Auditory and Vestibular Research
Volume:30 Issue: 2, Spring 2021

COVID-19 is a pandemic infectious disease caused by a novel coronavirus has made dramatic changes in people's individual, family, and social lifestyle. Most countries have implemented some regulations including wearing face masks, face shields, and gloves and physical, and social distance in public places to reduce the spread of the virus. However, these global recommendations may be associated with significant social, communication, and behavioral challenges for hearing-impaired people. This review explains the problems that hearing-impaired people may experience in the COVID-19 outbreak and also some helpful solutions that can be implemented by audiologists, healthcare professionals, and other members of the society that somehow interact with these people in such conditions that communication barriers increase.

Recent findings indicate that wearing face masks, physical, and social distan cing, e-learning and virtual communications during COVID-19 pandemic have provided some problems for people with hearing loss. This can, in turn, have negative consequences including increased feelings of loneliness, isolation and also some limitations in access to educational materials and rehabilitation training of lockdowns of schools and rehabilitation centers or some challenges of online learning at home.

People with hearing loss may experience problems during COVID-19 pandemic. There are some strategies that can be implemented to partially solve some communicative and social problems in this group. The use of transparent face masks, compensatory strategies, as well as optimization of virtual, and telehealth, telerehabilitation and tele-education services can be helpful for hearing-impaired people during this pandemic era.

Comorbid conditions and unhealthy lifestyles are risk factors for auditory dysfunction, including age-related hearing loss. With a focus on adults, this paper describes a new approach to hearing health care that aims to prevent or mitigate hearing loss and related disorders, like tinnitus. Accurate diagnosis and effective management of hearing loss is best achieved with a patient-specific test battery that includes sensitive measures of peripheral and central auditory function.

Within the past decade, peer reviewed research publications confirm the importance of comorbid conditions like diabetes, cardiovascular disease, and cognitive impairment as risk factors for hearing loss, tinnitus, and auditory processing disorders. Unhealthy lifestyles like poor diet, smoking, and chronic exposure to high intensity sound also contribute importantly to risk for hearing loss and tinnitus. In collaboration with physicians and other health care professionals, audiologists who recognize and address these risk factors for hearing loss have an opportunity to prevent or mitigate hearing loss in adult patients.

The traditional model for hearing health care service delivery relies on a rather outdated and simplistic protocol for evaluating and describing hearing loss, and a technology-focused approach for management. This paper offers an evidence-based rationale for expanding the test battery for diagnosing hearing loss, and a multidisciplinary intervention approach.

The acceptable noise level (ANL) assesses the noise that a person can tolerate during a running speech. Although it is a strong test, it has not yet become popular in clinical practice. One of the reasons is its contradictory results. Since it is a psychoacoustic test, psychological factors can affect its output. Investigation of these factors can provide more accurate results. This study aims to investigate the effects of noise and work-related fatigue on the ANL in normal-hearing people.

Participants were the male workers in the administration (n = 26) and production (n = 26) departments of an automotive manufacturing industry in Iran. They were evaluated before and after leaving the workplace in order to determine the effects of noise exposure, fatigue as well as their simultaneous effects on the ANL.

In both groups, the ANL showed a significant increase after work compared to its level before work, and the background noise level (BNL) was significantly decreased. There was no significant difference in the BNL between administration and production groups before work. The most comfortable level (MCL) showed no significant increase. Moreover, the MCL changes were not significantly different in the production group compared to administration group, but the BNL and ANL changes were significantly higher.

Noise exposure and work-related fatigue affect the ANL. During the ANL test, earlier exposure to noise and the amount of fatigue should be controlled.

It is not clear if the measurement of distortion product otoacoustic emissions (DPOAE) at frequencies above 8 kHz adds any value in determining the differences in the cochlear function between patients with and without tinnitus. This study aimed to compare DPOAE in the frequency range of 0.5−10 kHz in patients with normal hearing with and without tinnitus.

This comparative cross-sectional study was conducted on 20 individuals with tinnitus and normal hearing as a study group (SG) and a control group (CG) of 20 normal-hearing individuals without tinnitus. The DPOAE was measured with F1/F2 = 1.22 and intensities of F1 = 65 dB SPL and F2 =55 dB SPL in the frequency range of 0.5−10 kHz, moreover in the frequency of tinnitus in SG and corresponding frequency in CG.

DPOAE level at 10 kHz did not differ significantly between SG and CG (p = 0.491). However, the mean of overall DPOAE level, DPOAE level at the frequency of tinnitus, and F2 values of 2.5, 5, and 6.298 kHz were significantly lower in SG than CG (p < 0.05).

Measurement of DPOAE at 10 kHz did not seem to add any value in determining the differences in the cochlear function between patients with and without tinnitus. However, decreased DPOAE levels at 2.5, 5, and 6.298 kHz which were observed among patients who have tinnitus and normal hearing, indicates some outer hair cells damage that was not detectable by conventional audiometry.

Elderly people usually show poor performance in dichotic listening tasks. In this condition, the left ear being often the weaker one shows a performance below the normal limits. Studies have shown the effectiveness of dichotic listening training in auditory and language processing for adults and children with neurological disorders. This study aimed to deve lop a home-version of dichotic training and investigate its effectiveness in elderly adults.

Participants in this single-subject interventional study (AB design) were four elderly subjects (two males and two females) aged 65−75 years. The main inclusion criteria were dichotic listening deficit demonstrated by the dichotic digit test (DDT), no neurological or cognitive disorders, and normal hearing threshold. Dichotic listening training was performed with an informal home-version of dichotic interaural intensity difference (DIID) training program for seven weeks. DDT was performed seven consecutive weeks before (phase A) and after the intervention (phase B) at the end of each week.

Data were analyzed by single-subject study statistics. Findings demonstrated an imp rovement in DDT scores for the left ear and decrease in right ear advantage scores in all the elderly adults after DIID training program. It seems that this training program could remediate poor performance in dichotic listening tasks in elderly people.

The advantage of this method is that it can be easily done at home and is cost-effective. However, further studies are needed to approve the neuroplasticity and structural chan ges in the brain after the DIID training program in this population.

There are several prescriptive formulas for covering a variety of hearing loss, each of which applies relatively different amplifications at different frequencies. This study aims to compare the gains prescribed for digital behind-the-ear (BTE) hearing aids by the Desired Sensation Level Multi-Stage [Input/Output] (DSLm[I/O]), National Acoustic Laboratories-non linear2 (NAL-NL2) and manufacturer-specific formulas at different levels of input intensity.

The gain values in 12-channel BTE hearing aids prepared from four companies (Oticon, Phonak, ReSound and Siemens) were measured at three levels of input intensity (45, 65, and 85 dB SPL) and at a frequency range of 250−8000 Hz for two moderately severe flat and mild sloping to severe hearing losses by using the DSLm[I/O], NAL-NL2 and manufacturer-specific formulas in the Frye FP35 test box.

There was no significant difference between the four selected hearing aids in terms of prescribed gain values using the prescriptive formulas (p > 0.05).

The DSLm[I/O] formula prescribes higher gain in the 12-channel BTE hearing aids from Oticon, Phonak and Siemens companies at all input intensities and frequencies for moderately severe flat and mild sloping to severe hearing losses compared to the NAL-NL2 formula and manufacturer-specific formulas (Voice Ali gned Compression (VAC), Adaptive Phonak, Connexx Fit and audiogram+).

Expressive language is the most basic and widespread means of communication; children with hearing impairments are one of the largest groups of children with speech and language disorders. Therefore, this study compares the relationship between the development of expressive language and social skills in children with cochlear implants (CIs), hearing aid (HA) users and normal Persian-speaking peers aged five to seven years old.

The present study is a cross-sectional comparative study. 45 children in three groups; normal hearing, CIs and HA users were selected by convenience sampling. The child’s communication and social skills were assessed using Matson and children’s communication checklist (CCC) tests. Through the analysis of a descriptive speech sample of language indicators, the mean length of utterance- morpheme (MLU-m), number of different words (NDW) and the percentage of intelligible utterances (PIU) of the child were obtained and examined. ANOVA test was used to compare the groups and Pearson test was used to examine the correlation between variables.

The mean score of CCC test, PIU and NDW are significantly different in the three groups. MLU and Matson subtests are not significantly different in three groups. Correlation between variables was different in each group.

Communication skills, intelligibility, and lexical diversity are significantly different between normal and hearing- impaired children. MLU and Matson subtests are not significantly different in three groups. The correlation patterns among different subtests of CCC and Matson for children with hearing impairment were different form normal hearing children.

Auditory neuropathy spectrum disorder (ANSD) in the auditory neural pathway can affect the auditory and speech development of children. Since the symptoms and complications of this disorder are similar in different children, hearing management and rehabilitation can help with better development of speech/language and hearing perception in children with ANSD.

The Case:

 In this study, the case was a one-year-old boy with ANSD and mild to moderate high-frequency sensorineural hearing loss. He first underwent various audiological examinations. Then, an aural rehabilitation program containing different auditory information and games was provided to him, his family, and caregiver at their home and in the rehabilitation center.

Although auditory neuropathy/dissynchrony in the auditory neural pathway has negative effect on the auditory and speech development, but the children with ANSD can use different inputs for language comprehension and acquisition if they receive effective education, especially auditory training at an earlier age.