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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 (> 30 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


This systematic review aimed to explore the evidence on whether the preferred listening levels (PLLs) and durations of music listening through personal listening devices (PLDs) in adolescents and young adults exceed the current recommended 100% daily noise dose; together with the impact on hearing and possible influential factors of such listening behaviours.

Concepts: Sound, The Current, Hearing, Active listening


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 determine audiology student perceptions of two simulated learning environments (SLE) in paediatric audiology. Design: A one-shot case study design. Study sample: Fifteen audiology students who completed questionnaires after participating in two SLEs, one simulating auditory brainstem response (ABR) assessments of neonates in a hospital ward and one simulating visually reinforced orientation audiometry (VROA) assessments of young children in an audiology clinic. Results: The students responded positively to 11/11 areas of audiometric testing and client interaction in both SLEs, to 7/7 aspects of their interactions with the mannequins in both SLEs, and to 8/8 aspects of their interactions with fellow students playing the role of parent in the ABR SLE and 7/8 of these aspects in the VROA SLE. The students reported low levels of anxiety towards both SLEs but rated the ABR SLE more highly than the VROA SLE in areas of preparedness, effectiveness, realism, pre-SLE training, reinforcement of lecture content, and overall usefulness. Conclusions: The participating students responded positively to almost all aspects of both SLEs. Further research is warranted using research designs capable of determining if these SLEs directly improve student abilities as they transition from academic settings to clinical placements in paediatric audiology.


Objective: It is possible that tinnitus, hearing loss and insomnia are all linked to oxidative stress. If so, there should be a relationship between insomnia and hearing loss among patients with tinnitus. The aim of this study was to assess the relationship between insomnia and hearing thresholds for patients with tinnitus. Design: This was a retrospective study. Study sample: Data were gathered from records of 1066 consecutive patients (≥18 years old) with tinnitus who were seen in an audiology clinic in the UK. Results: Seventy percent of patients experienced some form of insomnia as measured via the Insomnia Severity Index (ISI). Thirty eight percent of patients had hearing loss. Regression models showed that the average hearing threshold across ears and frequencies (0.5-4 kHz), adjusted for age and gender, did not predict ISI scores: regression coefficient (b) = 0.02 (95% confidence interval, CI: -0.013 to 0.05, p = 0.25). Moreover, the ISI scores did not predict the severity of hearing loss: b = 0.07 (95% CI: -0.05 to 0.18, p = 0.25). Conclusion: The data do not support the idea that high levels of oxidative stress, which are associated with insomnia, have a strong influence on hearing loss among patients with tinnitus.


To consider the relationships between both peripheral and central hearing impairment and cognition.


Objective: This rapid systematic review investigated audio-vestibular symptoms associated with coronavirus.Design: The protocol for the rapid review was registered in the International Prospective Register of Systematic Reviews and the review methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the National Institute of Heath quality assessment tools.Study sample: After rejecting more than 2300 records, there were five case reports and two cross-sectional studies that met the inclusion criteria.Results: No records of audio-vestibular symptoms were reported with the earlier types of coronavirus (i.e. severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome [MERS]). Reports of hearing loss, tinnitus, and vertigo have rarely been reported in individuals who tested positive for the SARS-CoV-2.Conclusion: Reports of audio-vestibular symptoms in confirmed COVID-19 cases are few, with mostly minor symptoms, and the studies are of poor quality. Emphasis over time is likely to shift from life-threatening concerns to longer-term health-related consequences such as audio-vestibular dysfunction. High-quality studies are needed to investigate the acute effects of COVID-19, as well as for understanding long-term risks, on the audio-vestibular system. Review registration: Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020184932).


Hearing impairment is linked to increased fatigue, yet little is known about the real-world impact of this fatigue. This qualitative study investigated the experience of daily-life fatigue in people with a hearing impairment.