and may in future serve as a metric to help assess other, objective testing methods. Foreword Auditory processing disorder (APD) has a long (>‚ÄČ30 years) and controversial history. The controversies concern absolutely fundamental issues: the definition of APD, its neural basis, test validity and standardization, differentiation from other disorders, and even whether it exists as an independent disorder ( Jerger, 2009 ). To evaluate and interpret the scientific evidence on APD, and to advise the audiology profession, the British Society of Audiology (BSA) established a Special Interest Group (BSA SIG) on APD in 2003. That group has recently published two key documents, a ‘Position Statement’ and a ‘Management Overview’ ( BSA, 2011, a , b . See ‘Procedures and Publications’). In formulating the new position statement, it became clear to the group that several significant differences were developing between their interpretation of the evidence concerning APD and that of the American Academy of Audiology (AAA) , as stated in their recently published ‘Guidelines for the diagnosis, treatment and management of children and adults with central auditory processing disorder’ ( AAA, 2010 ). To address these differences, and borrowing from British Parliamentary procedure, the BSA SIG decided to develop a ‘white paper’, a discussion document that could then receive an international set of commentaries from other research groups working on APD. An approach was made to the editor of the International Journal of Audiology who agreed to this suggestion. This paper, and the associated commentaries that follow, are the result.

Concepts: Psychology, Cognition, Auditory system, Audiology, Evidence, Scientific evidence, Neural development, Auditory processing disorder


Objective: To use performance-based user-testing to evaluate the effectiveness of balance appointment patient information leaflets (PILs) in conveying important information. Design: The study used a sequential groups design. Twenty participants were asked to find and demonstrate understanding of 11 key points of information contained within two NHS leaflets, A and B (10 participants each), through individual structured-interviews. Participants' views of the leaflets were explored through a short semi-structured interview. Following analysis, a revised leaflet was developed and tested on a further 20 participants. Study sample: 40 participants (25F/15M, aged 46-72) with no experience of balance problems or balance assessment appointments. Results: Participants exhibited difficulties with finding and/or understanding 5/11 and 6/11 points of information within leaflets A and B, respectively. Five out of eleven points of the revised leaflet also posed problems. Ten out of eleven points were understood by > 90% of participants testing the revised leaflet compared with 6/11 points for leaflets A and B. Conclusions: Some balance appointment PILs contain information which is difficult to find and/or understand for some readers. PILs should be evaluated prior to use using performance-based methods, since poor information provision may lead to increased patient anxiety and appointment non-attendance, cancellation, or postponement.

Concepts: Anxiety, Understanding, Perception, Knowledge, Leaflet


Abstract Objective: Leisure activities that emit high noise levels have the potential to expose participants to excessive noise exposure, which can result in hearing damage. This study investigated young people’s participation in high-noise leisure activities and the relationship between their leisure noise exposure, symptoms of hearing damage, and perception of risk. Design: Participants completed an online survey relating to participation in selected high-noise leisure activities, symptoms of hearing damage, and beliefs about the risk posed by these activities. Study sample: One thousand 18- to 35-year-old Australian adults completed the survey. Results: Annual noise exposure from the five leisure activities ranged from 0-6.77 times the acceptable noise exposure, with nightclubs posing the greatest risk. Those who attended one noisy activity were more likely to attend others, in particular nightclubs, pubs, and live music events. Noise exposure was correlated with early warning signs of hearing damage and perceived risk of damage. Conclusions: Active young adults who engage in noisy activities are showing early signs of hearing damage. Furthermore, they perceive the risk associated with their activities. The challenge for researchers and hearing health practitioners is to convert self-perceived risk into positive hearing health behaviours for long-term hearing health.

Concepts: Psychology, Risk, Perception, Sense, Mind, Philosophy of perception, Risk perception, Cultural Theory of risk


Objective: The aim of this study was to determine the effect of ambient noise on the accuracy of thresholds obtained using the KUDUwave portable clinical audiometer as compared to those obtained using a GSI-61 clinical audiometer in a sound booth. Design: Pure-tone air conduction thresholds were obtained in three conditions: (1) with a clinical audiometer in a quiet sound booth, (2) with the KUDUwave in a quiet sound booth, and (3) with the KUDUwave with 40 dBA of background noise. Study sample: A total of 31 individuals ranging in age from 15 to 80 years participated in the study, 21 with normal hearing and ten with hearing loss. Results: Eighty-nine percent of thresholds obtained with the KUDUwave in quiet, and 92% of thresholds obtained with the KUDUwave in background noise were within 5 dB of those obtained with the clinical audiometer. Accuracy was poorer at 250 Hz and 8000 Hz. Conclusion: Ambient noise typical of that found in a non-sound-treated room, did not affect the accuracy of air conduction hearing thresholds obtained with the KUDUwave. The KUDUwave may be a viable method of testing when a clinical audiometer and sound booth are not available.

Concepts: Acoustics, Sound, Audiogram, Hearing, Ambient noise level, Noise, Noise pollution, Background noise


Objective: To estimate the prevalence of severe and profound hearing loss in a clinical population and to report the audiological and hearing-aid characteristics for this group, as well as outcome measures from use of hearing aids. Design: A retrospective observational study initially, followed by a postal Glasgow health status inventory (GHSI) to establish the patients functional outcomes. Study sample: A clinical database of 32 781 cases was interrogated from which 2199 cases of severe /profound hearing loss were identified. From these, an adult sample stratified in terms of age and gender of n = 302 was contacted. Results: An estimated 6.7% of the local clinical population and 0.7% of the general population were found to have hearing > 70 dB averaged over 0.5, 1, and 2 kHz. Most patients were fitted with bilateral hearing aids, using a non-linear prescription, and as a group they reported a high level of social support. Conclusions: This study has estimated the prevalence of severe and profound hearing loss as 6.7% of the clinical population, and 0.7% of the general population. This is consistent with previous work, although it probably underestimates the prevalence. Further work is indicated to strengthen the estimate.

Concepts: Health care, Statistics, Mathematics, Observational study, Otology, National Health Service, Estimation, Audiology


The aims of the current n200 study were to assess the structural relations between three classes of test variables (i.e. HEARING, COGNITION and aided speech-in-noise OUTCOMES) and to describe the theoretical implications of these relations for the Ease of Language Understanding (ELU) model.

Concepts: Cognition, Educational psychology, Psychometrics, Factor analysis, Language, Thought, Logic, The Current


Effective hearing loss rehabilitation support options are available. Yet, people often experience delays in receiving rehabilitation support. This study aimed to document support-seeking experiences among a sample of UK adults with hearing loss, and views towards potential strategies to increase rehabilitation support uptake. People with hearing loss were interviewed about their experiences of seeking support, and responses to hypothetical intervention strategies, including public awareness campaigns, a training programme for health professionals, and a national hearing screening programme.

Concepts: Empiricism


To assess patients' judgements of the effectiveness of the tinnitus and hyperacusis therapies offered in a specialist UK National Health Service audiology department.

Concepts: Health care provider, Medicine, Clinical trial, Therapy, Illness, Otology


Objective: Age-related hearing loss is an increasingly important public health problem affecting approximately 40% of 55-74 year olds. The primary clinical management intervention for people with hearing loss is hearing aids, however, the majority (80%) of adults aged 55-74 years who would benefit from a hearing aid, do not use them. Furthermore, many people given a hearing aid do not wear it. The aim was to collate the available evidence as to the potential reasons for non-use of hearing aids among people who have been fitted with at least one. Design: Data were gathered via the use of a scoping study. Study sample: A comprehensive search strategy identified 10 articles reporting reasons for non-use of hearing aids. Results: A number of reasons were given, including hearing aid value, fit and comfort and maintenance of the hearing aid, attitude, device factors, financial reasons, psycho-social/situational factors, healthcare professionals attitudes, ear problems, and appearance. Conclusions: The most important issues were around hearing aid value, i.e. the hearing aid not providing enough benefit, and comfort related to wearing the hearing aid. Identifying factors that affect hearing aid usage are necessary for devising appropriate rehabilitation strategies to ensure greater use of hearing aids.

Concepts: Health care, Otology, Ear, Sensorineural hearing loss, World Health Organization, Audiology


Validate use of the Extended Speech Intelligibility Index (ESII) for prediction of speech intelligibility in non-stationary real-world noise environments. Define a means of using these predictions for objective occupational hearing screening for hearing-critical public safety and law enforcement jobs.