Perceptual Error Analysis of Korean Monosyllabic Word Recognition I: Error Rates and Types According to Hearing Level

Purpose: This study aimed to analyze perceptual error patterns and mapping in Korean monosyllabic word recognition across different hearing levels, using confusion matrix analysis to quantify phoneme similarity and perceptual distance. By examining detailed phoneme-level confusions, the research sought to clarify how hearing loss alters recognition and discrimination. Methods: Seventytwo participants were divided into four hearing groups: normal hearing, mild, moderate, and severe hearing loss. Each participant listened to 726 Korean monosyllabic words spoken in a controlled acoustic environment and provided identifications for each. Recognition errors were systematically classified according to onset, nucleus, and coda positions. Confusion matrices were generated for each group and a six-level error bracket classification applied. Perceptual similarity and distance among phoneme pairs were assessed using Shepard’s Law and perceptual mapping was visualized for each hearing group. Results: Phoneme recognition accuracy declined with increasing hearing loss, most notably for onset and nucleus positions. Moderate and severe hearing loss groups exhibited significantly higher error rates and larger perceptual distances than normal hearing and mild loss groups. The total similarity counts for onset, vowel, and coda all increased as hearing impairment worsened. Severe hearing loss participants showed peak perceptual distances for critical phoneme pairs, indicating diminished discrimination ability. Group-wise perceptual maps clearly differentiated error patterns by hearing condition. Conclusion: Hearing loss substantially compromises Korean monosyllabic word recognition, leading to elevated error rates and increased perceptual distances among phonemes. These findings underscore the necessity for hearing-level-specific aural rehabilitation strategies and provide foundational auditory mapping data for hearing-impaired populations.

This study examined the relationship between behavioural thresholds as measured by pure tone audiometry and electrophysiological thresholds measured by the Auditory Steady-State Response (ASSR) in children with normal hearing and sensorineural hearing loss. After being assessed, 45 children of both sexes, ranging in age from 5 to 15, were split into four groups: 10 with moderate to moderately severe sensorineural hearing loss (G2M); 10 with steeply sloping sensorineural hearing loss (G2D); 10 with profound and severe sensorineural hearing loss (G2S); and 15 with normal hearing (G1). ASSR, tympanometry, acoustic reflex testing, pure tone audiometry, and speech audiometry (SRT and SDT) were performed. The electrophysiological maximum in the group with normal hearing thresholds varied from 19 to 27 dB NA. The correlation in the group with moderate to moderately severe hearing loss was 0.42-0.74. The correlation in the steeply sloping hearing loss group was 0.68-0.94. The correlation in the group of people with profound and severe hearing loss was 0.59-0.86. The normal hearing group's mean differences in ASSR threshold and audiometric threshold ranged from -0.3 to 12 dB, in the moderate and moderately severe hearing loss group from -9 to 2 dB, in the steeply sloping hearing loss group from 1.4 to 7.5 dB, and in the severe and profound hearing loss group from -0.40 to 8.5 dB. As expected, there was no strong relationship between behavioural and electrophysiological thresholds in the group with normal hearing. But in children with hearing loss, there was a strong correlation between electrophysiological and behavioural thresholds; this relationship was especially evident in children with severe and profound hearing loss and those with steeply sloping hearing loss.

Objective:To investigate the audiological characteristics and possible causes of unilateral hearing loss in infants and young children. Methods:105 infants from Beijing Maternal and Child Health Care Institution who failed the newborn hearing screening and were referred to the Children's Hearing Diagnosis Center of PLA General Hospital for hearing diagnosis. They were diagnosed with unilateral hearing loss and underwent clinical data collection. A full set of audiological examinations included ABR, 40 Hz auditory event related potential, ASSR, DPOAE, tympanometry. Results:①In initial diagnosis, 45 cases（42.86%） had mild hearing loss, 19 cases（18.10%） had moderate hearing loss, 14 cases（13.33%） had severe hearing loss, and 27 cases（25.71%） had severe hearing loss; Among them, 65 cases（61.90%） were conductive hearing loss or mixed hearing loss, and 40 cases（38.10%） were sensorineural hearing loss. ②83 of 105 cases had follow-up visits: 24 cases were normal, 15 cases with mild hearing loss, 4 cases with moderate hearing loss, 12 cases with severe hearing loss, and 26 cases with extremely severe hearing loss, 2 cases of hearing loss in both ears. ③From the initial diagnosis to the follow-up diagnosis, the change of mild hearing loss was the largest, followed by moderate hearing loss, severe and extremely severe hearing loss basically did not change; the number of mild and severe conductive hearing loss which recovered to normal hearing was most, the number of sensorineural hearing loss changed little. Conclusion:The infants who failed the newborn hearing screening and were diagnosed with unilateral hearing loss were mainly mild to moderate conductive hearing loss and severe to extremely severe sensorineural hearing loss. The hearing of children with hearing loss gradually improved, and severe and extremely severe sensorineural hearing loss remained unchanged.

Music to the Impaired or Implanted Ear

You have accessThe ASHA LeaderFeature1 Mar 2005Aural Habilitation Update: The Role of Speech Production Skills of Infants and Children With Hearing Loss Sheila R. Pratt Sheila R. Pratt Google Scholar More articles by this author https://doi.org/10.1044/leader.FTR2.10042005.8 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In It is well known that the development of speech is extremely limited without adequate auditory input and feedback. An obvious example is that hearing loss in infancy and early childhood usually affects all as pects of speech production unless there is early and consistent use of sensory aids as well as substantive sensorimotor and linguistic training. The speech development of infants and children with hearing loss hinges on their abilities to use audition not only to learn the sounds of their language, but also to use their articulators to produce those sounds and make use of auditory feedback to refine their speech over time. As such, the speech of children with prelingual hearing loss is particularly susceptible to delay and disorder, es pecially if the severity of the hearing loss is substantial and intervention is delayed or inadequate. Speech Development During the first six months of life (and possibly in utero) auditory perceptual learning is vital for acquiring oral language and speech, although the maturation timeline for the speech production in normal-hearing children is relatively lengthy. This protracted timeline may account for the long-term training and treatment needs of many children with hearing loss, even those identified and fitted early with sensory aids (Yoshinaga-Itano & Sedey, 2000). Young children with normal hearing typically begin babbling around 5–6 months of age and start verbal expression around 12 months of age. However, their speech production skills continue to be refined through the school-age years and well beyond when their basic phonological inventories have been established. For example, vowel space, voice-onset times, and vocal control adjust throughout early childhood (Assmann & Katz, 2000; Koenig, 2001; Lee, Pontamianos, & Naray anan, 1999). Furthermore, substantial acoustic variability is a hallmark of children’s speech production until late childhood. Although the research is somewhat mixed on the development of coarticulation, children appear to be less able than adults to coarticulate their speech gestures in a consistent manner, and as a consequence, their speech is less intelligible than that of adults (Katz, Kripke, & Tallal, 1991; Nittrouer, 1993). The refinement of auditory processing of speech has a similar developmental timeline. Child ren may apply different rules or weights to speech cues than adults, and these weights change throughout childhood (Nittrouer, 2003; Nit trouer, Crowther, & Miller, 1998). Their auditory processing of speech also appears to be more susceptible to acoustic and linguistic perturbations than is observed with adults. Children are more adversely affected than adults by background noise, reverberation, talker variability, re ductions in signal bandwidth, and the number of signal channels (Eisenberg et al., 2000; Ryalls & Pisoni, 1997; Kortekaas & Stelmachowicz, 2000). The Role of Audition in Speech Development and Production For mature speakers, audition acts as an error detector and a means of monitoring speaking conditions. It is considered to be slower than other forms of sensory information (i.e., proprioception) generated during speech, and therefore is likely limited to a feedback role (Perkell et al., 1997). Speakers use audition to determine if their articulators have produced sounds that are acoustically off-target. Audition also provides information for corrective adjustments, and as a consequence, is a contributor to the maintenance of speech integrity. Studies of frequency and spectrally shifted speech feedback have shown that adults rapidly adjust to minor acoustic perturbations with compensatory and/or matching strategies (Bauer & Larson, 2003; Houde & Jordan, 2002; Jones & Munhall, 2002, 2003). They appear to adjust their articulators so that their speech productions match their internal representations. In addition to acting as an error detector, hearing is used by mature speakers to determine how they should adjust their speech in various acoustic, linguistic, and social environments. For example, adults know when to speak slower, louder, softer, or more precisely in order to accommodate their listener or the environmental conditions (Perkell et al., 1997). In contrast, many young children are unable to adjust the clarity of their speech, even when explicitly directed to do so (Ide-Helvie et al., 2004). Audition also allows the development of articulatory organization by providing information about how to position, move, and coordinate the articulators for speech, movements that can differ from those associated with vegetative functions of the mechanisms (Moore & Ruark, 1996). For ex ample, infants use audition to learn how to shift from a vegetative breathing pattern to a pattern that can support speech. They learn how to position and move their tongues and to judge the acoustic consequences of those gestures. Coord ination of the larynx with the vocal tract and upper airway articulators is refined over years but requires an intact auditory system (Koenig, 2001; Tye-Murray, 1992). The lip and jaw movements associated with speech in infants and young children are highly variable but distinct from sucking, chewing, and smiling (Green et al., 2000; Green, Moore, & Reilly, 2002; Moore & Ruark, 1996). The implication is that although the same peripheral mechanisms are used across oral and respiratory functions, the differing goals require substantially distinct coordination and feedback efforts. The coordination needed to chew and swallow efficiently develops over early childhood but is largely independent of hearing, whereas the coordination required to move between vowel and consonant gestures, particularly in a coordinated and coarticulated manner, is strongly influenced by hearing (Baum & Waldstein, 1991; Guenther, 1995; Tye-Murray, 1992; Waldstein & Baum, 1991). Audition has a primary sensorimotor role in the development of speech, but it also is fundamental to infants and young children learning the sounds of their language. Furthermore, it helps them learn how specific speech events relate to their phonology, so that with development, young children become more able to use their hearing to inform them about the sequencing of speech gestures and the correctness of subsequent productions. Over time children learn to use audition to monitor ongoing speech, detect errors, and make corrective adjustments. Hearing Loss and Speech Production Hearing loss is common in the general population but its effects on speech production are most pronounced with individuals whose hearing loss is congenital or acquired in early childhood. Most adults who acquire their hearing losses later in life suffer little or no deterioration in intelligibility, likely because their residual hearing provides sufficient feedback since their mature speech production systems rely more on orosensory than auditory information to maintain proper control (Guenther, 1995; Goehl & Kaufman, 1984; Perkell et al., 1997). The speech differences that they do exhibit are subtle and usually imperceptible, even in cases of complete or nearly complete adventitious hearing loss. Nonetheless, some adventitiously deafened adults exhibit reduced speaking rate, and compromised articulatory and phonatory precision (Kishon-Rabin et al., 1999; Lane & Webster, 1991; Lane et al., 1995; Leder et al., 1987; Waldstein, 1990; Perkell et al., 1992). These speech differences are similar in nature, but not in severity, to those observed with prelingually deafened speakers. Most infants and young children with hearing loss demonstrate disordered phonation and articulation, as well as delays in the acquisition of sound categories. The entire speech production system can be affected, from respiratory support to the coarticulation of ongoing speech (Pratt & Tye-Murray, 1997). This is especially true if the hearing loss is identified late or after a period of protracted hearing loss. Furthermore, the overlap and interaction of disordered sound production and linguistic delay contribute to poor speech integrity and restricted speech development. Babbling generally does not appear before 12 months of age (Oller & Eilers, 1988; Oller et al., 1985) and canonical babbling has been observed as late as 31 months in this population (Lynch, Oller, & Steffens, 1989). Infants also produce fewer instances of canonical babble and include a more limited range of consonants in their babble (Stoel-Gammon, 1988; Stoel-Gammon & Otomo, 1986; Wallace, Menn, & Yoshinaga-Itano, 2000). However, later speech intelligibility is better predicted by the consonant inventory used in emerging spoken language during the second year of life than during babble (Obenchain, Menn, & Yoshinaga-Itano, 2000). The phonetic repertoires of infants with severe-to-profound hearing loss often are restricted when compared to their normal-hearing peers, although there is abundant individual variability (Lach, Ling, Ling & Ship, 1970; Stoel-Gammon & Otomo, 1986; Wallace et al., 2000; Yoshinaga-Itano & Sedey, 2000). The early speech inventories of infants with severe-to-profound hearing loss predominately consist of motorically easy sounds such as vowels and bilabial consonants. The sounds of their inventories also contain more low frequency information, which is more audible. For example, the babbling of infants with hearing loss often has a high concentration of nasals and glides, which include low-frequency continuant cues (Stoel-Gammon & Otomo, 1986). Without early intervention and appropriate fitting of sensory aids the speech-sound inventories of many children with hearing loss usually do not attain full maturity. Yoshinaga-Itano and Sedey (2000) found that children with moderate-to-severe hearing losses did not reach an age-appropriate complement of vowel and consonant sounds until about 4 and 5 years respectively, and many children with profound hearing loss had restricted inventories even at 5 years of age. Children with profound hearing loss often reach an early plateau in their speech skill development. For instance, the speech characteristics of many children with severe-to-profound hearing loss demonstrate little improvement in sound inventory and intelligibility after 8 years of age, even with the initiation of extensive training (Hudgins & Number, 1942, McGarr, 1987; Smith, 1975). Such results imply that, like auditory and language interventions, speech production therapy should be an important component of early intervention, and that the common practice of delaying speech training in children with hearing loss until they have functional language is developmentally untenable if the goal is for them to be oral communicators. In addition to the relationship between age-of-onset and speech impairment severity, there also is a moderately positive relationship between the severity of hearing loss and the extent of the associated speech difficulties (Boothroyd, 1969; Levitt, 1987; Smith, 1975). For example, children with mild-to-moderate hearing loss, particularly if well aided, tend to exhibit speech differences that are mild (Elfenbein, Hardin-Jones, & Davis, 1994; Oller & Kelly, 1974; West & Weber, 1973). Elfenbein and colleagues found that children with mild-to-moderate hearing loss exhibit good intelligibility but had higher than normal rates of affricate and fricative substitutions. Mild hoarseness and resonance problems also are present in 20% to 30% of this group of children. Moreover, they tend to have increased rates of voicing irregularities, difficulties with /r/ production, and omissions of back and word-final consonants. Early studies of children with profound prelingual hearing loss showed that most rarely acquired speech skills sufficient to interact easily using spoken language. On average, less than 20% of their words were intelligible to listeners who were not familiar with their speech (Hidgins & Numbers 1942; Markides, 1970; Smith, 1975). Smith (1975) evaluated 40 children with varying levels of hearing loss and, on average, only 18.7% (0% to 76%) of their words could be identified by inexperienced listeners. As expected, overall intelligibility was inversely related to the frequency of segmental and suprasegmental errors. However, with early identification of hearing loss and early intervention (i.e., fitting of sensory devices, behavioral training, and parent counseling), the numbers of children with severe-to-profound hearing loss and intelligible speech has increased (Uchanski & Geers, 2003). Many more children are developing sufficient speech perception to support development of speech production and oral language, but these advances may have added to the overall heterogeneity of the population (Higgins et al., 2003). Other factors contribute to the diversity of speech production skills observed with these children. For instance, cognitive skill (particularly nonverbal intelligence) has been found to be an important predictor of functional speech and oral language in children with hearing loss (Geers et al., 2002; Tobey et al., 2003). Auditory experience in infancy and early childhood, even of limited duration, positively influences the speech production skills of children who have severe-to-profound hearing loss (Geers, 2004). The use of sensory aids has a substantial impact on speech outcomes, but somewhat surprisingly, the age at which infants and young children are fitted with cochlear implants has not surfaced in studies of speech production as a significant predictor of later speech intelligibility (Geers et al., 2002; Tobey et al., 2003). Early implantation (less than 2 years) is, however, related to more normal oral communication development as a whole (both speech and oral language) (Geers, 2004). It may be that the age of implantation is not easily separated from other influences of intervention, like the orientation of the habilitation program and parent involvement, which relate strongly to children being auditory perceptual learners and users of auditory feedback. Another consideration is that many early-implanted children may be implanted too late to observe a clear impact on speech production. The critical ages at which hearing aids should be fitted has not been investigated, but like cochlear implants, it is assumed that earlier is better. The oromotor integrity and language skills are additional factors that often are neglected in studies of speech development in children with hearing loss. A substantial number of infants and children with hearing loss present with secondary handicapping conditions, such as neurological disorders. When these neurological disorders include the speech mechanism, the development of functional speech is difficult even if audition is optimized. As such, is it not unusual for a child with hearing loss to have a coexisting dysarthria along with the speech impairment secondary to the hearing loss. A subset of children with hearing loss also may have an apraxia of speech, but separating the impact of hearing loss from an apraxia of speech is difficult because the associated speech characteristics overlap (McNeil, Robin & Schmidt, 1997). Language disorders also are commonly observed in children with hearing loss, and are frequently evidenced in phonological disorder and lexical delay. As a result, extricating the sensorimotor impact of hearing loss on speech production from the influences of language disorder in individual children is not always straightforward (Peng et al., 2004). Habilitation: Sensory Aids and Treatment Most speech training approaches are dependent on optimizing the use of residual hearing although some approaches use other modalities (Pratt, Heintzelman, & Deming, 1993; Pratt & Tye-Murray, 1997). Correspondingly, it is generally believed that speech is learned most easily if infants and children learn and monitor their speech through their auditory systems. Therefore, the proper and early fitting, and consistent use of sensory aids, along with auditory and language training are important components of speech production training. In support of this auditory-based approach is the relationship between the severity of prelingual hearing loss and the extent of speech delay/disorder found in children (Boothroyd, 1969; Levitt, 1987; Smith, 1975), as well as any history of previous hearing (Geers, 2004). The relationship between audiometric configuration and speech intelligibility also argues for the importance of audition if the goal for a child is oral communication (Levitt, 1987; Osberger, Maso, & Sam, 1993). There is a growing literature supporting the positive impact of cochlear implants on speech development, as well as the role that auditory-oral-based training programs play in communication outcomes of children fitted with cochlear implants (Geers et al., 2002; Tobey et al., 2003). There is, however, limited efficacy data for children with less severe hearing loss who are typically fitted with hearing aids. The lack of research in this area is glaring because wearable electroacoustic hearing aids have been available for more than 50 years (Lybarger, 1988) and are a fundamental component of treatment approaches for most children with hearing loss. Furthermore, more infants and children are fitted with hearing aids than cochlear implants. Preliminary data reported by Stemachowicz and her colleagues (2004) on three infants fitted early with hearing aids suggested delays in sound category acquisition consistent with patterns previously reported in the literature. Sound inventories were impoverished, consonants were more affected than vowels, and sound containing high-frequency cues were particularly limited. Additional data by Pittman and colleagues (2003) observed that the amplitude of high-frequency speech cues directed to and produced by children wearing hearing aids may not be sufficient, although they did not connect their results directly to speech production outcomes. Pratt, Grayhack, Palmer, and Sabo (2003) found that differences in hearing aid configuration could alter vowel spacing of children even though the children in their study had intelligible speech, and the speech tokens measured were limited to acceptable productions. Their data indicated that hearing aids could alter the speech of children, but provided little information about the impact that hearing aids may have on speech development. Given the paucity of data-as well as the expansion of universal infant hearing screening programs-it is critical that more research be done in this area. Increasing numbers of infants with hearing loss will be identified shortly after birth and, if we are to effectively treat them, more should be known about the impact that hearing aids and other sensory aids have on speech and auditory system development. Aural Habilitation References Assmann P. F., & Katz W. F. (2000). Time-varying spectral change in the vowels of children and adults.Journal of the Acoustic Society of America, 108, 1856–1866. CrossrefGoogle Scholar Baum S., & Waldstein R. (1991). Perseveratory coarticulation in the speech of profoundly hearing-impaired and normally hearing children.Journal of Speech and Hearing Research, 34, 1286–1292. LinkGoogle Scholar Bauer J. J., & Larson C. R. (2003). Audio-vocal responses to repetitive pitch-shift stimulation during a sustained vocalization: Improvements in methodology for the pitch-shifting technique.Journal of the Acoustical Society of America, 114, 1048–1054. CrossrefGoogle Scholar Boothroyd A. (1969). 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The purpose of this study was to examine age- and hearing-related differences in school-age children's benefit from visual speech cues. The study addressed three questions: (1) Do age and hearing loss affect degree of audiovisual (AV) speech enhancement in school-age children? (2) Are there age- and hearing-related differences in the mechanisms underlying AV speech enhancement in school-age children? (3) What cognitive and linguistic variables predict individual differences in AV benefit among school-age children? Forty-eight children between 6 and 13 years of age (19 with mild to severe sensorineural hearing loss; 29 with normal hearing) and 14 adults with normal hearing completed measures of auditory and AV syllable detection and/or sentence recognition in a two-talker masker type and a spectrally matched noise. Children also completed standardized behavioral measures of receptive vocabulary, visuospatial working memory, and executive attention. Mixed linear modeling was used to examine effects of modality, listener group, and masker on sentence recognition accuracy and syllable detection thresholds. Pearson correlations were used to examine the relationship between individual differences in children's AV enhancement (AV-auditory-only) and age, vocabulary, working memory, executive attention, and degree of hearing loss. Significant AV enhancement was observed across all tasks, masker types, and listener groups. AV enhancement of sentence recognition was similar across maskers, but children with normal hearing exhibited less AV enhancement of sentence recognition than adults with normal hearing and children with hearing loss. AV enhancement of syllable detection was greater in the two-talker masker than the noise masker, but did not vary significantly across listener groups. Degree of hearing loss positively correlated with individual differences in AV benefit on the sentence recognition task in noise, but not on the detection task. None of the cognitive and linguistic variables correlated with individual differences in AV enhancement of syllable detection or sentence recognition. Although AV benefit to syllable detection results from the use of visual speech to increase temporal expectancy, AV benefit to sentence recognition requires that an observer extracts phonetic information from the visual speech signal. The findings from this study suggest that all listener groups were equally good at using temporal cues in visual speech to detect auditory speech, but that adults with normal hearing and children with hearing loss were better than children with normal hearing at extracting phonetic information from the visual signal and/or using visual speech information to access phonetic/lexical representations in long-term memory. These results suggest that standard, auditory-only clinical speech recognition measures likely underestimate real-world speech recognition skills of children with mild to severe hearing loss.

Objective:The aim of this study is to analyze the variation characteristics of ABR wave latency and wave interval in different functional states of middle ear and different hearing levels, and to explore the value of ABR detection method in hearing assessment of infants. Methods:A total of 670 children were enrolled in the Pediatric Hearing Diagnosis and Treatment Center of the Department of Otolaryngology head and Neck Surgery, Beijing Children's Hospital, Capital Medical University from May 2020 to April 2021. According to the hearing test results, they were divided into group A normal group（632 ears）. Group B consisted of normal middle ear function and abnormal hearing（157 ears）, further divided into mild hearing loss subgroup（49 ears）, moderate hearing loss subgroup（47 ears） and severe to very severe hearing loss subgroup（61 ears）. Group C was a group with abnormal middle ear function（551 ears）, which was further divided into normal hearing subgroup（307 ears）, mild hearing loss subgroup（110 ears）, moderate hearing loss subgroup（107 ears） and severe to very severe hearing loss subgroup（27 ears）. The differences of Ⅰ, Ⅲ, Ⅴ Wave Latency, Ⅰ-Ⅲ, Ⅰ-Ⅴ wave interval between subgroups B and C and Group A, and between subgroups B and C were analyzed. Results:When the stimulus intensity was 80 dB nHL, there was no significant difference in ABR latency and wave interval between group B and group A, and there was no significant difference between group B and group A（P>0.05）, nor between the two groups（P>0.05）. In the subgroup of severe to very severe hearing loss, some ABRⅠ, Ⅲ and Ⅴwaves could not be elicited, only Ⅲ and Ⅴ waves were elicited from 4 ears and Ⅴ waves were elicited from 7 ears. The mean latency of 11 ear Ⅲ and Ⅴ waves was （5.20±0.44） ms and （6.80±0.75） ms, respectively, which was longer than that of mild and moderate hearing loss subgroups. Compared with group A, the latency of normal hearing subgroup in group C was significantly prolonged only for wave Ⅰ, and the latency of wave I, Ⅲ and Ⅴin other subgroups was significantly prolonged（P<0.01）. In terms of Ⅰ-Ⅲ and Ⅰ-Ⅴ wave intervals, there was no significant difference between group C and group A in normal hearing subgroup and mild loss subgroup. The subgroup of moderate hearing loss and the subgroup of severe to very severe hearing loss were significantly shorter than the group A（P<0.01）. Compared with the normal group, the latency of Ⅰ, Ⅲ and Ⅴ waves in group C were significantly longer（P<0.01）. The latency of wave Ⅰ, in the moderate hearing loss group was significantly longer than that in the mild hearing loss group（P<0.001）. The latency of each wave in severe to very severe hearing loss subgroup was significantly longer than that in mild and moderate hearing loss subgroup（P<0.001）. There was no difference between mild hearing loss subgroup and normal hearing subgroup（P>0.05）. The subgroup of moderate hearing loss and severe to very severe hearing loss were significantly shorter than the subgroup of normal hearing and the subgroup of mild hearing loss, and there was a significant difference between the two groups（P<0.01）. Conclusion:In sensorineural hearing loss, mild and moderate hearing loss had no significant effect on the latency and interwave period of ABR. The latency of each wave in severe to very severe hearing loss cannot be elicited normally or only Ⅲ and Ⅴ waves can be elicited, and it is significantly prolonged. The latency of ABR Ⅰwave was significantly prolonged when middle ear function was abnormal. The latency of each wave was significantly prolonged when middle ear function was abnormal and hearing was abnormal. When hearing loss reaches a certain degree, the interwave period is shortened significantly. Therefore, for mild to moderate hearing loss, the prolonged latency of ABRⅠ wave is of certain value for the qualitative diagnosis of hearing loss, and the prolonged latency of ABR Ⅰwave is of significance for judging middle ear dysfunction in infants.

Vowel auditory formant distances were obtained from speakers with hearing loss to investigate how perceptual constraints affect the contrastiveness and intelligibility of their spoken vowels. These distances were evaluated in relation to the 3-Bark critical distance principle for vowel height and place as described by Syrdal (1985) and Syrdal and Gopal (1986). Seven speakers with profound hearing loss, 10 with severe hearing loss, and seven with normal hearing produced the vowels /u/, /i/, /I/, /ae/, /a/, and /--/ in an /hVt/ context. Vowel formants and fundamental frequencies were obtained with acoustic spectrographic and LPC analysis and converted to Bark values to establish auditory formant distances. Confusion matrices were constructed from normal listeners' identifications of recorded vowel productions. When frequency data were transformed to a Bark auditory scale, increasing convergence of vowel targets was obtained with increase in hearing loss. Percent correct identifications of the vowels produced by the three groups reflected speaker group differences seen in vowel contrastiveness/overlap in auditory phonetic space. Four levels of performance based on error incidence and type were determined. F1-F0 by F3-F2 Bark distance coordinate plots of a given speaker's vowel space reflected the differential intelligibility scores shown by confusion matrices of individual speakers from the four performance levels. Vowel organization by speakers with hearing loss was influenced by (a) formant critical distance, and (b) formant audibility. The least audible formants, F2 and F3, showed the greatest effects of severe and profound hearing loss. F1 and F0 showed further change with the most profound losses and revealed individual differences as well.

To investigate the efficacy of early intervention on language, pronunciation and cognitive developments of infants and toddlers with hearing loss and to build up an early intervention model. Fifty-six children with moderate to profound sensorineural hearing loss aged 10 months to 2 years were divided into two groups. 20 children, aged 10 months to 2 years, received early intervention services after wearing hearing aids for 6 - 18 months, and 36 children, aged 11 months to 2 years, didn't receive any intervention. The type and degree of hearing loss were measured by a series of auditory tests. Language and cognitive developments of the children with hearing loss and 28 age, and sex-matched children with normal hearing, aged 10 to 23 months, were evaluated by the Gesell developmental schedules. The results were expressed as developmental quotient (DQ). Pronunciation test in mandarin Chinese was adopted to evaluate the speech development of the 56 children with hearing loss. (1) The language DQ according the Gesell developmental schedules of the children with hearing loss who received early intervention was (92.25 +/- 17.32), significantly higher than those children with hearing loss who didn't receive intervention (70.44 +/- 29.99, P = 0.00), whish was significantly lower than that of the normal hearing children (P = 0.00). However, there was no significant difference in language DQ between the children who received early intervention and the normal hearing children. There was no significant correlation between the degree of hearing loss and language DQ in the children who received early intervention (P = 0.27). (2) The personal-social developmental quotient (DQ) of the children who received intervention was (101.40 +/- 7.66), significantly higher than that of the children who didn't receive intervention (83.94 +/- 22.09, P = 0.00), that were significantly lower than that of the children with normal hearing (P = 0.00). However, there were no significant difference in the personal-social DQ between the children who received early intervention and the children with normal hearing. No significant differences in the gross motor ability, fine motor ability and adaptive ability were observed between the two groups of children with hearing loss and normal hearing children. (3) The consonant pronunciation of the children with moderate to severe hearing loss who received early intervention was normal. Among those children only one case with profound hearing loss had/d/error. The consonant pronunciation of the children with moderate hearing loss who didn't receive early intervention of those was normal. One case with moderate-severe hearing loss and one case with severe hearing loss had/d/errors. Six cases with profound hearing loss had/d, m/errors. The tone of the children with moderate to severe hearing loss who received early intervention was normal. Three cases with profound hearing loss exhibited tone errors. Among the children who didn't receive early intervention, tone errors were found in two cases with moderate hearing loss, one case with moderate-severe hearing loss, one case with severe hearing loss, and twelve cases with profound hearing loss showed. The language, pronunciation and cognitive developments of the children who don't receive early intervention are significantly lower than those of the children with normal hearing. Early intervention can significantly improve the language, speech and cognitive abilities of children with hearing loss.

Age-related hearing loss (HL) is a highly prevalent and undertreated disease that has long been considered an inconsequential result of aging, and at worst, a simple quality of life problem. Recent research suggests that HL may have significant implications for mental and neurocognitive health. Several studies have shown preliminary evidence associating HL and depression.1 Identifying modifiable risk factors for late-life depression is crucial because depression is relatively common and disabling in the elderly. Late-life depression is often resistant to medications such as antidepressants. Since HL is highly prevalent, severely undertreated, easily diagnosed, and treatable (by hearing aids or cochlear implants), establishing a link between HL and late-life depression may yield a strategy to prevent or treat depression in the sub-group of patients who also have HL.Latinos, depression, mental healthTable 1: Participant Demographics by Hearing Loss CategoryTable 2: Odds of Clinically Significant Depressive Symptoms by Category of Hearing Loss (adjusted model)A recent study2 by our team investigated whether an association between audiogram-measured HL and clinically significant depressive symptoms exists by using data from the Hispanic Community Health Study/Study of Latinos (HCHS). Determining whether this association exists in a racial/ethnic minority, such as the Hispanic population, was of specific interest for several reasons. Depression has been reported to be more common in the Hispanic population compared to other ethnic/racial groups.3 In addition, depression may be underdiagnosed in Hispanic individuals due to language, cultural, and literacy barriers to health care.4 Moreover, early studies evaluating this association have largely been limited to Caucasian cohorts.1 A finding in one race/ethnic group does not necessarily translate to another. STUDY METHOD The HCHS is a multicenter, prospective, community-based cohort study of Hispanic/Latino adults in the United States. This dataset includes information from audiograms, interviews, physical examinations, and tests, such as laboratory bloodwork and neuropsychological testing. This cohort also happens to have a large sample of Hispanic individuals with audiometric hearing data—in fact, the largest study to date (5,328 subjects compared with 1,332 in the previously largest study5). Importantly, this dataset included a measure of depressive symptoms known as the Center for Epidemiologic Studies Depression Scale, 10-item version (CESD-10, a 10-question yes/no survey). Data collected from a total of 5,328 individuals were included in the study after excluding data on those below 50 years old and those with early-onset hearing loss or missing key data, such as audiograms, CESD-10 scores, or demographics. In this cross-sectional study, hearing loss was assessed using pure-tone audiometry in soundproof booths. All individuals had pure-tone audiometry across frequencies 500 Hz to 8,000 Hz tested by trained technicians. The four-frequency pure-tone average (PTA) based on hearing thresholds at 500, 1,000, 2,000, and 4,000 Hz was calculated for each ear; HL was based on the PTA of the better ear, and unilateral HL was excluded. Severity of HL was categorized as follows: absent or normal, 0 to 25 dB; mild 26 to 40 dB; moderate, 41 to 55 dB; moderately severe, 56 to 70 dB; severe 71 to 90 dB; and profound, 91 dB or greater.2 Since few participants had severe or profound HL, individuals in these categories were combined with those in the moderately severe HL group to form a category of moderately severe or worse (56 dB or greater) HL. Depressive symptoms were measured using the CESD-10. Examples of questions include “I felt depressed” and “I felt that everything I did was an effort.” Clinically significant depressive symptoms were defined by a CESD-10 score of 10 or higher, a cutoff also used in prior research.6 The study also adjusted for other variables that may confound the association between HL and depression. By confound, we mean that these variables might create a seemingly false association between HL and depressive symptoms. For example, age can cause both HL and depression. By adjusting for age, we take this into account to reduce or eliminate the confounding effect of age. These other variables were adjusted for included use of hearing aids, demographics (age, sex, educational level, etc.), and cardiovascular disease. RESULTS Baseline participant characteristics listed by HL category are provided in Table 1. The median age of participants was 58 years old. Of the 5,328 participants, 62 percent were women. Most patients (82%) had no HL, 14 percent had mild HL, 2.7 percent had moderate HL, and 0.9 percent had moderately severe or worse HL. The mean CESD-10 score was 7.7. Clinically significant depressive symptoms (i.e., a CESD-10 score ≥10) were present in 32 percent of participants without HL, 34 percent with mild HL, 45 percent with moderate HL, and 57 percent with moderately severe or worse HL. When adjusting for other variables that might cause confounding, such as hearing aid use, demographic factors, cardiovascular disease, and antidepressants, the odds of clinically significant depressive symptoms (CESD-10 score ≥10) increased 1.44 times for every 20 dB increase in HL. This adjusted model was used to calculate the odds of clinically significant depressive symptoms in each category of HL compared to normal hearing (0 dB hearing loss; Table 2). The odds of clinically significant depressive symptoms were 1.81 times as high for mild HL, 2.38 times as high for moderate HL, 3.12 times as high for moderately severe HL, and 4.30 times as high for severe HL. DISCUSSION The association between HL and depression, both common conditions of older life, was not previously well established. This study shows a strong association between audiometric HL and clinically significant depressive symptoms using a large Hispanic study population. When accounting for hearing aid use, age, sex, educational level, study site, geographic background, cardiovascular disease, and antidepressant use, the odds of having clinically significant depressive symptoms increased nearly 1.5 times for every additional 20 dB of HL. This is clinically significant, as 20 dB is approximately the difference between each category of HL; for example, moderate (41-55 dB) vs. mild (26-40 dB) HL. An individual with mild HL had almost twice the odds of having clinically significant depressive symptoms compared with someone with normal hearing (0 dB HL). An individual with moderate HL had nearly 2.5 times the odds and an individual with severe HL had over four times the odds of having clinically significant depressive symptoms. It is intuitive to hypothesize that HL may increase the risk for depression via the development of social isolation and loneliness, which themselves are associated with a higher risk of depression. HL treatments have been shown to improve loneliness,7 as well as social function and depressive symptoms.8 However, a key limitation of the study is that it does not prove that HL causes depression. This study was a cross-sectional, observational study that shows an association between HL and depression. As we know, association is not the same as causation; only a randomized controlled trial could show causation. This study adds to the growing literature examining HL and depression. It provides a more robust statistical analysis, includes data from multiple sites across the country, and is the largest to date examining HL and depression. The study also extends earlier findings9 to a different ethnic group. Given that the Hispanic population is the fastest growing ethnicity in the United States and depression may be more prevalent in this population compared to other ethnic/racial groups,3 identifying modifiable risk factors for depression in Hispanic/Latino individuals is crucial. This is especially important because Latino individuals are less likely to start medical (antidepressant) therapy and more likely to discontinue such therapy within the first 30 days of treatment.10 Depression in later life is a heterogeneous disorder with many risk factors, and results from this study suggest that HL may be one important pathway to becoming depressed. The high prevalence (80% in individuals older than 80 years of age) and infrequent treatment (<20% use hearing aids or cochlear implants) of HL amongst the elderly implies that recognizing and treating HL may have the potential to significantly improve health outcomes for older adults. While we don't know whether HL causes depression, nor do we know whether treating HL will prevent depression, it seems very reasonable to recommend treatment for older adults with HL given the low risk of hearing aid use and broad potential benefit. Future longitudinal studies and randomized controlled trials examining whether treating HL reduces the risk of late-life depression can help elucidate the relationship between HL and depression. Establishing a causal link between HL and depression may eventually guide clinical practice guidelines and treatment recommendations regarding HL as a modifiable risk factor for depression. Thoughts on something you read here? Write to us at [email protected]

Objective: To investigate the consistency between the hearing handicap inventory (HHI) and pure-tone audiometry (PTA) scores in assessing hearing status to provide valuable insights for clinical application. Methods: Retrospective analysis of clinical data and the HHI reporting status of 6540 patients admitted between April 2020 and July 2022 for self-reported unilateral hearing loss who met the study inclusion and exclusion criteria. The kappa coefficient was used to evaluate the consistency of HHI and PTA in assessing the hearing status of the participants. Results: The PTA results showed that among the 6540 participants, 3895 exhibited normal hearing, 1434 showed mild hearing loss, 809 presented with moderate hearing loss, and 402 showed severe hearing loss. The mean hearing thresholds from 0.5 to 4 kHz in healthy ears ranged from 3.65 to 18.45 dB HL, with a mean of 10.83 ± 5.29 dB HL; in ears affected by hearing loss, this ranged from 35 to 125 dB HL, with a mean of 69.63 ± 28.45 dB HL. The HHI scores showed that 4820 people had normal hearing, 1245 had mild-to-moderate hearing loss, and 475 had severe hearing loss. The kappa coefficients of normal, mild-to-moderate, and severe hearing loss were 0.312, 0.223, and 0.716, respectively (P = .001). The consistency between the 2 groups was particularly significant in the assessment of severe hearing loss. Using the PTA results as a benchmark, the sensitivity, specificity, positive predictive value, and negative predictive value of the HHI were found to be 73.08%, 87.83%, 95.60%, and 70.98%, respectively. Conclusion: The HHI and PTA results were consistent in the assessment of hearing status, particularly in the assessment of severe hearing loss, and the level of consistency between the 2 methods was high. The combined use of these tools can facilitate a comprehensive assessment of the auditory status of patients with hearing loss.

Despite the development of new antibiotics, acute bacterial meningitis remains a relatively common serious childhood illness with significant mortality and long-term morbidity, including neurological sequelae, such as severe hearing loss. The pathophysiology of neurological injury in meningitis appears to correlate with the severity of inflammation in the cerebrospinal fluid (CSF), which is attenuated by the use of systemic corticosteroids (1,2), and dexamethasone has been shown to decrease the incidence of severe hearing loss in Haemophilus influenzae type b (Hib) meningitis (3,4). However, there have been major shifts in causative organism and antibiotic resistance in the past 10 years, largely due to the introduction of the Hib vaccine in the developed world, and many paediatricians disagree about whether dexamethasone should be used routinely. The best available evidence indicates that while adjuvant dexamethasone therapy has no effect on mortality in children, this intervention significantly reduces the incidence of severe hearing loss in both Hib meningitis and non-Hib meningitis (5) (grade of recommendation: A, based on a systematic review of randomized controlled trials [RCTs] [6]). However, it is no longer possible to answer questions concerning the efficacy of dexamethasone in reducing neurological damage or the risk of side effects of such therapy because of widespread use of Hib and pneumococcal vaccines in First World countries, which have markedly reduced the incidence of meningitis. Answers that may come from Third World countries, where the incidence of meningitis is still high, will be difficult to apply to First World populations because of the fact that such a large proportion of children and adults come to hospital late in the course of their illness in Third World countries. To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis, a thorough search of three major databases – PubMed, EMBASE and the Cochrane Library – was performed. The search terms were ‘meningitis and dexamethasone or corticosteroid’, and the search was limited to paediatric populations and to RCTs or meta-analyses of RCTs. The most recent meta-analysis of RCTs was published in the Cochrane Library in 2003 by van de Beek et al (5); currently, one RCT involving children, published by Molyneux et al (7) in The Lancet in 2002, has not been considered in the Cochrane review. The quality of the studies used in the Cochrane review was high, with an average Jadad score of 4 out of 5 (points are awarded on a scale up to 5 for randomization, blinding, and reporting of withdrawals or losses to follow-up [8]). One problem encountered by the reviewers was that studies to date have been heterogeneous in the type of corticosteroid used, the dose amount and timing, and the outcomes measured. While it was generally agreed that to be most effective, steroids should be initiated before or with the first dose of antibiotic, the review did not break down the results in terms of when the dexamethasone was administered. Of 18 studies included by van de Beek et al (5), 15 tested dexamethasone; in most of those studies, the dose ranged from 0.4 mg/kg to 0.6 mg/kg divided into four doses daily for a duration of four days. In the remaining three studies, hydro-cortisone, prednisolone or a combination was given. Ten studies were used to calculate mortality in children, and only one of the studies (9) used a nondexamethasone regimen. That study showed a trend toward increased mortality with steroid use, and thus its removal from the meta-analysis favoured dexamethasone treatment. Of 12 studies used to calculate severe hearing loss and 10 studies used to calculate severe hearing loss in non-H influenzae species, all used dexamethasone as the intervention (5). van de Beek et al (5) found that adjuvant therapy with dexamethasone has no effect on the mortality rate of acute bacterial meningitis in children (relative risk of mortality with intervention [RR] 0.95, 95% CI 0.65 to 1.37). The reduction in severe hearing loss from 9.8% to 2.9% was significant (RR 0.31, 95% CI 0.18 to 0.54). However, there have been major shifts in causative organism and antibiotic resistance since 1988, when Lebel et al (10) showed a clear advantage of dexamethasone treatment. The most important change was the decrease in Hib meningitis after the introduction of the Hib vaccine in the early 1990s (11). Even so, the number of children with severe hearing loss in meningitis caused by pathogens other than Hib was significantly smaller in the dexamethasone group than in the placebo group (six of 191 [3.1%] versus 19 of 203 [8.3%], RR 0.42, 95% CI 0.20 to 0.89) (5). This means that the adjuvant dexamethasone treatment of 20 children would prevent one case of severe hearing loss. One issue that has complicated the debate is the suggestion that the use of anti-inflammatory steroids may decrease the CSF concentration of antibiotics. While this is not an issue for ceftriaxone, a third-generation cephalosporin with dependable penetration of the blood-brain barrier, it is a potential problem when dexamethasone is used with vancomycin. Vancomycin, the antibiotic of choice in penicillin-resistant pneumococcal meningitis, may rely on the inflammation in the subarachnoid space to increase penetration across the blood-brain barrier – inflammation that may be attenuated by the use of corticosteroids. A 1999 animal study (12) examining this topic suggested that there is a decreased rate of bacterial clearance from the CSF when adjunctive dexamethasone is used, but this was circumvented when the rabbits were given a higher dose (40 mg/kg instead of 20 mg/kg) of vancomycin. The issue was further laid to rest by a study (13) in children with acute meningitis, which demonstrated that dexamethasone does not attenuate either the penetration of vancomycin (15 mg/kg four times daily) into the CSF or the synergistic action of vancomycin with ceftriaxone. Dexamethasone also appears to be a safe adjunct to antimicrobial therapy. The Cochrane review defined adverse events as either clinically evident gastrointestinal (GI) tract bleeding or ‘other’, where the ‘other’ category included reactive arthritis, pericarditis, herpes zoster or herpes simplex virus infection, fungal infection, secondary fever or persistent fever. The 2003 Cochrane meta-analysis (5) found no significant increase in all adverse events in all participants as a group (RR 1.06, 95% CI 0.88 to 1.27). The review did not separate adults and children, but did suggest that the majority of study participants were paediatric: “in adults…there were few data” (5). Another problem with the review was that no absolute numbers were supplied in the GI bleed category. The study only states that the relative risk of GI tract bleeding was higher in the steroid group (RR 1.16) but did not reach statistical significance (5). No confidence intervals were supplied, and without absolute numbers to confirm the results, we do not know the full range of the potential risk. Steroids appear to be of no benefit for patients with late-stage meningitis. In patients with septic shock, corti-costeroids may also be detrimental and should not be administered (14). According to a well-done RCT (Jadad score of 5) conducted in Malawi (7), dexamethasone is not a useful adjunct to therapy. That study was done in a developing country where underlying disease is common and patients often present in a late stage of infection and often with initial mistreatment. Molyneux et al (7) found no difference in mortality with the use of dexamethasone (RR 1.00, 95% CI 0.80 to 1.25) and no effect on the proportion of participants with normal hearing (86 of 305 [28%] versus 92 of 293 [31%]) (7). The trial included mainly children who were presenting late, had HIV or AIDS, or were receiving inappropriate antibiotic therapy. Consequently, van de Beek et al (5) did not include that trial in their Cochrane review because they believed its results were not representative of the typical meningitis population in industrialized countries. In summary, dexamethasone (0.4 mg/kg to 0.6 mg/kg given every 6 h for four days) as an adjunct to antimicrobial therapy in acute bacterial meningitis, when initiated with or before antibiotic therapy, benefits children with meningitis caused by Hib or other bacterial pathogens. Dexamethasone significantly decreases the incidence of severe sensorineural hearing loss, with no significant increase in the risk of GI bleeding or other adverse effects, but should not be given to patients with late-stage meningitis or septic shock.

On the basis of strong research, universal newborn screening should be performed before age 1 month with repeat or follow-up testing for those who do not pass performed before age 3 months and intervention started before age 6 months. On the basis of strong research and consensus statement, tympanostomy tubes should be considered for individuals with bilateral persistent middle ear effusion for 3 months or greater and a documented conductive hearing loss. On the basis of consensus statement, all children with suspected hearing loss should have an age appropriate hearing test. On the basis of strong research, the most common form of congenital hearing loss is genetic. Most of this is nonsyndromic hearing loss.

Heteroplasmic mitochondrial DNA (mtDNA) defects are an important cause of neurological disease. Although hearing impairment is common in patients with mtDNA defects, the spectrum and pathophysiology of the hearing loss is not well characterized. We therefore studied the relationship between cochlear and brainstem auditory function in 23 patients harbouring a range of different mtDNA mutations. Based upon the pure tone audiogram, patients fell into three distinct groups: (i) normal hearing, (ii) mild to moderate predominantly high frequency hearing loss, and (iii) severe or profound hearing loss at all frequencies. Within this study group only certain genetic defects were associated with hearing loss, and for individuals harbouring the A3243G point mutation, the severity of the hearing loss correlated with the percentage level of mutated mtDNA (mutation load) in skeletal muscle. The 10 patients who had a moderate hearing loss or less had normal brainstem auditory evoked responses and MRI, but it was not possible to interpret the brainstem auditory evoked responses in 13 patients with severe hearing loss. Otoacoustic emissions were absent in patients with a moderate or more severe hearing loss. These findings are consistent with a predominantly cochlear origin for the hearing deficit, which is determined by the precise genetic defect and the percentage mutation load.

Hearing loss is common among Veterans, and extensive hearing care resources are prioritized within the Veterans Administration (VA). Severe hearing loss poses unique communication challenges with speech understanding that may not be overcome with amplification. We analyzed data from the VA Audiometric Repository between 2005 and 2017 and the relationship between hearing loss severity with speech recognition scores. We hypothesized that a significant subset of Veterans with severe or worse hearing loss would have poor unaided speech perception outcomes even with adequate audibility. Sociodemographic characteristics and comorbidities were compiled using electronic medical records as was self-report measures of hearing disability. We identified a cohort of 137,500 unique Veterans with 232,789 audiograms demonstrating bilateral severe or worse hearing loss (four-frequency PTA > 70 dB HL). The median (IQR; range) age of Veterans at their first audiogram with severe or worse hearing loss was 81 years (74 to 87; 21-90+), and a majority were male (136,087 [99%]) and non-Hispanic white (107,798 [78.4%]). Among those with bilateral severe or worse hearing loss, 41,901 (30.5%) also had poor speech recognition scores (<50% words), with greater hearing loss severity correlating with worse speech perception. We observed variability in speech perception abilities in those with moderate-severe and greater levels of hearing loss who may derive limited benefit from amplification. Veterans with communication challenges may warrant alternative approaches and treatment strategies such as cochlear implants to support communication needs.