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Meyer C.,HEARing CRC | Meyer C.,University of Queensland | Barr C.,HEARing CRC | Barr C.,University of Melbourne | And 4 more authors.
Patient Education and Counseling | Year: 2017

Objective: To profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients' decisions to pursue hearing aids. Methods: Sixty-three initial hearing assessment appointments were filmed and audiologist-patient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted. Results: Two distinct audiologist-patient communication profiles were identified during both the history taking phase (46 = biopsychosocial profile, 15 = psychosocial profile) and diagnosis and management planning phase (45 = expanded biomedical profile, 11 = narrowly biomedical profile). Longer appointments were significantly more likely to be associated with an expanded biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients' decisions to pursue hearing aids. Conclusion: Initial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction. Practice implications: Findings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients. © 2017 Elsevier B.V.

Newbold C.,HEARing CRC | Newbold C.,University of Melbourne | Peters L.,University of Melbourne | Cowan R.,HEARing CRC | And 2 more authors.
Audiology and Neurotology | Year: 2014

Cochlear implant stimulation creates a reduction in electrode impedance that returns to pre-stimulation levels following cessation of stimulation and is presumed to be associated with the fibrous tissue covering over the electrode array. This study assessed the possibility that transitory impedance reduction originates from a change in the membrane permeability of cells on the electrode (electropermeabilization). These changes can be recorded using the dye propidium iodide, which fluoresces upon entry into the leaky cell. The in vitro model used showed impedance reduction and dye uptake into adherent cells overlying planar gold electrodes stimulated with as little as 5 min of clinically relevant cochlear implant stimulation. The delayed additions of propidium iodide showed a similar dye uptake to those groups with concurrent dye addition, suggesting the electropermeabilization was not reversible. Further understanding of the mechanisms behind these impedance and cell permeability changes with cochlear implant electrical stimulation may provide opportunities for creating longlasting reductions in electrode impedance. © 2014 S. Karger AG, Basel.

Grenness C.,HEARing CRC | Grenness C.,University of Melbourne | Hickson L.,HEARing CRC | Hickson L.,University of Queensland | And 5 more authors.
Ear and Hearing | Year: 2015

Objectives: The nature of communication between patient and practitioner influences patient outcomes. Specifically, the history-taking phase of a consultation plays a role in the development of a relationship and in the success of subsequent shared decision making. There is limited research investigating patient-centered communication in audiology, and this study may be the first to investigate verbal communication in an adult audiologic rehabilitation context. This research aimed, first, to describe the nature of verbal communication involving audiologists, patients, and companions in the history-taking phase of initial audiology consultations and, second, to determine factors associated with communication dynamics. Design: Sixty-three initial audiology consultations involving patients over the age of 55, their companions when present, and audiologists were audio-video recorded. Consultations were coded using the Roter Interaction Analysis System and divided into three consultation phases: history, examination, and counseling. This study analyzed only the history-taking phase in terms of opening structure, communication profiles of each speaker, and communication dynamics. Associations between communication dynamics (verbal dominance, content balance, and communication control) and 11 variables were evaluated using Linear Mixed Model methods. Results: The mean length of the history-taking phase was 8.8 min (range 1.7 to 22.6). A companion was present in 27% of consultations. Results were grouped into three areas of communication: opening structure, information exchange, and relationship building. Examination of the history opening structure revealed audiologists' tendency to control the agenda by initiating consultations with a closed-ended question 62% of the time, followed by interruption of patient talk after 21.3 sec, on average. The aforementioned behaviors were associated with increased verbal dominance throughout the history and increased control over the content of questions. For the remainder of the history, audiologists asked 97% of the questions and did so primarily in closed-ended form. This resulted in the audiologist talking as much as the patient and much more than the companions when they were present. Questions asked by the audiologist were balanced in topic: biomedical and psychosocial/lifestyle; however, few emotionally focused utterances were observed from any speaker (less than 5% of utter ances). Conclusions: Analysis of verbal communication involving audiologists, patients, and companions in the history-taking phase in 63 initial audiology consultations revealed a communicative exchange that was audiologist-controlled and structured, but covered both medical and lifestyle content. Audiologists often attempted to create a relationship with their patients; however, little emotional relationship building occurred, which may have implications later in the consultation when management decisions are being made. These results are not in line with patient-centered communication principles. Further research and changes to clinical practice are warranted to transform patient-centered communication from an ideal to a reality. © 2014 Wolters Kluwer Health, Inc.

Salloum C.A.M.,University of Toronto | Valero J.,Hospital for Sick Children | Wong D.D.E.,University of Toronto | Papsin B.C.,University of Toronto | And 4 more authors.
Ear and Hearing | Year: 2010

Objectives: Interaural level differences (ILD) and interaural timing differences (ITD) are important cues for locating sounds in space. Adult bilateral cochlear implant (CI) users use ILDs more effectively than ITDs. Few studies investigated the ability of children who use bilateral CIs to make use of these binaural cues. Our working hypothesis was that children using bilateral CIs are able to perceive changes in ITDs and ILDs similar to their normal-hearing (NH) peers. Design: Participants were two groups of children; 19 bilateral implant users (CI) and nine NH children. The children in the CI group had received a second CI after 4.9 ± 2.8 yrs of unilateral use. Children performed a four alternative forced-choice lateralization task in which they were asked to describe stimuli as coming from the left side, right side, middle of the head, or from both sides simultaneously. Stimuli were 500 msec trains of electrical pulses delivered to apical electrode no. 18 (CI group) or clicks (NH group) presented 11 times per second with either ITDs (0, 400, 1000, or 2000 μsec delay between sides) or level differences (0, 10, or 20 Current Units (CI group) or 0, 10, or 20 dB (NH group) difference between sides). ITDs were presented using current levels that were balanced using left and right electrically evoked brain stem responses. Stimulus levels evoking response amplitudes that were most similar were used. Results: Responses from children in the CI group changed significantly with changes in ILD of bilateral stimuli, but not with changes in ITD. Responses from children in the CI group were significantly different from those in the NH group in three ways. Children in the CI group perceived bilaterally presented electrical pulses: (1) to come from the second implanted side more often than the first, (2) to rarely come from the middle, and (3) to come from both sides of the head simultaneously. Perceived changes in lateralization with ILD changes were correlated with differences in amplitudes of electrically evoked brain stem responses by the left versus right CI. Conclusions: The results of this study illustrate that children who use bilateral CIs can lateralize stimuli on the basis of level cues, but have difficulty interpreting interimplant timing differences. Perceived lateralization of bilaterally presented stimuli to the second implanted side in many of the stimulus conditions may relate to the use of different device generations between sides. Further differences from normal lateralization responses could be due to abnormal binaural processing, possibly resulting from a period of unilateral hearing before the provision of a second implant or due to insufficiently matched interimplant stimuli. It may be possible to use objective measures such as electrically evoked auditory brain stem responses wave eV amplitudes to provide balanced levels of bilateral stimulation in children who have had no binaural hearing experience. © 2010 Lippincott Williams & Wilkins.

Ching T.Y.C.,Macquarie University | Dillon H.,Macquarie University | Marnane V.,Macquarie University | Hou S.,Macquarie University | And 16 more authors.
Ear and Hearing | Year: 2013

Objective: To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment. DESIGN: All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes. Results: Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age. Conclusions: Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants. © 2013 by Lippincott Williams and Wilkins.

Monksfield P.,University of Melbourne | Husseman J.,University of Melbourne | Cowan R.S.C.,Hearing CRC | O'Leary S.J.,University of Melbourne | Briggs R.J.S.,University of Melbourne
Cochlear Implants International | Year: 2012

Objective: The Nucleus 5 or CI500 series cochlear implants are the new generation of Nucleus® cochlear implants. The receiver-stimulator package has a low profile without a pedestal projecting from the medial surface. This study aimed to demonstrate that the new design can facilitate a minimally invasive surgical approach, without the need for tie-down sutures and without a seat drilled for the receiver-stimulator package. Methods: The surgical technique involved placing the device directly on the surface of the bone in a secure sub-periosteal pocket with a channel drilled for the lead. A well or ramped seat was not drilled and tie-down sutures were not used. Measurements were taken from the transmitting coil to the tragus and the coil to the lobule immediately after implantation, and serially thereafter to document implant position. Results: To date, over 200 implants have been performed with the Nucleus 5 device. In all cases, healing was uneventful without major complications. Of 137 patients with at least 6-week follow-up data, 8% showed a measurement change of greater than 1 cm whereas only 4.4% demonstrated any clinically evident movement. None had any complications relating to migration and none required repositioning of the device. Discussion: The new design can safely be inserted without drilling a well for the receiver-stimulator package. Some early post-operative movement of the package was observed which caused no clinical impact. This modified surgical technique reduces the risk of intracranial complications and reduces operating time. © W.S. Maney & Son Ltd 2012.

Vandali A.,Hearing CRC | Sly D.,University of Melbourne | Cowan R.,Hearing CRC | Van Hoesel R.,Hearing CRC
Ear and Hearing | Year: 2015

Objectives: Perception of musical pitch in cochlear implant (CI) systems is relatively poor compared with normal hearing and can be adversely affected by changes in spectral timbre coded by stimulation place. In this study, we evaluated whether the perception of musical pitch could be improved through specific training designed to teach listeners to attend to fundamental frequency (F0) exclusively for judgment of pitch and to spectral envelope exclusively for discrimination of spectral timbre. Design: A computer-based training program to improve musical pitch perception was developed that required listeners to match acoustic patterns of pitch and spectral timbre to visual patterns. Ten adult CI recipients participated: five used the training program and five acted as controls. Before training, F0 and center frequency discrimination for band-limited complex harmonic stimuli presented in the sound field were measured in all subjects using their standard clinical device(s). The F0 tests were conducted with and without spectral variations. The trainees subsequently used the training program at home for a period of 4 months, during which they were asked to train for approximately 30 min per day. The training schedule comprised two successive phases, each lasting 2 months. In the first phase, training employed a single cue (i.e., F0 for pitch or center frequency for spectral timbre) in the absence of other cue variations. In the second phase, training incorporated more complex sounds in which multiple cues were varied. Discrimination thresholds were remeasured in all subjects after each phase and again with trainees 3 months after training had ceased. Results: Trainees obtained significant improvements in F0 and center frequency discrimination as compared with control subjects for tests conducted at 2 months. The improvements in F0 discrimination were observed both in the absence and presence of small variations in place. However, the effect of training diminished for large variations in place or for higher F0s. Neither group showed further improvement in tests after additional training in the second phase. Tests conducted with trainees after training had ceased showed that F0 discrimination improvements were retained. Conclusions: The results showed that performance on pitch and timbre discrimination can be improved by training with single cues (F0 and center frequency) in the absence of other cue variations. Although results indicated that training with single cues can improve F0 discrimination within more complex sounds in which multiple cues vary, little improvement was seen when large variations in place were present, which suggests a diminishing effect of the training with increased influence of place-pitch. These data imply that although such training techniques may help listeners to follow melody in music, changes in instrument are likely to affect perception of melody. Results of subsequent training with complex sounds in which multiple cues varied were less conclusive and showed no further improvement. Follow-up evaluations with trainees conducted well after training had ceased verified the robustness of the training effect on F0 but not center frequency discrimination. Further studies are needed, however, to determine whether and to what degree subject motivation may be an important factor in these outcomes. © 2014 Wolters Kluwer Health, Inc.

Meyer C.,HEARing CRC | Meyer C.,University of Queensland | Hickson L.,HEARing CRC | Hickson L.,University of Queensland | And 8 more authors.
Ear and Hearing | Year: 2011

OBJECTIVES: Hearing impairment constitutes a highly prevalent chronic health condition among older adults worldwide which negatively impacts on communication and health-related quality of life. Irrespective of this, the majority of older adults do not seek professional help for hearing impairment and/or do not obtain hearing aids. Therefore, a new approach for detecting and promoting help-seeking for hearing impairment is needed. The purpose of this study was to investigate the actions taken by those who failed Telscreen, a telephone-based screening tool for hearing loss, and to increase our understanding of factors that influence taking action. DESIGN: A cohort of 193 participants (112 females, 81 males; age range 24-93 yr) who had failed Telscreen participated in a follow-up telephone interview 4 to 5 mo later. Participants were asked why they called Telscreen, about their hearing ability, their Telscreen result, and what action they had taken toward hearing rehabilitation. One outcome measure was identified: decision to seek professional help for hearing impairment (yes/no). Given that the outcome measure was dichotomized, a logistic regression model for binary outcomes was fitted to the data. RESULTS: Of the 193 participants who failed Telscreen, only 36% sought help from a range of sources (e.g., audiologist, hearing service or hearing aid provider, and family doctor). Results of the logistic regression analysis indicated that individuals who had considered hearing aids before calling Telscreen and/or who recalled their Telscreen result were significantly more likely to seek professional help for their hearing impairment. Nineteen participants who sought help for their hearing impairment had hearing aid fitting recommended to them. Eight participants had aid/s fitted, and of these, six reported a successful outcome. CONCLUSIONS: For every 100 individuals who fail a hearing screening, only 36 seek help. Of these 36 individuals who take some action, 13 are recommended hearing aids, approximately half of whom follow this advice and obtain hearing aids. Approximately three-quarters of these individuals use and value their hearing aids. Provided that the screening is automated and low cost, hearing screening via telephone has proven to change the lives of 5% of individuals who decided to seek professional help for hearing impairment at little cost to the other 95% of individuals. Suggestions for future research based on the present research findings are discussed. Copyright © 2011 by Lippincott Williams & Wilkins.

Vandali A.E.,Hearing CRC | Van Hoesel R.J.M.,Hearing CRC
Journal of the Acoustical Society of America | Year: 2011

A sound-coding strategy for users of cochlear implants, named enhanced-envelope-encoded tone (eTone), was developed to improve coding of fundamental frequency (F0) in the temporal envelopes of the electrical stimulus signals. It is based on the advanced combinational encoder (ACE) strategy and includes additional processing that explicitly applies F0 modulation to channel envelope signals that contain harmonics of prominent complex tones. Channels that contain only inharmonic signals retain envelopes normally produced by ACE. The strategy incorporates an F0 estimator to determine the frequency of modulation and a harmonic probability estimator to control the amount of modulation enhancement applied to each channel. The F0 estimator was designed to provide an accurate estimate of F0 with minimal processing lag and robustness to the effects of competing noise. Error rates for the F0 estimator and accuracy of the harmonic probability estimator were compared with previous approaches and outcomes demonstrated that the strategy operates effectively across a range of signals and conditions that are relevant to cochlear implant users. © 2011 Acoustical Society of America.

Vandali A.E.,Hearing CRC | Van Hoesel R.J.M.,Hearing CRC
Journal of the Acoustical Society of America | Year: 2012

The abilities to hear changes in pitch for sung vowels and understand speech using an experimental sound coding strategy (eTone) that enhanced coding of temporal fundamental frequency (F0) information were tested in six cochlear implant users, and compared with performance using their clinical (ACE) strategy. In addition, rate- and modulation rate-pitch difference limens (DLs) were measured using synthetic stimuli with F0s below 300 Hz to determine psychophysical abilities of each subject and to provide experience in attending to rate cues for the judgment of pitch. Sung-vowel pitch ranking tests for stimuli separated by three semitones presented across an F0 range of one octave (139-277 Hz) showed a significant benefit for the experimental strategy compared to ACE. Average d-prime (d') values for eTone (d'=1.05) were approximately three time larger than for ACE (d'=0.35). Similar scores for both strategies in the speech recognition tests showed that coding of segmental speech information by the experimental strategy was not degraded. Average F0 DLs were consistent with results from previous studies and for all subjects were less than or equal to approximately three semitones for F0s of 125 and 200 Hz. © 2012 Acoustical Society of America.

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