Audiologic assessment of infants and young children with suspected hearing loss requires selection of differential diagnostic techniques that are age-appropriate and appropriate to the child’s developmental capabilities. Objective assessment includes electrophysiologic and electroacoustic methods: otoacoustic emissions, auditory brainstem response, auditory steady-state response, tympanometry and acoustic reflex. The use of behavioural methods in audiologic assessment requires a response from the patient. Depending on the child’s age, the following methods can be performed: visual reinforcement audiometry, conditioned play audiometry, pure tone audiometry, and (...) speech audiometry. Audiologic assessment in infants and children provides estimation of auditory sensitivity, evaluation of the integrity of auditory system andidentification of possible intervention options in case of existing hearing loss. Early detection and treatment of hearing loss in childhood is essential to ensure optimal speech and language development in the early years of life and optimal school performance for older children. (shrink)

Introduction Financial incentive schemes have been commonly used by the hearing aid industry as a way of encouraging device sales. These schemes can lead to a conflict of interest as the hearing device dispenser is torn between personal reward over the best interests of their client. This conflict of interest has the potential for the dispenser to develop “moral distress”, a negative state of mind when an individual’s ethical values contrast with those of the employing organization. The purpose of this (...) study was to investigate if there was a relationship between financial incentives and moral distress in Australian audiologists and audiometrists. Methods An online survey was distributed to all members of Audiology Australia and the Australian College of Audiology via email. Participants rated their perceived moral distress from 0 to 10 on the Moral Distress Thermometer and answered four questions about financial incentives in their respective workplace. Results A total of 65 participants, 42 females and 23 males, completed the online survey. A quarter of participants rated their moral distress corresponding to levels of uncomfortable or above. A statistically significant association was found between financial incentives, sales target setting, and higher perceived moral distress in participants. Conclusions For our sample, the implementation of financial incentives created ethical challenges for practicing audiologists and audiometrists. Modifications to employee rewards programs as well as a regulation of device sales are recommended. (shrink)

ObjectiveCochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.Data sourcesWe address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.Review methodsA systematic review using (...) three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.ConclusionsThe medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.Implications for practiceSimilar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family’s desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education. (shrink)

There are currently no instruments available to measure ethical sensitivity in the therapeutic sciences. This study therefore aimed to develop and implement a measure of ethical sensitivity that would be applicable to four therapeutic professions, namely audiology, occupational therapy, physiotherapy, and speech-language pathology. The study followed a two-phase, sequential exploratory mixed-methods design. Phase One, the qualitative development phase, employed six stages and focused on developing an instrument based on a systematic review: an analysis of professional ethical codes, focus group (...) discussions, in-depth interviews, a review of public complaints websites, and an expert panel review. The development phase culminated in the Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences (MIEST), a pen-and-paper measure for studying ethical sensitivity in the therapeutic sciences.Phase Two, the quantitative stage, focused on implementing the MIEST in two different stages. A total of 100 participants completed the instrument. MIEST scores were found to be comparable for all four professions, which confirmed the multidisciplinary usability of the instrument. Participants tended to base decisions on the ethical principle of beneficence. The MIEST is effective to assess and describe the ethical sensitivity of professionals in the four specified therapeutic sciences. The constructed vignettes also make the MIEST appropriate for use in problem-based learning programs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:“Destined to Fail”: Carl Seashore’s World of Eugenics, Psychology, Education, and Music by Julia Eklund KozaJune Boyce-TillmanJulia Eklund Koza, “Destined to Fail”: Carl Seashore’s World of Eugenics, Psychology, Education, and Music (Ann Arbor, MI: University of Michigan Press, 2021)This is a difficult book to read not only because of its length but also its content. While reading the history of eugenics and how it played out in the (...) invention of the holocaust, I found myself feeling the nausea that I similarly feel when embarking on Margaret Attwood’s Handmaid’s Tale. I also remembered how I had used the Seashore tests of musical ability in my time teaching in London primary schools. I was faced with a common problem in UK State schools–three places for violin tuition and twenty children seeking them. The Seashore tests appeared to be the answer to the problem. The claims made for them were that they would tell me which children were likely to succeed because they had more musical ability than others. It was only in the process of using them that I realized that this was an unjustified claim. Conversations with John Sloboda revealed two other aspects that might play out in musical success. One was a moment/event which made a person fall in love with a particular instrument and want to learn it. The other was the amount of time a person would put in to practice the instrument, which in many London contexts with high-rise flats and no soundproofing [End Page 83] was extremely difficult. All that the Seashore tests showed was the third aspect involved in engagement with music, which was the ability to recognize the musical patterns of a particular culture. But what this book shows us so clearly is the danger of rating this ability to grasp the musical patterns of the Western classical musical traditions as the totality of musical ability. Beneath this is the belief that some people are innately musical but, more significantly, others are not. In my experience, musicality is a difficult area in our UK culture; people are more likely to say that they are not musical in a way that they would not in relation to any other academic discipline such as English, geography or history. In many educational contexts, I have pointed out that, if a teacher believes that some students are musical and some are not, then it is unethical to have class music lessons for everyone in the curriculum. Helpfully, in the final chapter of the book, some of these shades from the past, that still color contemporary thinking about music education, are clearly set out.To turn to the book itself, the first chapter sets out Seashore’s life as a “Mendelian hereditarian who believed that musical talent is biologically inheritable, differently bestowed, and immutable.”1 The author contextualizes the belief system in which this is rooted, discussing the American Eugenics Society, the best baby contests, and the “great man” narratives of the early to mid-twentieth century (first set out in Galton’s idea of genius). Seashore’s legacy figures in a number of academic fields, including audiology, aesthetics, educational reform, the American Psychological Society, and the National Academy of Sciences. She hopes to initiate a debate about how eugenics has, and still does have, a part in stories of both music education and education generally. She situates her work in a view of “‘the past’ as a dynamic construct created and recreated in the present.”2 She sets up a different way of remembering the past by acknowledging that past, present, and future are culturally constructed and bounded, in which she uses Foucault’s concept of power.3 She considers the role of “solid” science in supporting both eugenics and its responsibility for the Holocaust. I would recommend that anyone embarking on historical musicology read this chapter to understand the complex mechanisms which need to underpin such study.My own academic research has been about deconstructing the patriarchal values that filled my own miseducation in music history. The legacy of Galton’s construction of genius dominated my music education and when I took my professorial... (shrink)

IntroductionThe present study aimed to evaluate the effects of the Active Communication Education program on the social/emotional impacts of hearing loss in a group of older adults with a cochlear implant.DesignProspective cohort study design, with a “within-subject” control procedure.Study SampleTwenty adults over-65 post-lingually deafened CI users. All subjects were required to be native Italian speakers, to have normal cognitive level, have no significant psychiatric conditions and/or diagnosed incident dementia, and used CI for at least 9 months.Materials and MethodsTwenty participants were (...) assessed using the Hearing Handicap Inventory for the Elderly, the Geriatric Depression Scale, and the Speech, Spatial, and Qualities of Hearing Scale before, during, and after ACE program, with a one and 6-month follow up. The cognitive and audiological evaluation was carried out before commencing the ACE program.ResultsThe ACE program had a positive impact by reducing HL’s social/emotional effects. Participants benefited from a rehabilitative approach by improving multilevel skills: comprehension of audiological and hearing dimensions, acquisition of communicative, pragmatic and problem-solving strategies, and interaction and sharing of experiences with peers.ConclusionAlthough targeting the older adults with moderate HL, the ACE program also seemed to benefit older adult CI users. An improvement in social and emotional adaptation to hearing difficulties can, in turn, significantly promote optimal use of CI in the older adults, thereby possibly reducing the risk of losing motivation and engagement in device use and in rehabilitation protocols. (shrink)

Permanent congenital and early-onset hearing impairment is the most common sensory disorder among newborns. The WHO recommends newborn and infant hearing screening for all member states to facilitate early identification and intervention for children with PCEOHI. Ethical implications of newborn/infant hearing screening in low-income and middle-income countries should be considered. Although the Pacific Island region is estimated to have among the highest global burden of hearing loss, hearing health services are limited and virtually non-existent in Pacific Island countries. The aim (...) of this brief report is to consider the ethical implications of implementing hospital-based universal newborn hearing screening in Samoa. Based on well-acknowledged screening principles, this report found that the Samoan context does not satisfy the screening principles for such a programme, and that the implementation of UNHS would, therefore, be unethical. This conclusion was reached even after considering the hypothetical provision of necessary screening and diagnostic audiology equipment from external donors. We recommend that current efforts should be directed towards the wider professional community involved in the daily care of children with a permanent hearing loss. Given the high prevalence of paediatric ear disease in the Pacific Islander population, an interim ear and hearing programme could be considered at the community level. These strategies should provide the infrastructure and referral pathways required in the advent of UNHS in Samoa. (shrink)

Despite educational efforts, the majority of Americans are still under the misconception that they are not at risk from HIV/AIDS infection. In addition, the federal government only spends 2% of the total designated federal AIDS funding toward prevention. Thus, information in respect to AIDS and health communication in any comprehensive nature is almost nonexistent.; This book aims to rectify the situation by presenting detailed analysis and actions necessary to confront the AIDS pandemic on every level of the communication realm. Contributors (...) are experienced researchers, educators, government officials, and physicians. They examine the issue from a number of standpoints, including: communication, adolescent medicine, public administration, psychology, journalism, audiology, speech and language pathology, neurological surgery, preventive medicine and public health. (shrink)

Perceived quality of experience for speech listening is influenced by cognitive processing and can affect a listener's comprehension, engagement and responsiveness. Quality of Experience is a paradigm used within the media technology community to assess media quality by linking quantifiable media parameters to perceived quality. The established QoE framework provides a general definition of QoE, categories of possible quality influencing factors, and an identified QoE formation pathway. These assist researchers to implement experiments and to evaluate perceived quality for any applications. (...) The QoE formation pathways in the current framework do not attempt to capture cognitive effort effects and the standard experimental assessments of QoE minimize the influence from cognitive processes. The impact of cognitive processes and how they can be captured within the QoE framework have not been systematically studied by the QoE research community. This article reviews research from the fields of audiology and cognitive science regarding how cognitive processes influence the quality of listening experience. The cognitive listening mechanism theories are compared with the QoE formation mechanism in terms of the quality contributing factors, experience formation pathways, and measures for experience. The review prompts a proposal to integrate mechanisms from audiology and cognitive science into the existing QoE framework in order to properly account for cognitive load in speech listening. The article concludes with a discussion regarding how an extended framework could facilitate measurement of QoE in broader and more realistic application scenarios where cognitive effort is a material consideration. (shrink)

Hearing loss in old age, which often goes untreated, has far-reaching consequences. Furthermore, reduction of cognitive abilities and dementia can also occur, which also affects quality of life. The aim of this study was to investigate the hearing performance of seniors without hearing complaints with respect to speech perception in noise and the ability to localize sounds. Results were tested for correlations with age and cognitive performance. The study included 40 subjects aged between 60 and 90 years with not self-reported (...) hearing problems. The subjects were screened for dementia. Audiological tests included pure-tone audiometry and speech perception in two types of background noise which was either co-located or spatially separated from the target speech. Sound localization ability was assessed and hearing performance was self-evaluated by a questionnaire. Speech in noise and sound localization was compared with young normal hearing adults. Although considering themselves as hearing normal, 17 subjects had at least a mild hearing loss. There was a significant negative correlation between hearing loss and dementia screening score. Speech perception in noise decreased significantly with age. There were significant negative correlations between speech perception in noise and DemTect score for both spatial configurations. Mean SRTs obtained in the co-located noise condition with amplitude-modulated noise were on average 3.1 dB better than with continuous noise. This gap-listening effect was severely diminished compared to a younger normal hearing subject group. In continuous noise, spatial separation of speech and noise led to better SRTs compared to the co-located masker condition. SRTs in MSNF deteriorated in modulated noise compared to continuous noise by 2.6 dB. Highest impact of age was found for speech perception scores using noise stimuli with temporal modulation in binaural test conditions. Mean localization error was in the range of young adults. Mean amount of front/back confusions was 11.5% higher than for young adults. Speech perception tests in the presence of temporally modulated noise can serve as a screening method for early detection of hearing disorders in older adults. This allows for early prescription of hearing aids. (shrink)

Clinical Ethics, Ahead of Print. ObjectiveThe purpose of this study was to assess if a relationship existed between audiologists’ perceptions of moral distress, occupational wellbeing, and patient-practitioner orientation.DesignThe Moral Distress Thermometer, Health and Safety Executive Management Standards Indicator Tool and Patient-Practitioner Orientation Scale was sent out to all audiologists registered with the professional body Audiology Australia.Study sample: A total of 43 audiologists completed the questionnaires.ResultsUsing a multiple linear regression model there was no evidence of a relationship between patient-practitioner orientation (...) and either moral distress or occupational wellbeing. However, an association between higher moral distress and lower occupational wellbeing was demonstrated. The occupational wellbeing subscales of ‘managerial support’, ‘peer support’, ‘relationships’, ‘role’, and ‘change’ were strongly associated with poorer scores on moral distress.ConclusionFor our sample of audiologists, ethical conflict appeared to be linked to reduced job satisfaction. There is a need to consider ways of providing supportive organisational structures in which ethical conflicts can be openly discussed and negotiated in order to improve occupational wellbeing in the profession. (shrink)

Focusing on the largest and, arguably, the least visible disability group, the hearing impaired, this paper explores present-day views and understandings of hearing impairment and rehabilitation in a Danish context, with particular focus on working-age adults with late onset of hearing impairment. The paper shows how recent changes in perception of the hearing impaired patient relate to the introduction of a new health care reform that turns audiological rehabilitation into a consumer issue. Ethnographic and interview data from hearing clinics provides (...) evidence that the hearing technologies that are on offer stabilise in specific forms through processes of negotiation among a variety of social actors representing the interests of science, industry, government, and hearing-impaired people. The discussion critically considers the emergence of an “informed consumer” in audiological practices. (shrink)