Biomedical subjects

Stephen A Fausti

Publications and source records attributed to Stephen A Fausti.

16 recordsLinked to original sources

PubMed2006

Screening for Auditory Impairment-Which Hearing Assessment Test (SAI-WHAT): RCT design and baseline characteristics.

BACKGROUND: Effective screening programs should not merely detect presence of disease, but also lead to long-term benefit. We describe the rationale and design of the first randomized clinical trial to study the long-term effects of routine screening for hearing loss. We also describe the baseline characteristics of the randomized cohort. METHODS: We randomized 2305 veterans age 50 years or older to a control arm without screening, or to screening with: physiologic testing (AudioScope), a self-administered questionnaire (Hearing Handicap Inventory for the Elderly-Screening version [HHIE-S]), or both tests. The primary outcome measure will be hearing aid use one year after screening. We will also study a number of secondary outcomes, including appointments made with and visits to an audiologist, cases of aidable hearing loss, hearing aids dispensed, self-rated communication ability, and hearing-related quality of life. RESULTS: Baseline demographic and health status measures were evenly distributed across the screening arms. The percentage of patients who screened positive for hearing loss was 18.6%, 59.2%, and 63.6% for the AudioScope, HHIE-S, and combined screening arms, respectively. IMPLICATIONS: Long-term results are needed to gain insight into whether the AudioScope is associated with high rates of false negative screening, the HHIE-S is associated with high rates of false positive screening, or a combination of both. Identifying the best screening program will depend on determining which strategy leads to successful hearing aid use.

Female↗

PubMed2006

Frequency-modulation (FM) technology as a method for improving speech perception in noise for individuals with multiple sclerosis.

Almost half of the population with multiple sclerosis (MS) complains of difficulty hearing, despite having essentially normal pure-tone thresholds. The purpose of the present investigation was to evaluate the effects of frequency-modulation (FM) technology utilization on speech perception in noise for adults with and without MS. Sentence material was presented at a constant level of 65 dBA Leq from a loudspeaker located at 0 degrees azimuth. The microphone of the FM transmitter was placed 7.5 cm from this loudspeaker. Multitalker babble was presented from four loudspeakers positioned at 45 degrees, 135 degrees, 225 degrees, and 315 degrees azimuths. The starting presentation level for the babble was 55 dBA Leq, The level of the noise was increased systematically in 1 dB steps until the subject obtained 0% key words correct on the IEEE (Institute for Electrical and Electronic Engineers) sentences. Test results revealed significant differences between the unaided and aided conditions at several signal-to-noise ratios.

Acoustic Stimulation↗

PubMed2004

The performance-perceptual test and its relationship to unaided reported handicap.

OBJECTIVE: Measurement of hearing aid outcomes is necessary for demonstration of treatment efficacy, third-party payment, and cost-benefit analysis. Outcomes are usually measured with hearing-related questionnaires and/or tests of speech recognition. However, results from these two types of test often conflict. In this paper, we provide data from a new test measure, known as the Performance-Perceptual Test (PPT), in which subjective and performance aspects of hearing in noise are measured using the same test materials and procedures. A Performance Speech Reception Threshold (SRTN) and a Perceptual SRTN are measured using the Hearing In Noise Test materials and adaptive procedure. A third variable, the discrepancy between these two SRTNs, is also computed. It measures the accuracy with which subjects assess their own hearing ability and is referred to as the Performance-Perceptual Discrepancy (PPDIS). DESIGN: One hundred seven subjects between 24 and 83 yr of age took part. Thirty-three subjects had normal hearing, while the remaining seventy-four had symmetrical sensorineural hearing loss. Of the subjects with impaired hearing, 24 wore hearing aids and 50 did not. All subjects underwent routine audiological examination and completed the PPT and the Hearing Handicap Inventory for the Elderly/Adults on two occasions, between 1 and 2 wk apart. The PPT was conducted for unaided listening with the masker level set to 50, 65, and 80 dB SPL. RESULTS: PPT data show that the subjects with normal hearing have significantly better Performance and Perceptual SRTNs at each test level than the subjects with impaired hearing but that PPDIS values do not differ between the groups. Test-retest reliability for the PPT is excellent (r-values > 0.93 for all conditions). Stepwise multiple regression analysis showed that the Performance SRTN, the PPDIS, and age explain 40% of the variance in reported handicap (Hearing Handicap Inventory for the Elderly/Adults scores). More specifically, poorer performance, underestimation of hearing ability and younger age result in greater reported handicap, and vice versa. CONCLUSION: Reported handicap consists of a performance component and a (mis)perception component, as measured by the Performance SRTN and the PPDIS respectively. The PPT should thus prove to be a valuable tool for better understanding why some individuals complain of hearing difficulties but have only a mild hearing loss or conversely report few difficulties in the presence of substantial impairment. The measure would thus seem to provide both an explanation and a counseling tool for patients for whom there is a mismatch between reported and measured hearing difficulties.

Adult↗

PubMed2004

Use of auditory brainstem responses for the early detection of ototoxicity from aminoglycosides or chemotherapeutic drugs.

Effective objective HF (high-frequency) testing methodology provides for the early detection of ototoxic hearing loss because it typically progresses from high to low frequencies. Such early detection is considered necessary to prevent hearing loss from progressing into the frequency range important for understanding speech. Objective tests must be reliable, sensitive to hearing change, and time efficient. Auditory brainstem responses (ABRs) appear well suited to this task; however, current ABR techniques have limitations. Conventional clicks stimulate middle (1-4 kHz) rather than high frequencies (>8 kHz). Responses to HF tone bursts require considerable recording time. We hypothesized that using HF band-limited clicks (HF clicks) could overcome these limitations. Two different HF clicks, with bandwidths of 8-14 kHz were used to elicit ABRs. The current study compared responses among these stimuli. The results demonstrate the reliability of HF-click responses and of tone bursts presented in trains.

Adult↗

PubMed2004

Comparison of manual and computer-automated procedures for tinnitus pitch-matching.

Clinical assessment of tinnitus usually includes pitch-matching between the tinnitus and a pure tone. Although such testing is performed routinely, response reliability has not been demonstrated yet. The present study continues a series of studies designed to develop automated methodology for quantifying tinnitus perceptual characteristics. Three methods for tinnitus pitch-matching were performed in a group of 42 subjects. Two methods were computer-automated (Binary and Subject-Guided) and the third method was a traditional manual technique. Each method provided excellent response reliability for about half of the subjects. The most reliable subjects, however, differed widely between the different methods. Each subject provided a total of 14 pitch matches using the three different methods. Analyses based on each subject's total of 14 pitch matches revealed the range of pitch matches for each subject. About half of the subjects selected pitch matches over a range of 2 1/3 octaves. Results of this study suggest that specifying the range of tinnitus pitch matches rather than attempting to identify a single pitch match may be more appropriate.

Adult↗

PubMed2003

Comparison of ABR stimuli for the early detection of ototoxicity: conventional clicks compared with high frequency clicks and single frequency tonebursts.

Effective objective testing methodology is needed for early detection of the effects of ototoxicity on hearing in patients. The requirements for such testing include responses that are: 1) reliable across test sessions; 2) sensitive to ototoxic change ( > 8 kHz), and 3) recordable in a time-efficient manner. Auditory brainstem responses (ABR) appear well suited to this task however, conventional clicks stimulate primarily mid-frequencies (1-4 kHz) and high frequency tonebursts require too much time. We hypothesized that delivery of a band of high frequencies (a high frequency "click"), would elicit reliable and useful ABRs. In the current study, flat and sloped HF (high frequency) clicks with a bandwidth of 8-14 kHz were used. The purpose was to compare brainstem responses elicited by tonebursts, two HF clicks and conventional clicks. The results show that the reliability of responses to the HF clicks were comparable to the tonebursts and further, both HF clicks produced responses slightly larger than tonebursts.

Acoustic Stimulation↗

PubMed2003

Early detection of ototoxicity using 1/6th-octave steps.

The National Center for Rehabilitative Auditory Research has developed a protocol to provide early identification of ototoxicity for patients receiving ototoxic medications. The initial work involved patients with relatively good high-frequency hearing and resulted in the use of an individualized, sensitive frequency range separated by 1/6th-octave intervals. This protocol tested pure-tone frequencies at 1/6th-octave steps above 9 kHz, but only conventional audiometric frequencies were tested below 9 kHz. More recently, the testing protocol was expanded to include 1/6th-octave testing below 9 kHz. The primary question of interest was to determine whether adding 1/6th-octave test frequencies below 9 kHz would increase the ototoxicity detection rate for patients with poorer hearing. Results indicated 76 of the 210 (36.2%) ears that demonstrated initial ototoxic hearing change would have been missed or detected later if only conventional frequency testing was conducted.Therefore, for individuals with poorer hearing, expanding the use of the 1/6th-octave test protocol provides earlier identification of ototoxicity.

Adult↗

PubMed2002

A multi-center, double blind clinical trial comparing benefit from three commonly used hearing aid circuits.

OBJECTIVE: Although numerous studies have demonstrated that hearing aids provide significant benefit, carefully controlled, multi-center clinical trials have not been conducted. A multi-center clinical trial was conducted to compare the efficacy of three commonly used hearing aid circuits: peak clipping, compression limiting, and wide dynamic range compression. DESIGN: Patients (N = 360) with bilateral, sensorineural hearing loss were studied using a double blind, three-period, three-treatment crossover design. The patients were fit with each of three programmable hearing aid circuits. Outcome tests were administered in the unaided condition at baseline and then after 3 mo usage of each circuit, the tests were administered in both aided and unaided conditions. The outcome test battery included tests of speech recognition, sound quality and subjective scales of hearing aid benefit, including patients' overall rank-order rating of the three circuits. RESULTS: Each hearing aid circuit improved speech recognition markedly, with greater improvement observed for soft and conversationally loud speech in both quiet and noisy listening conditions. In addition, a significant reduction in the problems encountered in communication was observed. Some tests suggested that the two compression hearing aids provided a better listening experience than the peak clipping hearing aid. In the rank-order ratings, patients preferred the compression limiting hearing aid more frequently than the other two hearing aids. CONCLUSIONS: The three hearing aid circuits studied provide significant benefit both in quiet and in noisy listening situations. The two compression hearing aids appear to provide superior benefits compared to the linear circuit, although the differences between the hearing aids were smaller than the differences between unaided and aided conditions.

Aged↗

PubMed2002

Tympanometric findings in patients with enlarged vestibular aqueducts.

OBJECTIVES: The purpose of this study was to study systematically some relationships between the resonance frequency of the middle-ear transmission system and the volume of the endolymphatic duct and sac in patients with an enlarged vestibular aqueduct (EVA). STUDY DESIGN: Prospective study. METHODS: Thirteen patients (24 ears) with EVA, 17 subjects (29 ears) with normal hearing, and 17 patients (21 ears) with sensorineural hearing loss without EVA served as experimental subjects. Standard pure-tone audiometry, standard clinical tympanometry (using a 226-Hz probe tone), and multifrequency tympanometry were performed on each ear. Magnetic resonance imaging was used to determine the area of the cochlear modiolus and the volume of the endolymphatic duct and sac. RESULTS: The audiometric configurations for most patients sloped downward from the low to the high frequencies. A significant air-bone gap was computed at each of these test frequencies. Multifrequency tympanometry yielded resonance frequencies for the patients with EVA that was significantly lower than those measured for the control subjects. In general, for patients with EVA, the resonance frequency of the middle ear system decreased as the volume of the endolymphatic duct and sac increased. This inverse relation was significant (correlation coefficient = -0.483, P =.0157). However, there was no correlation between resonance frequency and the degree of cochlea modiolar deficiency. CONCLUSIONS: Clinically, our findings suggest that EVA probably should be included in the differential diagnosis for a patient who presents with a moderate to severe mixed hearing loss, a normal tympanogram at 226 Hz, and a resonance frequency that is abnormally low.

Acoustic Impedance Tests↗

PubMedDate not supplied

Evaluation of insert earphones for high-frequency bedside ototoxicity monitoring.

Ototoxic hearing loss is usually detected earliest through monitoring of the highest audible frequencies in individuals administered ototoxic medications. Conducting ototoxicity monitoring may require testing patients in the hospital room. This study evaluated the use of insert earphones for obtaining reliable threshold responses at bedside. Twenty adult subjects were tested during two different sessions in the sound booth and on the ward. Thresholds were obtained for frequencies from 5 to 16 kHz and at 2 kHz with the use of the KOSS Pro/4X Plus earphones and Etymotic ER-4B MicroPro insert earphones. Results indicate that ER-4B insert earphones are as reliable as KOSS earphones for testing on the ward for high-frequency ototoxicity monitoring.

Acoustic Stimulation↗

PubMedDate not supplied

Some effects of multiple sclerosis on speech perception in noise: Preliminary findings.

The present investigation examined speech perception in noise of adults with and without multiple sclerosis (MS). Institute of Electrical and Electronic Engineers (IEEE) sentences were presented at a constant level of 65 dBA L(eq) (equivalent continuous noise level [4 dB exchange rate]) from a loudspeaker located at 0-degree horizontal azimuth and 1.2 m from the study participant. Uncorrelated multitalker babble was presented from four loudspeakers positioned at 45-, 135-, 225-, and 315-degree azimuths and 1.7 m from the study participant. The starting presentation level for the babble was 55 dBA L(eq). The level of the babble was increased systematically in 1 dB steps until the subject obtained 0% key words correct on the IEEE sentences. Results revealed a significant difference in speech perception between the two groups at nine signal-to-noise ratios. Some clinical implications of these results are discussed.

Adult↗

PubMedDate not supplied

Hearing health and care: the need for improved hearing loss prevention and hearing conservation practices.

Hearing loss affects 31 million Americans, particularly veterans who were exposed to harmful levels of noise during military functions. Many veterans also receive treatment with ototoxic medications, which may exacerbate preexisting hearing loss. Thus, hearing loss is the most common and tinnitus the third most common service-connected disability among veterans. Poor implementation of hearing protection programs and a lack of audiometric testing during medical treatment leave veterans vulnerable to unrecognized and untreated hearing loss until speech communication is impaired. Individualized audiometric testing techniques, including assessment of high frequencies, can be used in clinical and occupational settings to detect early hearing loss. Antioxidants also may alleviate cochlear damage caused by noise and ototoxicity. Ultimately, hearing loss prevention requires education on reducing occupational and recreational noise exposure and counseling on the risks and options available to patients. Technological advances will improve monitoring, allow better noise engineering controls, and lead to more effective hearing protection.

Anti-Infective Agents↗

PubMedDate not supplied

Assessment of patients for treatment with tinnitus retraining therapy.

Clinical management for patients complaining of severe tinnitus has improved dramatically in the last 25 years. During that period of time, various methods of treatment have been introduced and are being used with varying degrees of success. One method that has received considerable attention is tinnitus retraining therapy (TRT). This method is being practiced by hundreds of clinicians worldwide, and retrospective clinical data indicate that TRT has been effective for the majority of patients. This article provides a guide for clinicians to evaluate their patients for treatment with TRT. Included in this guide is the expanded version of the TRT initial interview and specific instructions for the clinician administering the interview.

Audiometry, Pure-Tone↗

PubMedDate not supplied

Comparison of tinnitus masking and tinnitus retraining therapy.

Two methods for treating tinnitus are compared. Tinnitus masking has been used for over 25 years, and although this method is used in clinics around the world, there are many misconceptions regarding the proper protocol for its clinical application. Tinnitus retraining therapy has been used clinically for over 12 years and has received considerable international attention. Although these methods are distinctive in their basic approach to tinnitus management, certain aspects of treatment appear similar. These aspects of treatment have created considerableconfusion and controversy, especially regarding the use of "sound therapy" as a basic component of treatment. It is the objective of this article to clarify the major differences that exist between these two forms of treatment.

Acoustic Stimulation↗

PubMedDate not supplied

Reliability of computer-automated hearing thresholds in cochlear-impaired listeners using ER-4B Canal Phone earphones.

This paper describes the second phase of a study to determine test-retest reliability of hearing thresholds using a computer-automated technique with ER-4B Canal Phone insert earphones. The first phase documented reliable hearing thresholds in 20 normal-hearing individuals. For this second phase, 20 individuals with cochlear hearing loss completed the same testing protocol as for phase one. During each of two sessions, hearing thresholds were obtained in one-third octave steps at 500 Hz to 16,000 Hz. The octave frequencies were immediately retested, followed by ear-tip reinsertion and further retesting at octave frequencies. Both groups showed overall good threshold reliability, with observable differences between groups. First, repeated testing resulted in improved hearing thresholds for the normal-hearing group, but not for the cochlear-loss group. Second, the normal-hearing group showed overall better response reliability, both within and between sessions, than the cochlear-loss group. These differences were small but consistent.

Adult↗

PubMedDate not supplied

Guide to conducting tinnitus retraining therapy initial and follow-up interviews.

Tinnitus Retraining Therapy (TRT) is a structured method of tinnitus treatment that has been performed since 1990. The TRT Initial Interview form was developed to guide clinicians in obtaining essential information from patients that would specify treatment needs. The TRT Follow-up Interview form is similar to the initial interview form and is designed to evaluate outcomes of treatment. The clinician administers these forms verbally. The forms have been used in a highly abbreviated format with the potential for inconsistent interview administration between examiners. This project was to expand the forms to provide specific wording for each question. The expanded forms are presented in this article, and the intent of each question is explained. Standardized administration of these interview forms will facilitate greater uniformity in the initial evaluation and outcomes analyses of patients treated with TRT.

Habituation, Psychophysiologic↗