American Academy of Audiology

The frequency-tuning properties of the otolith system are driven by the mass and stiffness of the organs and can vary depending on several factors such as age and disease. Although vestibular evoked myogenic potential (VEMP) responses can be extremely variable in terms of amplitude, depending on the stimulus used, they can offer helpful insight into different disease processes. What is challenging is that, in the vestibular laboratory, clinicians are often attempting to gather as much diagnostic data as possible in a limited amount of time.

As an audiologist, the renewed interest in simultaneously studying the effects of factors such as age, noise exposure, and genetics on both the vestibular system and the auditory system is exciting. Historically, many of us in the profession doing research would identify as individuals who investigate vestibular and balance function or some line of auditory function. Accordingly, there are large bodies of literature for each system, but comparably very few that address the effects of similar disorders and testing on both systems in the same study subjects.

The JAAA will turn 30 years of age this coming year as we put to bed the November/December issue of volume 29. Neither the Journal nor the Academy itself would exist were it not for Dr. James Jerger who is the Academy’s first President and the Journals’ first Editor-in-Chief. It is certainly noteworthy that Dr. Jerger will celebrate his 90th birthday this coming year. We wish him all the best.

To compare the diagnostic performance of the Hum Test against the Weber Test using pure tone audiometry (PTA) as the "gold standard" comparator. 29 participants with normal hearing of ages 18 to 35 without any history of hearing abnormalities or otologic conditions were enrolled. Subjects underwent three tests (Hum Test, Weber Test, and PTA) across two conditions: with an ear plug in one ear (side randomized) and without ear plugs. When examining the ability of the Hum Test to detect simulated conductive hearing loss (CHL), the test had a sensitivity of 89.7% and specificity of 100% with high pitched humming and 93.1% and 100%, respectively, with low pitched humming. The Weber Test had a sensitivity and specificity of 96.6% and 100%, respectively. McNemar's test demonstrated agreement between the Hum Test, performed with either high pitched ( P = .32) or low pitched ( P = .56) humming, and the Weber Test. Receiver operating characteristic (ROC) curves for the Hum Test (both high and low pitched) and Weber test were compared and demonstrated no statistically significant difference. The Hum Test is comparable to the Weber Test with regards to its sensitivity, specificity, and diagnostic accuracy in assessing new onset unilateral CHL in previously normal hearing subjects.

"Have you ever tasted gunmetal in your mouth?” asked a patient with severe, chronic tinnitus. The patient went on to describe precisely how he planned to kill himself when his tinnitus becomes unbearable. Another patient reported being “literally at the end of my rope” by the end of the year. While there is limited data indicating no direct relationship between tinnitus and suicide, it is not uncommon to see tinnitus patients reporting suicidal thoughts in clinical practice (Jacobson. J Am Acad Audiol 2001;12:493 http://1.usa.gov/22PqjIn). This research investigated the prevalence of suicidal ideation in patients with chronic tinnitus. Findings may support development of clinical protocols and additional training in mental health for students and clinicians who are actively working with this potentially vulnerable population. METHODS Clinical records for 218 patients seen for a tinnitus evaluation and/or consultation were reviewed. Of these, 200 qualified as subjects because they had completed the Tinnitus Reaction Questionnaire (TRQ) at the time of the initial appointment and were at least 18 years of age. The TRQ is a validated psychometric inventory used to measure tinnitus disturbance that includes a question (#24) addressing suicidal thoughts related to tinnitus: “My tinnitus has led me to think about suicide” (Wilson. J Speech Lang Hear Res 1991;34:197 http://1.usa.gov/217Khwp). Patients were instructed to respond based on “how tinnitus has affected you over the past week.” Using a 5-point Likert scale (0-4), patients rated tinnitus distress for 26 items ranging from “not at all” to “almost all of the time.” The total score was computed as the sum of all 26 items and was used to classify the level of tinnitus disturbance (maximum possible score = 104).Figure 1: Number of patients in each category was determined by the total score on the TRQ: “Not significant” = 0-16; “Significant” = 17-26 (> 25th percentile); “Mild” = 27-46 (> 50th percentile); “Moderate” = 47-59 (> 75th percentile); “Severe” = 60-71 (> 90th percentile); “Profound” = 72+ (> 95th percentile).Figure: Lisa G. Fox-Thomas, PhDThe mean age of patients was 59 years (range: 21-88) with a greater number of males (64%) than females (36%). The mean score on the TRQ was 43 (range: 1-102; SD=25). Thirty-two patients (16%) reported tinnitus disturbance that was not clinically significant (Figure 1). A majority of the patients (32%) reported “mild” tinnitus disturbance, while 27% reported “severe” to “profound” tinnitus disturbance. RESULTSFigure 2: The percentage of patients seen for a tinnitus evaluation who reported suicidal ideation varied according to degree of overall tinnitus disturbance.Of the 200 patients with tinnitus included in this study, 32 (16%) reported suicidal thoughts on question #24 of the TRQ. These patients had a mean age of 61 years (range: 25-79) and were predominantly male (59%). The average total score on the TRQ was 72, which falls in the “profound” category. Nearly half of the patients with profound tinnitus disturbance reported thinking about suicide (Figure 2). However, even some patients with mild (5%) or moderate (20%) tinnitus disturbance had suicidal ideations.Figure 3: The majority of patients (75%) reported thinking about suicide “a little” or “some” of the time. One in four patients (25%) reported thinking about suicide “a good deal” or “almost all” of the time.The amount of time spent thinking about suicide varied in the largest group of patients reporting “a little of the time.” Twenty-five percent of patients reported thinking about suicide “a good deal of the time” or “almost all of the time” (Figure 3). Notably, two of these patients had moderate tinnitus disturbance overall. Thus, a higher TRQ score was not necessarily indicative of more time spent thinking about suicide.Figure 4: The percentage of patients with tinnitus who report suicidal ideation (16%) was four times greater than in the general U.S. adult population. The prevalence also exceeded that reported for other health conditions.When compared with other populations, patients with tinnitus were more likely to have suicidal ideation (Figure 4). One in six patients with tinnitus (16%) reported suicidal thoughts, which is four times greater than the suicidal ideation incidence among US adults in general (CDC. Suicide Facts at a Glance 2015http://1.usa.gov/217LlAk). The prevalence of suicidal ideation among patients with tinnitus was also greater than those reported for patients with other chronic health conditions including cancer, insomnia, and Parkinson's disease (Kling. SLEEP 2010http://wb.md/217L4NV; Kummer. CNS spectrums 2009;14[8]:431 http://1.usa.gov/217M8S3; Spencer. Am J Geriatr Psychiatry 2012;20[4]:327 http://1.usa.gov/217M1pz). Suicidal ideation in patients with tinnitus was slightly less common than among those with chronic pain (Smith. Pain 2004;111[1-2]: 201 http://1.usa.gov/217MyYD). CONCLUSIONS The prevalence of suicidal ideation is greater among patients with tinnitus compared with the general population and those with other chronic health conditions, except for chronic pain. Suicidal thoughts were even reported by patients with a mild tinnitus disturbance. These findings suggest future research to focus on identifying important warning signs and factors such as associated or concomitant conditions (e.g., depression, sleep disturbance, sound sensitivity) that could contribute to suicidal ideation among tinnitus patients. Audiologists offering tinnitus management also need to be prepared to address suicidal ideations. While mandated reporting varies from state to state, it is important for clinicians to know the applicable laws and established clinical protocols to plan (e.g., Patient Safety Plan http://bit.ly/217M2tr) and manage caring discussions about suicide, and to ensure the wellbeing of patients and clinicians alike.

SummaryBackgroundThe literature suggests that contralateral acoustic stimulation (CAS) alters the amplitude of the distortion product otoacoustic emissions (DPOAEs), but it is still unknown whether the DPOAE Input/Output (I/O) functions are also affected. To elucidate this aspect of the DPOAEs, the present study assessed the effects of CAS on DPOAE I/O functions at the frequencies of 2 kHz and 4 kHz, in a sample of term neonatal subjects.Material/MethodsSixty randomly selected neonates were included in the study. The DPOAE I/O functions were obtained at 2 kHz and 4 kHz, in the presence of a 60 dB SPL broad band-contralateral white noise, using the TDH39 headphones contralaterally. DPOAEs were recorded up to a stimulus level of L2=35 dB peSPL.ResultsSignificant DPOAE amplitude suppression effects were observed at various L2 stimulus levels for both tested frequencies at 2 and 4 kHz. In contrast, the corresponding DPOAE slopes showed various alterations that were not statistically significant.ConclusionsThe data from the present study show that contralateral acoustic stimulation significantly affects only the amplitude of the DPOAE I/O functions; the slope is affected, but not significantly. This observation can shed light on the nature of CAS, suggesting that the latter is primarily a linear phenomenon without the cochlear compression and non-linear components seen in the healthy cochlea. From the available data it is not possible to infer whether the sample size has influenced the obtained results and the study should be repeated with a larger sample size and assessing more frequencies.

Cochlear implant technology continues to advance, placing new challenges on physicians, audiologists, speech-language pathologists, and deaf educators to properly determine cochlear implant candidacy. This panel addressed the topics of new technology applied to elderly and to very young children. Six panelists were selected to represent varied regions of the world, prompting interesting discussion and interaction with the audience.

The mission of the American Academy of Audiology is to promote quality hearing and balance care by advancing the profession of audiology through leadership, advocacy, education, public awareness, and support of research. Founded 15 years ago, the Academy's membership grew to over 8700 members during 2003, making it the world's largest independent organization of audiologists. The Academy was created in audiology's quest to be recognized as an independent profession, with the ability to set standards of excellence and the obligation to provide the highest quality of care to patients. In one way or another, all of the Academy's accomplishments in 2003 and its expectations for 2004 are aimed at achieving that autonomy. QUEST FOR AUTONOMY To do so, the Academy is engaged in activities that nurture and support a strong research and academic base, support and encourage the transition to a new model of AuD education, seek to ensure integrity in business and professional practices, promote state licensure as the practice credential, and promote recognition by the government and others of the independent practice of audiology and the range of services audiologists provide. In 2003, the Academy continued to support the important research and academic base of the profession of audiology. The Academy's scientific journal, the Journal of the American Academy of Audiology, completed its 14th volume under the sage leadership of its editor-in-chief, Dr. James Jerger. In April, the Academy's Annual Convention and Exposition was held in San Antonio. Over 5800 were in attendance and enjoyed over 250 clinical and scientific presentations. Also in 2003, the American Academy of Audiology Foundation was launched. This new foundation has a mission to raise funds and support programs of excellence in education and research in audiology and hearing science. One of the biggest issues in graduate audiology education is the 4th-year clinical practicum experience. To bring together a variety of perspectives on the topic, the Academy is organizing a consensus conference on this challenging issue to be held in January 2004 The Academy also supports the evolution of audiology education into a professional education model, culminating in the doctor of audiology (AuD) degree. Academic programs have made tremendous strides in reorganizing to fulfill the expectations of the new model. The Academy continues to support efforts to reinvigorate accreditation standards by means of the new Accreditation Commission on Audiology Education. In 2003, the Academy's Ethical Practices Board (EPB) completed two important documents: “Ethics Guidelines on Financial Incentives from Hearing Instrument Manufacturers” and “Issues and Guidelines for Ethical Practice in Research for Audiologists.” Credentialing of audiologists is now accomplished through state regulation in 48 states. A new challenge that faces the profession is to revise the state laws to reflect the changes in our academic model. The Academy's State Licensure Subcommittee of the Government Relations Committee began work in 2003 to develop model language and a nationwide strategy for implementing such changes. GAINING RECOGNITION An autonomous profession is one that is recognized appropriately by the government and others for the range of services it provides. In 2003, the Center for Medicare and Medicaid Services published a proposed regulatory revision that would change the definition of an audiologist in the Medicaid program to be identical to that in the Medicare program by deferring to state licensure for defining an audiologist. The Academy, along with the Academy of Dispensing Audiologists (ADA), worked long and hard to bring about this change and we hope to see it finalized by the end of this year. Among many third-party payers, audiologists enjoy direct access and reimbursement for diagnostic and treatment services. The federal Medicare program is a notable exception. Through the Academy's efforts, a bill to give Medicare patients direct access to audiologists was introduced in 2003 in the House of Representatives by Jim Ryun (R-KS) and Lois Capps (D-CA) and in the Senate by Ben Nighthorse Campbell (R-CO) and Tim Johnson (D-SD). In addition to these efforts, board, committee members, and staff have worked tirelessly over the past year to promote the profession of audiology. The Reimbursement Committee has published a number of very useful documents on coding and related issues. The Marketing Committee has been attending family practice and other physician meetings to promote the practice of audiology. The Government Relations Committee and State Network have been actively working at the state and federal levels to ensure the profession's autonomy. The Education Committee has launched a series of virtual workshops to provide continuing education for the membership. In 2004, the Academy will promote direct access to audiologists for patients enrolled in the Medicare program; promote excellence in outcomes and practices through its journal, convention, research, and continuing education; promote AuD education through effective accreditation; and, with these accomplishments, strive to ensure the best possible hearing care to our patients.

To measure hearing aid performance using circuitry representative of the major eras of technological advancement during the 20th century. Twenty subjects with audiometric profiles consistent with hearing aid candidacy were fit with each of seven hearing aids. No directional microphones were used and binaural benefit was not assessed. Each hearing aid was fit to the strategy or fitting scheme of the era, or that which was intended by the presenting manufacturer. Electroacoustic and/or real ear measures of gain, output, bandwidth, and distortion were obtained. Objective outcome measures assessing speech perception in backgrounds of noise were obtained. Subjective outcome measures of sound quality and ease of listening were obtained in the laboratory and in real life settings. Electroacoustic and real ear measures indicate that gain and bandwidth have increased, and output and distortion have decreased with current electronic aids. Speech perception ability across the different outcome measures showed significantly poorer performance with the body and linear hearing aids when input levels were high; when input levels were low, outcome measures with hearing aids using a dynamic range compression were not negatively affected. At the most adverse signal to noise ratios, none of the hearing aids was shown to be superior. Measured bandwidth did not correlate highly with speech perception ability for any of the objective outcome measures used. For the subjective measures of sound quality done in a blinded manner, no significant differences were found across different listening situations for current hearing aids. The two most important factors for aided speech perception appear to be the audibility and distortion of the signal. No current compression scheme proved superior with the outcome measures used in this investigation.