Machine learning (ML) is transforming nearly every aspect of modern life including medicine and its subfields, such as hearing science. This article presents a brief conceptual overview of selected ML approaches and desc...Machine learning (ML) is transforming nearly every aspect of modern life including medicine and its subfields, such as hearing science. This article presents a brief conceptual overview of selected ML approaches and describes how these techniques are being applied to outstanding problems in hearing science, with a particular focus on auditory evoked potentials (AEPs). Two vignettes are presented in which ML is used to analyze subcortical AEP data. The first vignette demonstrates how ML can be used to determine if auditory learning has influenced auditory neurophysiologic function. The second vignette demonstrates how ML analysis of AEPs may be useful in determining whether hearing devices are optimized for discriminating speech sounds.
The frequency-following response (FFR) provides enriched information on how acoustic stimuli are processed in the human brain. Based on recent studies, machine learning techniques have demonstrated great utility in model...The frequency-following response (FFR) provides enriched information on how acoustic stimuli are processed in the human brain. Based on recent studies, machine learning techniques have demonstrated great utility in modeling human FFRs. This tutorial focuses on the fundamental principles, algorithmic designs, and custom implementations of several supervised models (linear regression, logistic regression, -nearest neighbors, support vector machines) and an unsupervised model ( -means clustering). Other useful machine learning tools (Markov chains, dimensionality reduction, principal components analysis, nonnegative matrix factorization, and neural networks) are discussed as well. Each model's applicability and its pros and cons are explained. The choice of a suitable model is highly dependent on the research question, FFR recordings, target variables, extracted features, and their data types. To promote understanding, an example project implemented in Python is provided, which demonstrates practical usage of several of the discussed models on a sample dataset of six FFR features and a target response label.
Little is known about objective classifying of noise exposure risk levels in personal listening device (PLD) users and electrophysiologic evidence of cochlear synaptopathy at very fast click rates. The aim of the study w...Little is known about objective classifying of noise exposure risk levels in personal listening device (PLD) users and electrophysiologic evidence of cochlear synaptopathy at very fast click rates. The aim of the study was to objectively classify noise exposure risk using iPhone Health app and identify signs of cochlear synaptopathy using behavioral and electrophysiologic measures. Thirty normal-hearing females (aged 18-26 years) were grouped based on their iPhone Health app's 6-month listening level and noise exposure data into low-risk and high-risk groups. They were assessed using a questionnaire, extended high-frequency (EHF) audiometry, QuickSIN test, distortion-product otoacoustic emission (DPOAE), and simultaneous recording of electrocochleography (ECochG) and auditory brainstem response (ABR) at three click rates (19.5/s, 97.7/s, 234.4/s). A series of ANOVAs and independent samples -test were conducted for group comparison. Both groups had within-normal EHF hearing thresholds and DPOAEs. However, the high-risk participants were over twice as likely to suffer from tinnitus, had abnormally large summating potential to action potential amplitude and area ratios at fast rates, and had slightly smaller waves I and V amplitudes. The high-risk group demonstrated a profile of behavioral and objective signs of cochlear synaptopathy based on ECochG and ABR recordings at fast click rates. The findings in this study suggest that the iPhone Health app may be a useful tool for further investigation into cochlear synaptopathy in PLD users.
The influence of male and female vowel characteristics on the envelope-following responses (EFRs) is not well understood. This study explored the role of vowel characteristics on the EFR at the fundamental frequency (f0)...The influence of male and female vowel characteristics on the envelope-following responses (EFRs) is not well understood. This study explored the role of vowel characteristics on the EFR at the fundamental frequency (f0) in response to the vowel /ε/ (as in "head"). Vowel tokens were spoken by five males and five females and EFRs were measured in 25 young adults (21 females). An auditory model was used to estimate changes in auditory processing that might account for talker effects on EFR amplitude. There were several differences between male and female vowels in relation to the EFR. For male talkers, EFR amplitudes were correlated with the bandwidth and harmonic count of the first formant, and the amplitude of the trough below the second formant. For female talkers, EFR amplitudes were correlated with the range of f0 frequencies and the amplitude of the trough above the second formant. The model suggested that the f0 EFR reflects a wide distribution of energy in speech, with primary contributions from high-frequency harmonics mediated from cochlear regions basal to the peaks of the first and second formants, not from low-frequency harmonics with energy near f0. Vowels produced by female talkers tend to produce lower-amplitude EFR, likely because they depend on higher-frequency harmonics where speech sound levels tend to be lower. This work advances auditory electrophysiology by showing how the EFR evoked by speech relates to the acoustics of speech, for both male and female voices.
Prior to the fitting of hearing aids, clinicians and patients must discuss the best treatment options for the physical and audiologic needs of the patients. To be able to confidently make these decisions, the clinician s...Prior to the fitting of hearing aids, clinicians and patients must discuss the best treatment options for the physical and audiologic needs of the patients. To be able to confidently make these decisions, the clinician should complete a medical and audiological case history. Additionally, clinicians need accurate results from a comprehensive audiologic evaluation. The evaluation should include the following: pure-tone testing, word recognition testing, speech-in-noise testing, and loudness discomfort level measures. This article will outline the process and procedures for acquiring this information in line with the Audiology Practice Standards Organization (APSO) Guidelines for Adult Hearing Aid Fittings Standards 1 and 4. This article will also discuss how results can affect decision-making during the hearing aid selection and fitting process.
This article explores the clinical applications of Audiology Practice Standards Organization (APSO) Standards 2 and 13, both of which keep us fully focused on the patient-as-person. The topics within Standard 2 include a...This article explores the clinical applications of Audiology Practice Standards Organization (APSO) Standards 2 and 13, both of which keep us fully focused on the patient-as-person. The topics within Standard 2 include audiologists' interpersonal communication skills, specifically clarity (ensuring patient comprehension) and empathy (understanding the patient's experiences). Standard 2 also addresses the topic of health literacy, which has been recently expanded to consider not only the degree to which individuals are able to find, understand, and use information and services to inform health-related decisions but also how organizations equitably support those necessary skills. The characteristics and benefits of services provided in patient- and family-centered care contexts are also described. Standard 13 addresses audiologists' support toward overall successful adjustment as defined by the patient, including both technical and personal adjustment to amplification, nontechnical communication issues, and rehabilitation support using readily available technologies. A new assessment protocol that includes goal setting and intervention is described, as well as a patient-centered intervention strategy involving discussion of personally meaningful photographs. Both standards provide a necessary balance to our technology-reliant profession.
The recent hearing aid fitting standard for adults outlines the minimum practice for audiologists fitting adult patients with hearing loss. This article focuses on three items of the standard (5, 6, and 7), which focus o...The recent hearing aid fitting standard for adults outlines the minimum practice for audiologists fitting adult patients with hearing loss. This article focuses on three items of the standard (5, 6, and 7), which focus on the selection of unilateral/bilateral hearing aids, hearing aid style, and coupling, in addition to feature selection. The standard emphasizes that decisions around these three aspects should be recommended for a patient in an individualized manner, based on their needs assessment. For these decisions, the needs assessment might include measures of speech-in-noise ability, social network size, patient preference, and a trial period. Additional elements could include assessments of manual dexterity, binaural interference, and attitude toward hearing aids. However, there are a multitude of ways to practice clinically and still meet the items outlined in the standard. As long as the selection decisions consider individualized patient factors and are capable of meeting validated prescriptive targets, a clinician would be meeting the adult hearing aid fitting minimum standard guidance. In addition, despite the large number of past studies supporting these standards, additional, high-quality research including randomized, controlled, clinical trials are still needed to further support appropriate minimum standard recommendations.
The Audiology Practice Standards Organization (APSO) which was formed in 2017 set out to compile basic services that audiologists within the field should adhere to in their practice. The second standard of the APSO is th...The Audiology Practice Standards Organization (APSO) which was formed in 2017 set out to compile basic services that audiologists within the field should adhere to in their practice. The second standard of the APSO is the Hearing Aid Fitting Standard for Adult and Geriatric Patients. Among the services outlined for an adult hearing aid fitting, orientation is discussed. A hearing aid fitting orientation needs to be device- and patient-centered while also covering various aspects of hearing aid orientation that supports patient's success during the process. This article discusses APSO Standard 12 regarding hearing aid orientation and details how this standard can be implemented in the clinic.
The Audiology Practice Standards Organization (APSO) has published its second audiology standard. This second standard is focused on adult hearing aid fittings. These standards put forward information about verification...The Audiology Practice Standards Organization (APSO) has published its second audiology standard. This second standard is focused on adult hearing aid fittings. These standards put forward information about verification that should be completed on hearing aids before, during, and after a fitting. Validation following the verification of the hearing aids to ensure patient satisfaction with the devices is also included in the standards. The goal of this article is to provide clinicians with the guidelines related to hearing aid verification and validation while also providing information about how to put these standards into clinical practice.
Helping your client adjust to being a hearing aid (HA) user and learn to manage their hearing challenges requires a combination of technical skill and psychosocial counseling in the short- and long-term periods. A key as...Helping your client adjust to being a hearing aid (HA) user and learn to manage their hearing challenges requires a combination of technical skill and psychosocial counseling in the short- and long-term periods. A key aspect of providing support in this time period is to keep the door open for psycho-social-emotional counseling that is often necessary even when the HA user was motivated to make this change, and even when, objectively, they seem to be fit successfully. Another key aspect is not to assume that once they have checked off all the HA fitting boxes, you are done. Over the long term, the user will experience changes in their own hearing abilities and in their life circumstances that will require on-going support to adapt to new communication needs. Approaching the post-fitting period from a person-/family-centered perspective and using a holistic approach to consider how this treatment fits into the HA user's broader life will result in the most success for that person.
Although there is a strong trend of satisfaction with hearing aids, recent consumer surveys indicate that there are still challenges with understanding speech in background noise and low penetration of wireless technolog...Although there is a strong trend of satisfaction with hearing aids, recent consumer surveys indicate that there are still challenges with understanding speech in background noise and low penetration of wireless technologies using many modern-day communication and audio devices, such as smartphones, tablets, and computers. For some listening and communication settings, many patients could benefit from assistive technology that exceeds the capabilities of their hearing aids. When patients are not wearing their hearing aids, such as during sleep, concerns about environmental awareness and safety begin to arise. This article describes some current assistive technologies and accessories that facilitate accessibility to other devices and to satisfy the patient's listening and communication needs.
The proportion of individuals who pose to benefit from the use of hearing aids is much smaller than those who adopt them. Likewise, many adults who try hearing devices abandon using them after a short period of time. Mos...The proportion of individuals who pose to benefit from the use of hearing aids is much smaller than those who adopt them. Likewise, many adults who try hearing devices abandon using them after a short period of time. Most factors related to hearing aid use are unrelated to a patient's hearing loss severity. Hearing loss treatment requires more than the provision of hearing aids as a sole intervention. Adoption rates could be improved through the implementation of evidence-based clinical protocols which maximize patients' success. Recently, the Audiology Practice Standards Organization (APSO) released evidence-based, formal standards of practice addressing hearing aid selection, fitting, and rehabilitation for adult and geriatric patients. Notably, the standards acknowledge the importance of an amplification needs assessment, including hearing aid outcomes measurement. In this brief narrative, we describe Standards 3 and 14 ( and ) and offer an example of the clinical implementation of a comprehensive needs assessment and hearing aid outcomes measurement currently being used in a multisite, longitudinal clinical trial.
Healthcare policy decisions that affect the day-to-day work of an audiologist and his/her ability to best serve our patients occur every day. It is imperative that every professional participate in advocacy efforts; howe...Healthcare policy decisions that affect the day-to-day work of an audiologist and his/her ability to best serve our patients occur every day. It is imperative that every professional participate in advocacy efforts; however, many audiologists are unfamiliar with current advocacy initiatives, how to participate, or how critical one phone call, email, or meeting could be in the legislative process.
In 2016, the National Academies on Science, Engineering, and Medicine (NASEM) released a report titled, "Hearing Health Care for Adults," which detailed the challenges and provided recommendations for improving the acces...In 2016, the National Academies on Science, Engineering, and Medicine (NASEM) released a report titled, "Hearing Health Care for Adults," which detailed the challenges and provided recommendations for improving the access to affordable hearing care for adults in the United States. Arguably the most significant outcome from this report was the subsequent passage of the Over-the-Counter Hearing Aid Act in 2017, which requires the Food and Drug Administration to develop regulations for a class of hearing aids that address mild to moderate hearing loss to be available for sale over the counter (OTC). While this presents an important step toward improving access and affordability of hearing treatment, it does not represent a complete solution. In fact, optimizing the new landscape of hearing care for individuals with hearing loss also may require new policy solutions. This article reflects on the progress achieved since the NASEM report and the policy issues that remain to improve accessibility and affordability of hearing care among older adults.
Professional advocacy communicates a viewpoint for or against a policy or issue, and is used to influence change to public policy, legislation, and/or regulations. State audiology associations are perfectly positioned to...Professional advocacy communicates a viewpoint for or against a policy or issue, and is used to influence change to public policy, legislation, and/or regulations. State audiology associations are perfectly positioned to organize advocacy efforts for the profession at the state level. Therefore, the purpose of this article is to review the types of advocacy available to state organizations and the steps for hiring a lobbyist. In addition, the article presents a unique advocacy model in which multiple audiology and speech-language pathology organizations in the state of Ohio joined to form the Ohio Speech and Hearing Governmental Affairs Coalition (OSHGAC). There are numerous advantages of an advocacy coalition, most importantly a shared financial responsibility. Finally, several examples of the OSHGAC recent legislative and regulatory advocacy efforts are reviewed.
Advocacy is a core component of moving the hearing healthcare environment forward to optimize patient care and allow providers to work to the full extent of their scope of practice. Despite its importance, advocacy, part...Advocacy is a core component of moving the hearing healthcare environment forward to optimize patient care and allow providers to work to the full extent of their scope of practice. Despite its importance, advocacy, particularly at the level of state governments, can present to many as a daunting, sometimes futile, task. The purpose of this article is to describe advocating at the state level for hearing healthcare service providers. This article will discuss considerations for audiology practitioners interested in state-level advocacy, including variations in state government organization, benefits and barriers to state advocacy, and state-level issues that affect practitioners.
Many barriers to accessibility exist for Medicare beneficiaries seeking hearing and balance care such as availability of providers, coverage for services, and ability to pay. Other statutory and administrative barriers e...Many barriers to accessibility exist for Medicare beneficiaries seeking hearing and balance care such as availability of providers, coverage for services, and ability to pay. Other statutory and administrative barriers exist including the need for physician orders to have audiology services covered, the classification of audiologists as suppliers of "other diagnostic tests" under Medicare payer policy, and non-coverage of certain audiologic management and treatment services. Nearly two decades of legislative efforts have not resulted in any substantial changes to U.S. health policy, while the need for audiology services has increased due to a growing demographic of older adults. The Medicare Audiologist Access and Services Act (MAASA) has been introduced in the 116th and 117th Congress and proposes amendments to the Social Security Act that would address statutory barriers to accessing hearing and balance care among Medicare beneficiaries and would recognize audiologists for their scope of practice within the Medicare program. Objectives of the present review are to provide a summary of statutes in the Social Security Act and Standard Occupational Classification system which affect audiologists, audiology services, and Medicare beneficiaries and to discuss previous and current legislative health policy efforts to address these statutory barriers to hearing and balance care access.