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Ear and Hearing

Neural Indices of Vowel Discrimination in Monolingual and Bilingual Infants and Children Objectives: To examine maturation of neural discriminative responses to an English vowel contrast from infancy to 4 years of age and to determine how biological factors (age and sex) and an experiential factor (amount of Spanish versus English input) modulate neural discrimination of speech. Design: Event-related potential (ERP) mismatch responses (MMRs) were used as indices of discrimination of the American English vowels [ε] versus [I] in infants and children between 3 months and 47 months of age. A total of 168 longitudinal and cross-sectional data sets were collected from 98 children (Bilingual Spanish–English: 47 male and 31 female sessions; Monolingual English: 48 male and 42 female sessions). Language exposure and other language measures were collected. ERP responses were examined in an early time window (160 to 360 msec, early MMR [eMMR]) and late time window (400 to 600 msec, late MMR). Results: The eMMR became more negative with increasing age. Language experience and sex also influenced the amplitude of the eMMR. Specifically, bilingual children, especially bilingual females, showed more negative eMMR compared with monolingual children and with males. However, the subset of bilingual children with more exposure to English than Spanish compared with those with more exposure to Spanish than English (as reported by caretakers) showed similar amplitude of the eMMR to their monolingual peers. Age was the only factor that influenced the amplitude of the late MMR. More negative late MMR was observed in older children with no difference found between bilingual and monolingual groups. Conclusions: Consistent with previous studies, our findings revealed that biological factors (age and sex) and language experience modulated the amplitude of the eMMR in young children. The early negative MMR is likely to be the mismatch negativity found in older children and adults. In contrast, the late MMR amplitude was influenced only by age and may be equivalent to the Nc in infants and to the late negativity observed in some auditory passive oddball designs. ACKNOWLEDGMENTS: The authors thank A. Barias and M. Wroblewski for helping with data collection, B. Tagliaferri for technical support, and W. Strange and R. G. Schwartz for advice on the design. This research was supported by NIH HD46193 to V. L. Shafer. V. L. S. oversaw the project, designed the experiments, and was involved in writing the article; Y. H. Y. helped with data collection, performed data analyses, and wrote wrote the initial draft in conjunction with V. L. S., and led the manuscript revision process;. C. T. helped with data collection and interpreting the language measures; H.H. and L. C. performed the early stages of the Mixed-Effect Modeling analysis in conjunction with Y. H. Y.; N. V. helped design the language background questionnaire and collect the data; J. G. helped collect the data; K. G. and H. D. helped design and pilot the electrophysiological paradigm and helped collect the data. All authors were involved in revising the article. The authors have no conflicts of interest to disclose. Received May 10, 2018; accepted January 24, 2019. Address for correspondence: Yan H. Yu, Department of Communication Sciences and Disorders, St. John's University, 8000 Utopia Parkway, Queens, NY 11437, USA. E-mail: yuy1@stjohns.edu and Valerie L. Shafer, Ph.D. Program in Speech-Language-Hearing Sciences, The Graduate Center, City University of New York, 365 Fifth Avenue, New York, NY 10016, USA. E-mail: vshafer@gc.cuny.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Impact of Lexical Parameters and Audibility on the Recognition of the Freiburg Monosyllabic Speech Test Objective: Correct word recognition is generally determined by audibility, but lexical parameters also play a role. The focus of this study was to examine both the impact of audibility and lexical parameters on speech recognition of test words of the clinical German Freiburg monosyllabic speech test, and subsequently on the perceptual imbalance of test lists observed in the literature. Design: For 160 participants with normal hearing that were divided into three groups with different simulated hearing thresholds, monaural speech recognition for the Freiburg monosyllabic speech test was obtained via headphones in quiet at different presentation levels. A software manipulated the original speech material to simulate two different hearing thresholds. All monosyllables were classified according to their frequency of occurrence in contemporary language and the number of lexical neighbors using the Cross-Linguistic Easy-Access Resource for Phonological and Orthographic Neighborhood Density database. Generalized linear mixed-effects regression models were used to evaluate the influences of audibility in terms of the Speech Intelligibility Index and lexical properties of the monosyllables in terms of word frequency (WF) and neighborhood density (ND) on the observed speech recognition per word and per test list, respectively. Results: Audibility and interactions of audibility with WF and ND correctly predicted identification of the individual monosyllables. Test list recognition was predicted by test list choice, audibility, and ND, as well as by interactions of WF and test list, audibility and ND, ND and test list, and audibility per test list. Conclusions: Observed differences in speech recognition of the Freiburg monosyllabic speech test, which are well reported in the literature, depend not only on audibility but also on WF, neighborhood density, and test list choice and their interactions. The authors conclude that future creations of speech test material should take these lexical parameters into account. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank Sascha Bilert, Tina Gebauer, Lena Haverkamp, Britta Jensen, and Kristin Sprenger for their support performing the measurements and categorizing the monosyllables per database. The authors also thank Daniel Berg for technical support and Thomas Brand for support on the SII predictions. English language support was provided by www.stels-ol.de. This work was supported by the Ph.D. program Jade2Pro of Jade University of Applied Sciences, Oldenburg, Germany. The authors have no conflicts of interest to disclose. Received October 14, 2017; accepted March 8, 2019. Address for correspondence: Alexandra Winkler, Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Ofener Straße 16/19, D-26121 Oldenburg, Germany. E-mail: alexandra.winkler@jade-hs.de Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Age-Related Changes in Temporal Resolution Revisited: Electrophysiological and Behavioral Findings From Cochlear Implant Users Objectives: The mechanisms underlying age-related changes in speech perception are still unclear, most likely multifactorial and often can be difficult to parse out from the effects of hearing loss. Age-related changes in temporal resolution (i.e., the ability to track rapid changes in sounds) have long been associated with speech perception declines exhibited by many older individuals. The goals of this study were as follows: (1) to assess age-related changes in temporal resolution in cochlear implant (CI) users, and (2) to examine the impact of changes in temporal resolution and cognition on the perception of speech in noise. In this population, it is possible to bypass the cochlea and stimulate the auditory nerve directly in a noninvasive way. Additionally, CI technology allows for manipulation of the temporal properties of a signal without changing its spectrum. Design: Twenty postlingually deafened Nucleus CI users took part in this study. They were divided into groups of younger (18 to 40 years) and older (68 to 82 years) participants. A cross-sectional study design was used. The speech processor was bypassed and a mid-array electrode was used for stimulation. We compared peripheral and central physiologic measures of temporal resolution with perceptual measures obtained using similar stimuli. Peripherally, temporal resolution was assessed with measures of the rate of recovery of the electrically evoked compound action potential (ECAP), evoked using a single pulse and a pulse train as maskers. The acoustic change complex (ACC) to gaps in pulse trains was used to assess temporal resolution more centrally. Psychophysical gap detection thresholds were also obtained. Cognitive assessment included two tests of processing speed (Symbol Search and Coding) and one test of working memory (Digit Span Test). Speech perception was tested in the presence of background noise (QuickSIN test). A correlational design was used to explore the relationship between temporal resolution, cognition, and speech perception. Results: The only metric that showed significant age effects in temporal processing was the ECAP recovery function recorded using pulse train maskers. Younger participants were found to have faster rates of neural recovery following presentation of pulse trains than older participants. Age was not found to have a significant effect on speech perception. When results from both groups were combined, digit span was the only measure significantly correlated with speech perception performance. Conclusions: In this sample of CI users, few effects of advancing age on temporal resolution were evident. While this finding would be consistent with a general lack of aging effects on temporal resolution, it is also possible that aging effects are influenced by processing peripheral to the auditory nerve, which is bypassed by the CI. However, it is known that cross-fiber neural synchrony is improved with electrical (as opposed to acoustic) stimulation. This change in neural synchrony may, in turn, make temporal cues more robust/perceptible to all CI users. Future studies involving larger sample sizes should be conducted to confirm these findings. Results of this study also add to the growing body of literature that suggests that working memory is important for the perception of degraded speech. ACKNOWLEDGMENTS: We thank Paul Abbas for helpful suggestions on study design and data analysis, and Jacob Oleson for assistance with statistical analyses. We also acknowledge Wenjun Wang for help in developing the perception testing software. This study was funded by a Student Investigator Research Grant from the American Academy of Audiology (B. S. M.) and by an NIH P50 DC000242 grant. The authors have no conflicts of interest to disclose. Received June 21, 2017; accepted February 21, 2019. Address for correspondence: Bruna S. S. Mussoi, AuD, PhD, Kent State University, Speech Pathology and Audiology, A140 Center for Performing Arts, 1325 Theatre Drive, Kent, OH 44242, USA. E-mail: bmussoi@kent.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Round Window Membrane Motion Induced by Bone Conduction Stimulation at Different Excitation Sites: Methodology of Measurement and Data Analysis in Cadaver Study Objectives: The aim of this study was to investigate the following: (1) the vibration pattern of the round window (RW) membrane in human cadavers during air (AC) and bone conduction (BC) stimulation at different excitation sites; (2) the effect of the stimulation on the fluid volume displacement (VD) at the RW and compare the VD between BC and AC stimulation procedures; (3) the effectiveness of cochlear stimulation by the bone implant at different excitation sites. Design: The RW membrane vibrations were measured by using a commercial scanning laser Doppler vibrometer. The RW vibration amplitude was recorded at 69 measurement points evenly distributed in the measurement field covering the entire surface of the RW membrane and a part of the surrounding bony surface. RW vibration was induced first with AC and then with BC stimulation through an implant positioned at two sites. The first site was on the skull surface at the squamous part of the temporal bone (implant no. 1), a place typical for bone-anchored hearing aids. The second site was close to the cochlea at the bone forming the ampulla of the lateral semicircular canal (implant no. 2). The displacement amplitude (dP) of the point P on the promontory was determined and used to calculate the relative displacement (drRW) of points on the RW membrane, drRW = dRW − dP. VD parameter was used to analyze the effectiveness of cochlear stimulation by the bone implant screwed at different excitation sites. Results: RW membrane displacement amplitude of the central part of the RW was similar for AC and BC implant no. 1 stimulation, and for BC implant no. 2 much larger for frequency range >1 kHz. BC implant no. 2 causes a larger displacement amplitude of peripheral parts of the RW and the promontory than AC and BC implant no. 1, and BC implant no. 1 causes larger than AC stimulation. The effect of BC stimulation exceeds that of AC with identical intensity, and that the closer BC stimulation to the otic capsule, the more effective this stimulation is. A significant decrease in the value of VD at the RW is observed for frequencies >2 kHz for both AC and BC stimulation with BC at both locations of the titanium implant placement. For frequencies >1 kHz, BC implant no. 2 leads to a significantly larger VD at the RW compared to BC implant no. 1. Thus, the closer to the otic capsule the BC stimulation is located, the more effective it is. Conclusions: Experimental conditions allow for an effective acoustic stimulation of the inner ear by an implant screwed to the osseous otic capsule. The mechanical effect of BC stimulation with a titanium implant placed in the bone of the ampulla of the lateral semicircular canal significantly exceeds the effect of an identical stimulation with an implant placed in the temporal squama at a conventional site for an implant anchored in the bone. The developed research method requires the implementation on a larger number of temporal bones in order to obtain data concerning interindividual variability of the observed mechanical phenomena. ACKNOWLEDGMENTS: This study was supported by the Polish National Center for Research and Development, grant number: PBS3/B7/25/2015. M. K. designed and performed experiments, analyzed data and wrote the article. K. N. designed and performed experiments, and wrote the article. J. W. collected data and wrote the article. M. L. reviewed data from all sites and provided interpretative analysis and wrote the article. P. B. analyzed data and wrote the article. M. M. designed experiments and reviewed the article. J. S. collected data and wrote the article. All authors discussed the results and implications and commented on the article at all stages. The authors have no conflicts of interest to disclose. Received September 11, 2018; accepted February 12, 2019. Address for correspondence: Magdalena Lachowska MD, PhD, Department of Otolaryngology, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa, Warsaw, Poland. E-mail: mlachowska@wum.edu.pl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Interactions Between Item Set and Vocoding in Serial Recall Objectives: Serial recall of digits is frequently used to measure short-term memory span in various listening conditions. However, the use of digits may mask the effect of low quality auditory input. Digits have high frequency and are phonologically distinct relative to one another, so they should be easy to identify even with low quality auditory input. In contrast, larger item sets reduce listener ability to strategically constrain their expectations, which should reduce identification accuracy and increase the time and/or cognitive resources needed for identification when auditory quality is low. This diminished accuracy and increased cognitive load should interfere with memory for sequences of items drawn from large sets. The goal of this work was to determine whether this predicted interaction between auditory quality and stimulus set in short-term memory exists, and if so, whether this interaction is associated with processing speed, vocabulary, or attention. Design: We compared immediate serial recall within young adults with normal hearing across unprocessed and vocoded listening conditions for multiple stimulus sets. Stimulus sets were lists of digits (1 to 9), consonant-vowel-consonant (CVC) words (chosen from a list of 60 words), and CVC nonwords (chosen from a list of 50 nonwords). Stimuli were unprocessed or vocoded with an eight-channel noise vocoder. To support interpretation of responses, words and nonwords were selected to minimize inclusion of multiple phonemes from within a confusion cluster. We also measured receptive vocabulary (Peabody Picture Vocabulary Test [PPVT-4]), sustained attention (test of variables of attention [TOVA]), and repetition speed for individual items from each stimulus set under both listening conditions. Results: Vocoding stimuli had no impact on serial recall of digits, but reduced memory span for words and nonwords. This reduction in memory span was attributed to an increase in phonological confusions for nonwords. However, memory span for vocoded word lists remained reduced even after accounting for common phonetic confusions, indicating that lexical status played an additional role across listening conditions. Principal components analysis found two components that explained 84% of the variance in memory span across conditions. Component one had similar load across all conditions, indicating that participants had an underlying memory capacity, which was common to all conditions. Component two was loaded by performance in the vocoded word and nonword conditions, representing the sensitivity of memory span to vocoding of these stimuli. The order in which participants completed listening conditions had a small effect on memory span that could not account for the effect of listening condition. Repetition speed was fastest for digits, slower for words, and slowest for nonwords. On average, vocoding slowed repetition speed for all stimuli, but repetition speed was not predictive of individual memory span. Vocabulary and attention showed no correlation with memory span. Conclusions: Our results replicated previous findings that low quality auditory input can impair short-term memory, and demonstrated that this impairment is sensitive to stimulus set. Using multiple stimulus sets in degraded listening conditions can isolate memory capacity (in digit span) from impaired item identification (in word and nonword span), which may help characterize the relationship between memory and speech recognition in difficult listening conditions. ACKNOWLEDGMENTS: This work was supported by NIH Centers of Biomedical Research Excellence (COBRE) grant (NIH-NIGMS/5P20GM109023-05). The TOVA company provided test credits at a discounted rate in support of this research. The authors thank the COBRE human subjects core for assisting in participant recruitment and testing. Kaylah Lalonde, Katherine Gordon, and Angela AuBuchon provided advice for analyzing and interpreting our data. Angela AuBuchon and Sangsook Choi provided helpful comments on a previous draft of this manuscript. The authors have no conflicts of interest to disclose. Received November 15, 2018; accepted January 21, 2019. Address for correspondence: Adam K. Bosen, Boys Town National Research Hospital, 555 N. 30th Street, Omaha, NE 68131, USA. E-mail: Adam.bosen@boystown.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Validating a Quick Spectral Modulation Detection Task Objectives: The Quick Spectral Modulation Detection (QSMD) test provides a quick and clinically implementable spectral resolution estimate for cochlear implant (CI) users. However, the original QSMD software (QSMD(MySound)) has technical and usability limitations that prevent widespread distribution and implementation. In this article, we introduce a new software package EasyQSMD, which is freely available software with the goal of both simplifying and standardizing spectral resolution measurements. Design: QSMD was measured for 20 CI users using both software packages. Results: No differences between the two software packages were detected, and based on the 95% confidence interval of the difference between tests, the difference between the tests is expected to be <2% points. The average test duration was under 4 minutes. Conclusions: EasyQSMD is considered functionally equivalent to QSMD(MySound) providing a clinically feasible and quick estimate of spectral resolution for CI users. ACKNOWLEDGMENTS: We are grateful for the time and dedication of all of the people who participated in this study as well as Advanced Bionics, Chris Hetlinger, and Tony Spahr, for incorporating and supporting Quick Spectral Modulation Detection (QSMD) in MySound. Support for this research was provided by the National Institute on Deafness and Other Communication Disorders (NIDCD) R01 DC012152 (D.M.L.) and R01 DC13117 (R.H.G.). Additional support comes from a contract from Cochlear Americas to J. Thomas Roland. The authors have no conflicts of interest to disclose. Received July 28, 2018; accepted January 12, 2019. Address for correspondence: David M. Landsberger, Department of Otolaryngology, New York University School of Medicine, 550 1st Avenue, STE NBV 5E5, New York, NY 10016, USA. E-mail: David.Landsberger@nyumc.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Synchrotron Radiation-Based Reconstruction of the Human Spiral Ganglion: Implications for Cochlear Implantation Objective: To three-dimensionally reconstruct Rosenthal's canal (RC) housing the human spiral ganglion (SG) using synchrotron radiation phase-contrast imaging (SR-PCI). Straight cochlear implant electrode arrays were inserted to better comprehend the electro-cochlear interface in cochlear implantation (CI). Design: SR-PCI was used to reconstruct the human cochlea with and without cadaveric CI. Twenty-eight cochleae were volume rendered, of which 12 underwent cadaveric CI with a straight electrode via the round window (RW). Data were input into the 3D Slicer software program and anatomical structures were modeled using a threshold paint tool. Results: The human RC and SG were reproduced three-dimensionally with artefact-free imaging of electrode arrays. The anatomy of the SG and its relationship to the sensory organ (Corti) and soft and bony structures were assessed. Conclusions: SR-PCI and computer-based three-dimensional reconstructions demonstrated the relationships among implanted electrodes, angular insertion depths, and the SG for the first time in intact, unstained, and nondecalcified specimens. This information can be used to assess stimulation strategies and future electrode designs, as well as create place-frequency maps of the SG for optimal stimulation strategies of the human auditory nerve in CI. ACKNOWLEDGMENTS: This study was supported by Swedish Research Council (2017–03801), ALF grants from the Uppsala University Hospital, Tysta Skolan Foundation, Swedish Hearing Research Foundation, The Ingrid Löwenström Foundation, and by generous private funds from Börje Runögård, Sweden. This work was made in collaboration with MED-EL Medical Electronics, R&D, GmbH, and Innsbruck, Austria. Part of the research described in this article was performed at the BioMedical Imaging and Therapy (BMIT) facility at the Canadian Light Source, Inc. (CLSI), which is funded by the Canada Foundation for Innovation, the Natural Sciences and Engineering Research Council of Canada, the National Research Council Canada, the Canadian Institutes of Health Research, the Government of Saskatchewan, Western Economic Diversification Canada, and the University of Saskatchewan. This work was made in collaboration with MED-EL Medical Electronics, R&D, GmbH, and Innsbruck, Austria. They provided Ci electrodes for surgery and salary support for one research group member (H.L.) in accordance with the contract agreement with Uppsala University, Sweden during 2018. S.A. prepared specimens, implantation, and article. H.L. was responsible for optimizing and applying SR-PCI to imaging of the cochlea, sample preparation, and relevant data processing. He reviewed the article, focusing on editing the Methods section. R.S.A. was responsible for applying SR-PCI to image of the cochlea, sample preparation, and relevant data processing. He reviewed the article, focusing on editing the Methods section. H.L. processed file data in Sweden, made 3D reconstructions, segmentation, and modeling. N.S.-M. planned the study, analyzed anatomical results, and prepared the article. H.R.-A. analyzed anatomical data, prepared images, and the article. The authors have no conflicts of interest to disclose. Received December 31, 2018; accepted March 8, 2019. Address for correspondence: Helge Rask-Andersen, Department of Surgical Sciences, Head and Neck Surgery, Section of Otolaryngology, Uppsala University Hospital, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. E-mail: helge.rask-andersen@surgsci.uu.se Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Children With Congenital Unilateral Sensorineural Hearing Loss: Effects of Late Hearing Aid Amplification—A Pilot Study Objectives: Although children with unilateral hearing loss (uHL) have high risk of experiencing academic difficulties, speech-language delays, poor sound localization, and speech recognition in noise, studies on hearing aid (HA) outcomes are few. Consequently, it is unknown when and how amplification is optimally provided. The aim was to study whether children with mild-to-moderate congenital unilateral sensorineural hearing loss (uSNHL) benefit from HAs. Design: All 6- to 11-year-old children with nonsyndromic congenital uSNHL and at least 6 months of HA use were invited (born in Stockholm county council, n = 7). Participants were 6 children (9.7- to 10.8-years-old) with late HA fittings (>4.8 years of age). Unaided and aided hearing was studied with a comprehensive test battery in a within-subject design. Questionnaires were used to study overall hearing performance and disability. Sound localization accuracy (SLA) and speech recognition thresholds (SRTs) in competing speech were measured in sound field to study hearing under demanding listening conditions. SLA was measured by recording eye-gaze in response to auditory-visual stimuli presented from 12 loudspeaker–video display pairs arranged equidistantly within ±55º in the frontal horizontal plane. The SRTs were measured for target sentences at 0º in spatially separated (±30º and ±150º) continuous speech. Auditory brainstem responses (ABRs) were obtained in both ears separately to study auditory nerve function at the brainstem level. Results: The mean ± SD pure-tone average (0.5, 1, 2, and 4 kHz) was 45 ± 8 dB HL and 6 ± 4 dB HL in the impaired and normal hearing ear, respectively (n = 6). Horizontal SLA was significantly poorer in the aided compared with unaided condition. A significant relationship was found between aided SLA (quantified by an error index) and the impaired ear's ABR I to V interval, suggesting a relationship between the two. Results from questionnaires revealed aided benefit in one-to-one communication, whereas no significant benefit was found for communication in background noise or reverberation. No aided benefit was found for the SRTs in competing speech. Conclusions: Children with congenital uSNHL benefit from late HA intervention in one-to-one communication but not in demanding listening situations, and there is a risk of degraded SLA. The results indicate that neural transmission time from the impaired cochlea to the upper brainstem may have an important role in unilaterally aided spatial hearing, warranting further study in children with uHL receiving early HA intervention. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors express their gratitude to the test participants and their parents. They also thank Per-Olof Larsson for his excellent technical assistance. This study was funded by the Oticon Foundation, the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, Tysta Skolan Foundation, Karolinska University Hospital, the Jerring foundation, the Nordic Audiological Society, the Danavox Jubilee Foundation, the Swedish Audiological Society, and Stingerfonden. Part of this study was presented as a poster during the 40th Midwinter Research Meeting, Association for Research in Otolaryngology, Baltimore, Maryland, USA, 2017 and as an oral presentation at the International Symposium on Auditory and Audiological Research (ISAAR), Nyborg, Denmark, 2017, and during the 41th Midwinter Research Meeting, Association for Research in Otolaryngology, San Diego, California, USA, 2018. All authors contributed to the design, data collection, analyses, and article writing. M. J. drafted the article. The authors have no conflicts of interest to disclose. Received August 28, 2018; accepted February 22, 2019. Address for correspondence: Marlin Johansson, Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Alfred Nobels Allé 8, 141 52 Stockholm, Sweden. E-mail address: marlin.johansson@ki.se Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Auditory Training for Adult Cochlear Implant Users: A Survey and Cost Analysis Study Objectives: The aims of this study were as follows: (a) to describe audiologists' practices toward auditory training (AT) for adult cochlear implant (CI) users with a postlingual hearing loss; and (b) to assess the cost of different AT methods for clients and service providers in comparison with no AT delivery. Design: A survey was distributed to approximately 230 Australian CI audiologists to investigate the range, magnitude, and rationale of AT practices adopted as part of rehabilitation services with adult CI users. The cost of these different AT practices was then estimated from the perspectives of both clients and service providers, and compared against no AT delivery. Results: Seventy-eight audiologists responded to at least one section of the survey (16% to 33% response rate), of which 85.5% reported that they viewed AT as a necessary component of rehabilitation. Home-based and face-to-face were the methods most frequently adopted to deliver AT. Methods used during training, such as stimuli type, feedback, and encouragement for training adherence, varied across respondents. The cost analysis indicated that home-based training resulted in the lowest program costs, whereas face-to-face AT (when delivered independently from routine appointments) was the method with highest cost for clients and service providers. Conclusions: The type of AT, recommended frequency of sessions, and overall duration of programs varied widely across respondents. Costs incurred by clients depended mainly on whether the AT was home-based or clinician-led (i.e., face-to-face, group-based), program fees, and travel arrangements made by clients, as well as clinicians' wages and the method chosen to deliver AT. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank Audiology Australia for dissemination of the questionnaire, survey respondents for their participation in this study, and Dr. Helen Henshaw, Professor Catherine McMahon, and Professor Robert Cowan for reviewing and commenting earlier versions of this article. This study was supported by the HEARing Cooperative Research Centre, established under the Australian Government's Cooperate Research Centres Program. The HEARing CRC Program supports industry-led collaborations between industry, researchers, and the community. Supporting Information: Survey of Auditory Training Practices in Cochlear Implant Clinics in Australia.I. B. conceived the experiment. M. R., I. B., and E. B. designed and conducted the experiment and data analysis for the survey. M.R., I.B., and V. M. designed and conducted the cost analysis. M. R. prepared the article with contributions from I.B., E.B., and V. M. Parts of this work were presented at the British Society of Audiology Annual Conference, Harrogate, June 2017. The authors have no conflicts of interest to disclose. Received October 12, 2018; accepted February 13, 2019. Address for correspondence: Mariana Reis, The Australian Hearing Hub, Macquarie University, Room G.330, Ground Floor, 16 University Avenue, NSW 2109, Australia. E-mail: mariana.reis@mq.edu.au Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Otitis Media in Childhood and Disease in Adulthood: A 40-Year Follow-Up Study Objectives: The pathogenesis of chronic suppurative otitis media (CSOM) includes complex interactions between microbial, immunologic, and genetic factors. To our knowledge, no study has focused on the association between childhood otitis media, immune regulation, inflammatory conditions, and chronic disease in adulthood. The present study aims to assess whether CSOM in childhood predicts immune-related inflammatory disorders or cardiovascular disease in adulthood. Another aim is to assess the association with oto-vestibular diseases in adulthood. Design: Population cohort study in Norway comprised 51,626 participants (mean age 52 years) who underwent a hearing investigation at 7 to 13 years of age where 189 were diagnosed with CSOM (otorhinolaryngologist diagnose) and 51,437 had normal hearing thresholds (controls). Data on adult disease were obtained from the Norwegian Patient Registry (ICD-10 codes from the specialist health services). We estimated associations with logistic regression analyses. Results: The associations between CSOM in childhood and disease in adulthood were as follows: chronic sinusitis (odds ratio 3.13, 95% confidence interval 1.15 to 8.52); cardiovascular disease (1.38, 1.01 to 1.88); hearing loss (5.58, 3.78 to 8.22); tinnitus (2.62, 1.07 to 6.41). The adult hearing loss among cases with childhood CSOM was most frequently registered as sensorineural. There was no statistically significant increased risk of later asthma (1.84 [0.98 to 3.48]), inflammatory bowel disease, inflammatory joint disease, systemic tissue disease, or vestibulopathy. The estimates were adjusted for age, sex, socio-economic status, and smoking. Conclusion: Our large cohort study, which is the first to focus on the link between otitis media in childhood and immune-related inflammatory disorders later in life, does not confer a clear association. CSOM in childhood was strongly related to adult tinnitus and hearing loss, which was most frequently registered as sensorineural. ACKNOWLEDGMENT: We are grateful to the late Dr. H. M. Fabritius and to Namsos Hospital for the SHINT data. The Nord-Trøndelag Health Study (The HUNT study) is a collaboration between the HUNT Research Center (Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Nord-Trøndelag county council, Central Norway regional health authority, and the Norwegian Institute of Public Health. Bo Engdahl, Lisa Aarhus, and Preben Homøe conceptualized and designed the study, reviewed and revised the article. Lisa Aarhus drafted the initial article. Bo Engdahl carried out the statistical analyses. All authors approved the final article as submitted and agree to be accountable for all aspects of the work. The authors have no conflicts of interest to disclose. Received November 9, 2018; accepted February 21, 2019. Address for correspondence: Lisa Aarhus, Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, postboks 8146 Dep, 0033 Oslo, Norway. E-mail: lisa.aarhus@stami.no Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.