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Dullard B.,University of Connecticut | Saunders G.H.,National Center for Rehabilitative Auditory Research

Purpose of the Study: To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI]). Design and Methods: A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years. Results: Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care. Implications: Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI. © The Author 2014. Source

Rosowski J.J.,Massachusetts Eye and Ear Infirmary | Stenfelt S.,Linkoping University | Lilly D.,National Center for Rehabilitative Auditory Research
Ear and Hearing

This article reviews the relationships among different acoustic measurements of the mobility of the tympanic membrane, including impedance, admittance, reflectance, and absorbance, which the authors group under the rubric of immittance measures. Each of these quantities is defined and related to the others. The relationship is most easily grasped in terms of a straight rigid ear canal of uniform area terminated by a uniform middle ear immittance placed perpendicular to the long axis of the ear canal. Complications due to variations from this geometry are discussed. Different methods for measuring these quantities are described, and the assumptions inherent within each method are made explicit. The benefits of wideband measurements of these quantities are described, as are the benefits and limitations of different components of immittance and reflectance/ absorbance. While power reflectance (the square of the magnitude of pressure reflectance) is relatively invariant along the length of the ear canal, it has the disadvantage that it ignores phase information that may be useful in assessing the presence of acoustic leaks in ear-canal measurements and identifying other potential error sources. A combination of reflectance and impedance magnitude and angle give a more complete description of the middle ear from measurements in the ear canal. Copyright © 2013 by Lippincott Williams & Wilkins. Source

Souza P.,Northwestern University | Gallun F.,National Center for Rehabilitative Auditory Research
Ear and Hearing

Objective: In previous work, a simplified version of the modulation spectrum, the Spectral Correlation Index, was shown to be related to consonant error patterns. It is unknown what effect clinical amplification strategies will have on the modulation spectrum. Accordingly, the goals of this study were to examine the effect of clinical amplification strategies on the consonant modulation spectrum and to determine whether there was a relationship between the modulation spectrum and consonant errors for spectrally robust, amplified speech presented to listeners with hearing loss. Design: Participants were 13 adults (mean age, 67 yrs) with mild to moderate sensorineural hearing loss. Each listener was fit monaurally in the test ear with a 16-band, four-channel behind the ear hearing aid. One memory of the hearing aid was programmed with compression limiting amplification and one with fast-acting wide-dynamic range compression (WDRC) amplification. Twenty-two consonant-vowel syllables were presented to the listener and recorded at the output of the hearing aid using a probe microphone system. A modulation spectrum was obtained for each amplified and unamplified consonant-vowel. Consonant recognition was also measured for each listener. Results: Results show that (1) WDRC increased heterogeneity of the modulation spectrum across consonants and (2) for spectrally robust speech processed with either compression limiting or WDRC amplification, two consonants with similar modulation spectra are more likely to be confused with one another than are the two consonants with dissimilar modulation spectra. Conclusion: These data expand and confirm earlier results linking the modulation spectrum to specific consonant errors. Copyright © 2010 by Lippincott Williams & Wilkins. Source

Souza P.,Northwestern University | Hoover E.,Northwestern University | Gallun F.,National Center for Rehabilitative Auditory Research
Journal of Speech, Language, and Hearing Research

Purpose: Amplitude compression is a common hearing aid processing strategy that can improve speech audibility and loudness comfort but also has the potential to alter important cues carried by the speech envelope. In previous work, a measure of envelope change, the Envelope Difference Index (EDI; Fortune, Woodruff, & Preves, 1994), was moderately related to recognition of spectrally robust consonants. This follow-up study investigated the relationship between the EDI and recognition of spectrally sparse consonants. Method: Stimuli were vowel-consonant-vowel tokens processed to reduce spectral cues. Compression parameters were chosen to achieve a range of EDI values. Recognition was measured for 20 listeners with normal hearing. Results: Both overall recognition and perception of consonant features were reduced at higher EDI values. Similar effects were noted with noise-vocoded and sine-vocoded processing and regardless of whether periodicity cues were available. Conclusion: The data provide information about the acceptable limits of envelope distortion under constrained conditions. These limits can be used to consider the impact of envelope distortions in situations where other cues are available to varying extents. © American Speech-Language-Hearing Association. Source

Gallun F.J.,National Center for Rehabilitative Auditory Research
Proceedings of Meetings on Acoustics

The effects of informational masking (IM) can be recast as a question of which cues to sound source identity (auditory object formation) are most useful for overcoming IM. We hypothesize that individual differences are related to specific interactions of stimulus and listener-specific variables that determine the effectiveness of the auditory object formation process. Results from our laboratory generally support the well-established relationship between performance and stimulus variables such as spectrotemporal cues (in this case, voice differences) and spatial cues (talker locations). In addition, the listener-specific variables of age and hearing loss were found to interact with the stimulus variables and to be correlated with potential mediating variables such as interaural time sensitivity and minimum levels at which speech identification was possible. Future work will involve developing predictive models that focus on identifying the mediating variables responsible for increased susceptibility to IM and efficient tests to reveal these relationships in individual listeners. The clinical relevance of the ability to identify factors predictive of IM susceptibility will be discussed, including the potential for improved fitting of hearing aids and cochlear implants. © 2013 Acoustical Society of America. Source

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