Click Test Research Articles

Instrumental and clinical diagnosis of interdigital Morton neuroma

Background: Interdigital neuroma is one of the most common diseases in foot surgery. It is a common cause of metatarsalgia leading to debilitating pain. At the same time, the diagnosis of neuroma can be a difficult task for an orthopedic surgeon due to the complex anatomy of the forefoot and a large number of soft-tissue and bone structures. Besides, the existing manual testing methods are not pathognomonic specifically for neuroma. The clinical symptoms and history, as well as a physical exam and instrumental evidence are important in assessing and grading the disease. However, there are no recommendations in the modern Russian literature regarding the need for routine visualization of neuroma. The reproducibility of the study, the absence of ionizing radiation and the possibility of obtaining a second opinion, as well as high sensitivity makes magnetic resonance imaging an important diagnostic tool in the diagnosis of neuroma. Aim: To evaluate the importance of the anamnesis and complaints and the sensitivity of clinical tests and magnetic resonance imaging of the foot in the diagnosis of interdigital neuromas. Methods: The study presents a retrospective analysis of the medical histories and outpatient records of 28 patients (8 men and 20 women) treated at the EMC ECSTO in the period from 2017 to 2022. The examination was performed according to a standardized protocol: collection of complaints and anamnesis, palpation, manual testing, including Mulder's click test. As a part of examination, magnetic resonance imaging of the foot was performed for all the patients. The average patient’s age at the time of the surgical treatment was 45 years. The resection of a part of the affected nerve with the subsequent histological examination was considered a gold standard for the treatment and verification of interdigital neuromas. In all the cases, the histopathological study confirmed the diagnosis. Results: The sensitivity of magnetic resonance imaging in the diagnosis of interdigital neuromas was 86%, the sensitivity of the Mulder test was 61%. Pain during the palpation of the affected interdigital space was determined in 100% of cases. Conclusion: The combination of a manual examination and magnetic resonance imaging, along with the analysis of complaints and anamnesis makes it possible to diagnose Morton's neuroma in most cases.

An Empirical Study on the Influence of Smart Home Interface Design on the Interaction Performance of the Elderly.

The concept of the smart home has been widely recognized and accepted, but the differentiated characteristics of elderly smart products in terms of demand and use are becoming more and more prominent. The lack of an efficient navigation design of the smart product interface increases the cognitive burden of elderly users, and how to better meet the needs of the elderly with smart products gradually becomes the focus of attention. This study was conducted for the elderly group, using the scenario-based design method to analyze the needs of elderly users, combining the research results of scenario theory with the smart home interaction design research method, focusing on how to make the style of interface navigation, sliding layout and button size more suitable for the cognitive behavior of elderly users. The purpose of this research is to realize an age-friendly smart home interaction design in terms of functional design and interface design. The experiment is divided into two stages: in stage 1, two different layouts and operation methods are commonly used for the age-friendly smart home interface: up and down sliding and left and right sliding; in stage 2, the functional buttons are square, where 4 styles are selected, and the side lengths are set to 10 mm, 12 mm, 15 mm, 18 mm and 22 mm. The sliding and retrieval test and retrieval and click test results show that for different sliding layout methods, the interactive performance and subjective evaluation of the interface with the up-and-down sliding layout are better. Among all functional button styles, the interaction performance and subjective evaluation of the simple button style with lines are the best. Among the function keys with a size of 10–22 mm, the interaction performance is better from 12 mm to 18 mm. The conclusion of the better interface data information obtained from this experiment improves the rationality of the age-friendly smart home interface and makes the smart home interface better for the age-friendly scenario.

OCENA AUDIOLOGICZNA URAZOWEGO USZKODZENIA MÓZGU – STUDIUM PRZYPADKU

BackgroundTraumatic brain injury (TBI) is a pathology frequently causing mortality or serious sequelae. About 20% of individuals with TBI will have some degree of auditory alteration. The aim of the present study was to use behavioural and electrophysiological assessments to analyse the hearing of a patient with TBI.Case reportA young male adult who had suffered severe TBI caused by a motorcycle accident was evaluated. The patient underwent a peripheral hearing evaluation and electrophysiological assessment. Pure tone audiometry revealed profound sensorineural hearing loss in the left ear and normal hearing in the right. In the electrophysiological assessment, an ABR click test showed the presence of a response in the right ear at 80 dB HL but no response in the left ear at 90 dB HL. Evaluation of the Middle Latency Response revealed the presence of both an electrode effect (C3) and an ear effect (A1). The P300 wave showed an event-related potential within normal limits in the right ear and no responses in the left.ConclusionsThe present case study verifies the importance of assessing the peripheral and central auditory nervous system in cases of patients with a history of TBI. It reinforces the need for diagnosis and audiological monitoring of these patients.

Collecting and Applying Usability Data from Distance Learners

ABSTRACTGrowth of their college's off-campus and online course offerings led librarians at SUNY Oswego to run usability tests with off-campus students to compensate for a lack of responses from this population during earlier usability testing. Constraints on testing with off-campus students included lack of funding and librarian time, as well as difficulty in attracting student participation. A brief usability study that could be completed by students in the first 10 minutes of class was devised, consisting of a first click test, a survey question, and a top task analysis activity. The study was conducted with 22 students from a satellite-campus Master's in Education program. Discussion includes selecting appropriate tests, analysis of study results, and application of data for improving Website design and information literacy instruction in an academic library.

Postural Stability of Students of Pavol Jozef Šafárik University

The objective of this study was to determine the point values of movement patterns using the FMS™ method and to compare them amongst various groups of students of Pavol Jozef Safarik University in Kosice (UPJS). The group consisted of students of P.J. Safarik University (n = 30, 21 women and 9 men). The average body height was 170,1 cm, average age was 20,9 years of age, average body weight without distinguishing gender was 65,8 kg and average BMI was 22,6. FMS™ testing was made up of 10 standard tests of which 7 tests had scores from 0 to 3 points. The presence of pain in predetermined movements was evaluated in three additional tests. The average overall score in the FMS™ test, evaluating the entire group regardless of gender, was 16.1 points. When comparing the results achieved in the tests amongst groups of subjects we demon-strated a statistically significant higher level in groups of men (FMSm = 2,78) than in groups of women (FMSf = 1,24; p ≤ 0,01). When comparing the results between students of the “Sports and Health” area of study (FMSs = 2,33) and other students of UPJS (FMSu = 1,43), we demonstrated a statistically higher level in students of the sport field. Statistically significant differences between the studied groups were shown by analytical evaluation of scores achieved in each FMS system test. We have shown a higher statistically significant level in the average test score of the torso stability click test in the group of men (FMSm = 2,78) than in the group of women (FMSf = 1,24; p ≤ 0,01; graph 1). We have also shown a statistically significant higher score in the torso stability click test in the student group SAR (FMSs = 2,33) than in the group of students of other UPJS faculties (FMSu = 1,43; p ≤ 0,01 graph 1). We can conclude that our results are comparable with similar studies published abroad. Higher points of joint mobility and movement patterns of the lower extremities have been reported in females sample. For men, we observed a higher points value in the evaluation of trunk stability. Which we attributed to the development of muscles of the upper body of men as an expression of muskulinity contrary unhappiness with appearens in women (gynoid type) motivates to work on lower body. We contemplate that the above-mentioned reality influenced the point values of our sample. We are aware of the need for further research in this area with the aim of better understanding the factors underlying a given reality.

Różnicowanie niedosłuchów ciężkich od głębokich u niemowląt i małych dzieci przy użyciu ASSR „CE-Chirp”

IntroductionOne of the most difficult tasks in pediatric audiology is to assess the precisely hearing level of the child in the first months of life. It is rather impossible to acquire frequency specific responses precisely in hard of hearing infants using tone bursts or clicks. But the distinction between severe and profound hearing loss is clearly meaningful and significant with regard to aural rehabilitation and selection of powerful hearing aids versus cochlear implants.In recent years, the “CE-Chirp” stimuli have been introduced in the “Interacoustics” ASSR system to maintain a larger quantity of hair cells in the response, thus making the response more robust and easier to detect. Input compensation of “CE-Chirp” allows low frequency acoustics segments to initiate before high frequencies, causing sequential frequencies to reach their destinations along the basilar membrane at the same time.Clinical testing involving subjects with normal hearing demonstrates that the Chirp ABR is 1.5–2.0 times larger than the corresponding click ABR. But there is a lack of research that shows convincing advantages of chirps in testing hard of hearing infants. AimThe aim of the study has been to assess hearing levels with ASSR “CE-Chirp” in children who have no, or residual response in the first year of life. Materials and methodsEleven children were included in the study. These patients had no, or residual response between the ages of 3 and 6 months, in click and tone bursts ABR. Eight infants were referred for cochlear implantation.In the ages between 12 and 18 months we tested these hearings using Interacoustics ASSR “CE-Chirp”. ResultsSix patients of the tested group were recognized as severely hard of hearing (mean 60–80dB nHl), three as profoundly hard of hearing (≥90dB nHl). In two children we did not find any response. ConclusionsThe ABR tone bursts and click tests can overestimate hearing loss in the first six months of life.We can evaluate the quantity of hearing more exactly in infants and toddlers, with ASSR “CE-Chirp”.

Efficiency of Stenger test in confirming profound, unilateral pseudohypacusis

Conscious and deceptive exaggeration of hearing loss is termed pseudohypacusis. Even though the Stenger test has been used in the management of pseudohypacusis for almost a century, its sensitivity, specificity and predictive values for unilateral pseudohypacusis have not previously been reported, to our best knowledge. We investigated the efficiency of the Stenger test in detecting unilateral pseudohypacusis, accepting auditory brainstem response testing as the 'gold standard'. Candidates with questionable profound or total hearing loss were enrolled in the study. Pure tone audiometry, speech and tonal Stenger tests, and click test auditory brainstem response measurement were performed. Accepting auditory brainstem response testing as the gold standard, the sensitivity, specificity and predictive values of the Stenger test for unilateral, profound pseudohypacusis were assessed. Two hundred military candidates were enrolled in the study. The sensitivity and specificity of the Stenger test in verifying unilateral, profound hearing loss were 99.4 and 70 per cent, respectively. The positive and negative predictive values of the test were 87.5 and 98.4 per cent, respectively. The Stenger test is widely used for the evaluation of unilateral or asymmetrical pseudohypacusis. In our opinion, it is a powerfully reliable test. More difficult cases require objective electrophysiological testing to verify functional hearing loss and to exclude specific diagnoses that may imitate pseudohypacusis.

Composite cerebellar functional severity score: validation of a quantitative score of cerebellar impairment

Reliable and easy to perform functional scales are a prerequisite for future therapeutic trials in cerebellar ataxias. In order to assess the specificity of quantitative functional tests of cerebellar dysfunction, we investigated 123 controls, 141 patients with an autosomal dominant cerebellar ataxia (ADCA) and 53 patients with autosomal dominant spastic paraplegia (ADSP). We evaluated four different functional tests (nine-hole pegboard, click, tapping and writing tests), in correlation with the scale for the assessment and rating of cerebellar ataxia (SARA), the scale of functional disability on daily activities (part IV of the Huntington disease rating scale), depression (the Public Health Questionnaire PHQ-9) and the EQ-5D visual analogue scale for self-evaluation of health status. There was a significant correlation between each functional test and a lower limb score. The performance of controls on the functional tests was significantly correlated with age. Subsequent analyses were therefore adjusted for this factor. The performances of ADCA patients on the different tests were significantly worse than that of controls and ADSP patients; there was no difference between ADSP patients and controls. Linear regression analysis showed that only two independent tests, the nine-hole pegboard and the click test on the dominant side (P < 0.0001), accounted for the severity of the cerebellar syndrome as reflected by the SARA scores, and could be represented by a composite cerebellar functional severity (CCFS) score calculated as follows: [Formula: see text]. The CCFS score was significantly higher in ADCA patients compared to controls (1.12 +/- 0.18 versus 0.85 +/- 0.05, P(c) < 0.0001) and ADSP patients (1.12 +/- 0.18 versus 0.90 +/- 0.08, P(c) < 0.0001) and was correlated with disease duration (P < 0.0001) but independent of self-evaluated depressive mood in ADCA. Among genetically homogeneous subgroups of ADCA patients (Spinocerebellar ataxia 1, 2, 3), SCA3 patients had significantly lower (better) CCFS scores than SCA2 (P(c) < 0.04) and the same tendency was observed in SCA1. Their CCFS scores remained significantly worse than those of ADSP patients with identified SPG4 mutations (P < 0.0001). The pegboard and click tests are easy to perform and accurately reflect the severity of the disease. The CCFS is a simple and validated method for assessing cerebellar ataxia over a wide range of severity, and will be particularly useful for discriminating paucisymptomatic carriers from affected patients and for evaluating disease progression in future therapeutic trials.

Assessment of Nerve Regeneration Across Nerve Allografts Treated with Tacrolimus

Although regeneration of nerve allotransplant is a major concern in the clinic, there have been few papers quantitatively assessing functional recovery of animals' nerve allografts in the long term. In this study, functional recovery, histopathological study, and immunohistochemistry changes of rat nerve allograft with FK506 were investigated up to 12 weeks without slaughtering. C57 and SD rats were used for transplantation. The donor's nerve was sliced and transplanted into the recipient. The sciatic nerve was epineurally sutured with 10-0 nylon. In total, 30 models of transplantation were performed and divided into 3 groups that were either treated with FK506 or not. Functional recovery of the grafted nerve was serially assessed by the pin click test, walking track analysis and electrophysiological evaluations. A histopathological study and immunohistochemistry study were done in the all of the models. Nerve allografts treated with FK506 have no immune rejection through 12 weeks. Sensibility had similarly improved in both isografts and allografts. There has been no difference in each graft. Walk track analysis demonstrates significant recovery of motor function of the nerve graft. No histological results of difference were found up to 12 weeks in each graft. In the rodent nerve graft model, FK506 prevented nerve allograft rejection across a major histocompatibility barrier. Sensory recovery seems to be superior to motor function. Nerve isograft and allograft treated with FK506 have no significant difference in function recovery, histopathological result, and immunohistochemistry changes.

The role of hippocampal theta activity in sensory gating in the rat

Sensory gating is defined as a decreased reaction on the second click, measured as evoked potentials (EP) within a double click paradigm. Recently, it was established that gating in rats was decreased during REM sleep compared to wakefulness and non-REM sleep. REM sleep in the rat is characterized by hippocampal theta rhythm. Therefore, it was investigated whether sensory gating would also be diminished during other states with hippocampal theta. Twelve Wistar rats were implanted with hippocampal electrodes and exposed to double clicks during passive wakefulness, REM sleep, and activity (voluntary movements and walking on a moving belt). Gating was examined by use of the amplitudes of the EPs in reaction to the first conditioned amplitude (CAMP) and second click test amplitude (TAMP), as well as two gating parameters ( C− T score and T/ C ratio). Except passive wakefulness all behavioral conditions were accompanied by hippocampal theta. Normal gating was always found, except during REM sleep. The CAMP was than lower than during passive wakefulness. Gating was less disturbed during behavioral activity. Negative correlations were found between the percentage theta power on the one side and the CAMP, respectively, the C− T score, on the other. The correlation between the percentage theta power and the T/ C ratio was also significant. It is concluded that the presence of hippocampal theta is not a sufficient condition to cause disturbances in auditory sensory gating. Behavioral states that accompany theta activity, however, tend to affect the CAMP. The decrease in gating found during REM sleep cannot be easily related to well-known neurochemical and pharmacological data.

Abnormal surfactant composition and activity in severe bronchiolitis

A prospective study of infants under 1 y of age, ventilated for severe viral bronchiolitis, was carried out in four paediatric intensive care units in order to study surfactant activity and composition in this condition. Lung lavage fluid from 24 infants with bronchiolitis, 19 with bronchiolitis and sepsis or cardiac failure and 12 controls were analysed by the “click test” for surfactant activity and for phospholipids. Surfactant activity was present in all controls, but in only 2 of the 24 infants with bronchiolitis alone. The presence of phosphatidylglycerol correlated perfectly with the click test, suggesting that reduced activity is due to changes in surfactant lipid composition. In those with bronchiolitis plus coexisting disease, surfactant activity and phosphatidylglycerol were absent in only half. Surfactant activity and phosphatidylglycerol re‐appeared by extubation. Severe viral bronchiolitis is associated with an absence of surfactant activity and PG, which resolves by clinical recovery. Infants with coexisting conditions are not always surfactant deficient. Surfactant administration is likely to be beneficial, but requires a selective approach. □Bronchiolitis, lung surfactant, phosphatidylglycerol

Echo avoidance in a computational model of the precedence effect

The precedence effect, though a topic of continuous theoretical interest in hearing research, so far cannot be predicted explicitly by a model. Zurek (1987) reviewed the precedence effect and gave a general structure for the model of the precedence effect. However, it is still not clear how the inhibition of localization is generated. This paper proposes a computational echo-avoidance model by assuming that the precedence effect is caused by the inhibition of sound localization which depends on the estimated sound-to-echo ratio. We assume there is a neural echo-estimation mechanism in the human auditory system. It is found that a temporal pattern of aftereffect with delay and decay features, which is adopted from the previous psychological tests on the increase of the perceptual threshold of interaural time difference following a preceding impulsive sound, can be used for echo estimation. The time variance of the precedence effect is briefly discussed. The results of psychological experiments, e.g. equal-level and unequal-level paired click tests, Haas's tests and Franssen's tests, are interpreted consistently. This model can also give criteria for an available onset and an explanation of why the precedence effect occurs in transient onsets.

Abnormal surfactant composition and activity in severe bronchiolitis.

A prospective study of infants under 1 y of age, ventilated for severe viral bronchiolitis, was carried out in four paediatric intensive care units in order to study surfactant activity and composition in this condition. Lung lavage fluid from 24 infants with bronchiolitis, 19 with bronchiolitis and sepsis or cardiac failure and 12 controls were analysed by the "click test" for surfactant activity and for phospholipids. Surfactant activity was present in all controls, but in only 2 of the 24 infants with bronchiolitis alone. The presence of phosphatidylglycerol correlated perfectly with the click test, suggesting that reduced activity is due to changes in surfactant lipid composition. In those with bronchiolitis plus coexisting disease, surfactant activity and phosphatidylglycerol were absent in only half. Surfactant activity and phosphatidylglycerol re-appeared by extubation. Severe viral bronchiolitis is associated with an absence of surfactant activity and PG, which resolves by clinical recovery. Infants with coexisting conditions are not always surfactant deficient. Surfactant administration is likely to be beneficial, but requires a selective approach.

Interobserver reliability of the click test: a rapid bedside test to determine surfactant function.

To determine the interobserver reliability of the click test, a rapid bedside test of surfactant function. One hundred samples (48 amniotic fluid, 28 gastric aspirates, 24 tracheal aspirates) were obtained from pregnant women, term and preterm infants managed at two perinatal centres. Gestational ages of the pregnancies or infants at time of sampling ranged from 24 to 40 weeks (mean +/- s.d.: 31+/-5). The click test was performed independently by two observers, with differing levels of experience, and blinded to each other's results. Interobserver reliability was determined for samples classified as negative (no clicking bubbles), equivocal (a few clicking bubbles seen after 2 min of looking), and positive (clicking bubbles seen easily on first look). As negative and equivocal test results suggest surfactant dysfunction, these results were also combined to provide a dichotomised result. For samples classified as negative, equivocal and positive the interobserver agreement was 0.83, with agreement beyond chance shown by a quadratic weighted Kappa of 0.74 (95% CI = 0.62-0.86). When negative and equivocal results were combined, the simple Kappa was 0.73 (95% CI = 0.59-0.87). The click test has a high level of interobserver reliability. It is rapid, simple, accurate and able to be taught to medical and nursing staff with appropriate training. It has many potential applications including the prediction of fetal lung maturity in women with premature rupture of membranes, and in term and preterm infants who require the bedside testing of surfactant function.

Prediction of surfactant dysfunction in term infants by the click test.

Pulmonary surfactant dysfunction (inactivation, deficiency) has been implicated in term neonates with respiratory failure. This study has evaluated the click test, a biophysical test for surfactant function, which will be useful in rapidly and reliably identifying term neonates with surfactant dysfunction. Samples of tracheal and or gastric aspirates (0.2 ml) from 55 neonates, varying from 36 to 42 weeks of gestational age, with respiratory distress and fractional inspired oxygen concentration requirements of > 0.5 were shaken with 95% ethanol. Once bubbles formed the samples were examined in air-free water under a microscope. In a positive click test, the bubbles rhythmically increase and then decrease in size, denoting the presence of active surfactant. When few bubbles were observed, the specimen was labelled as equivocal, and if none were seen, it was called negative. Surfactant dysfunction (negative or equivocal test) was consistently seen in respiratory distress syndrome (RDS), transient tachypnea of the newborn, and severe meconium aspiration syndrome (MAS). Preliminary data suggest that the click test will provide a rapid and early diagnosis of surfactant dysfunction in term neonates. This should facilitate early treatment with exogenous surfactant in RDS, by early diagnosis of surfactant deficiency, and provide justification for immediate and ongoing surfactant treatment in newborns with MAS. The click test can provide a diagnostic tool for surfactant dysfunction and deficiency in randomized controlled trials of therapy in those disease states in which exogenous surfactant therapy may be useful.

A computational model of the precedence effect based on echo avoidance

A computational model of the precedence effect is proposed by assuming that the precedence effect is caused by the inhibition of sound localization which depends on the estimated sound-to-echo ratio. It is found that a generalized pattern of impulse response with delay and decay features can be used for echo estimation. As a real neural implementation, the pattern of an after-effect in the human auditory system, based on the previous psychoacoustic just-noticeable-difference tests of interaural delay and intensity, is adopted. This pattern has delay and decay features similar to those in the generalized pattern of impulse response, and the difference in decay scales is shown to cause little difference in echo estimation. The results of psychoacoustic experiments, e.g., equal-level and unequal-level paired click tests [P. M. Zurek, J. Acoust. Soc. Am. 67, 952–964 (1980); K. Saberi and D. R. Perrott,ibid . 87, 1732–1737 (1990)], Haas’s tests [H. Haas, J. Audio Eng. Soc. 20, 146–159 (1972)], Franssen’s tests [J. Blauert, Spatial Hearing (MIT, Cambridge, MA, 1983)], and others, can be interpreted consistently. This model can also give criteria for an available onset and an explanation of why a transient onset is required for the precedence effect.

"Click test": rapid diagnosis of the respiratory distress syndrome.

Appropriate and early treatment with exogenous surfactant has clinical and economic benefits for neonates with pulmonary surfactant deficiency. In order to rapidly and reliably identify such neonates, we have evaluated the shake and click tests, biophysical tests of surfactant function, using 0.2 mL samples of tracheal (TA) and gastric aspirates (GA). Samples from 181 neonates with a gestational age range of 24-40 weeks were shaken with 95% ethanol. If bubbles formed (positive shake test) they were examined in air-free water under a microscope. In a positive shake or click test, the bubbles rhythmically increase and then decrease in size, denoting the presence of active surfactant. The probability of the tests to predict clinical surfactant deficiency was analyzed. The latter was defined as respiratory distress syndrome or transient tachypnea of the newborn diagnosed by chest radiography and clinical criteria. The click test on TA from preterm infants was most accurate, with a 100% positive predictive value and specificity, and a 93% and 94% negative predictive value and sensitivity respectively. These values for GA were 73%, 84%, 97%, and 95%, respectively. The test is quick, simple, inexpensive, reproducible, and unaffected by contamination with blood. The accuracy of this test on TA in diagnosing surfactant deficiency in neonates would permit early and optimal treatment with exogenous surfactant. When performed on GA, the test could aid decisions regarding transfer of neonates to tertiary level care.

Neurophysiological studies of sensory gating in rats: Effects of amphetamine, phencyclidine, and haloperidol

Central mechanisms of sensory gating were assessed in Sprague-Dawley rats by an evoked potential technique similar to one that we have previously used to show diminished sensory gating in psychotic patients. Middle latency (15–50 msec) auditory evoked potential responses were recorded at the skull in unanesthetized freely moving animals. Gating mechanisms were assessed in a conditioning-testing paradigm by measuring the supression of response to a 74 dB click test stimulus following an earlier identical conditioning stimulus at 0.5-sec intervals. The rats demonstrated significant suppression of the N50 response to the second auditory stimulus. Amphetamine treatment significantly interfered with the suppression of the response to the second stimulus; haloperidol, injected after the amphetamine, returned the conditioning-testing ratio toward normal values. Phencyclidine caused a similar decrease in suppression and was similarly antagonized by haloperidol. During some periods of hyperarousal, animals showed spontaneous loss of suppression; this condition could be reversed by haloperidol treatment. These results with psychotomimetic drugs in an animal model parallel abnormalities in sensory gating previously observed in psychotic human subjects.

A Study of Children’S Hearing as it Relates to Reading

In recent years the question of reading and reading difficulties has occupied an important place in educational and psychological litera ture. Probably no question has been raised with greater frequency than that concerning the causes of reading deficiencies found with apparently unhandicapped school chil dren. A number of possible causes have been suggested and studied more or less thor oughly. Such suggested causes have included practically every phase of human adjustment ?emotional, intellectual, physical, environ mental, and pedagogical. In 1932 Marion Monroe published one of the most significant of the books dealing ob jectively and specifically with the problems of reading difficulties.1 This book has been followed by other books which also deal with the causative factors and remedial procedures in reading disability. Many of the recent gen eral books on reading contain at least one chapter devoted to the problems of diagnosis and remediation of reading difficulties. Certainly no author at the present time claims that any one factor is the sole cause of reading disability but rather the concept of multiple causation is being given greater emphasis. Among the factors which are pro posed as possible contributors to reading dif ficulty hearing deficiency is referred to fre quently. Monroe mentioned it but cited no evidence beyond stating that on a whispered voice and coin click tests 2 per cent of the reading defect cases in her study were rated as defective in hearing.2 Gates,3,4 Betts,5 Monroe and Backus,6 Witty and Kopel,7 and Strang,8,9 also men tion hearing as a possible contributing factor to reading difficulty and all cite as their only supporting evidence a study by Bond.10 Cole,11 and Stanger and Donahue,12 Durrell,13 Kirk,14 and Dolch15 mention hearing but give no direct reference to any study showing a relationship between hearing and reading, although they do make reference to two of the authors mentioned above?namely Betts and Gates. Only two, those by McCallister16 and Dearborn,17 of fifteen of the most recent books on reading or reading difficulties fail to mention hearing deficiency as a possible related factor. Since it is well known that deaf children