Research (R)
Pediatrics (P)
Hailey A. Kingsbury
Doctor of Audiology Student
University of Iowa
University of Iowa
Iowa City, Iowa
Disclosure(s): No financial or nonfinancial relationships to disclose.
Elizabeth Walker, PhD
Associate Professor
University of Iowa
Iowa City, Iowa
Disclosure(s): No financial or nonfinancial relationships to disclose.
.jpg "Ryan McCreery, PhD photo")
Ryan McCreery, PhD
Vice President of Research
Boys Town National Research Hospital
Omaha, Nebraska
Disclosure(s): Boys Town National Research Hospital: Employment (Ongoing); NIH/NIDCD: Grant/Research Support (Ongoing)
Clinical assessments currently lack sensitivity in auditory threshold measurements that differentiate children with normal hearing from children with mild hearing loss. This research is an offshoot of the Finding Appropriate Solutions to Treat Reduced Audibility in Kids (FASTRAK) study that is developing clinical tools to assist with identification and management of children with mild hearing loss. This study adapts the FASTRAK audiogram using conditioned play audiometry to evaluate the associations between ear canal acoustics, self-generated noise, and audiometric thresholds in 36 preschoolers with typical hearing. Accounting for ear canal acoustics and self-generated noise may allow for more accurate threshold measures.
Summary:
Rationale: The Finding Appropriate Solutions to Treat Reduced Audibility in Kids (FASTRAK) study is a multi-center 5-year study designed to develop and validate clinical tools to improve diagnosis and outcome assessment for children with mild hearing loss. The current study is an adaptation of FASTRAK using conditioned play audiometry (CPA) to assess the influence of self-generated noise and ear canal acoustics on threshold estimation in preschoolers. Audiometric evaluations do not account for individual differences in ear-canal acoustics (Bagatto et al., 2002) or the influence of self-generated noise on threshold elevation (Buss et al., 2016). Both factors increase variability in the assessment and identification of children with mild hearing loss. For children of the same age, differences in ear canal sound pressure levels can range from 10-15 dB SPL (Bagatto et al. 2002). Additionally, self-generated noise is audible to and can mask thresholds of children with normal hearing or mild hearing loss (Buss et al., 2016; McCreery et al., 2019). Accounting for ear canal acoustics and self-generated noise may improve the accuracy of behavioral threshold assessments in children.
Objectives: The specific questions addressed by this study include:
1) How is threshold accuracy affected in preschoolers when using audiometric procedures that calibrate signal level in the ear canal? We predicted that the FASTRAK audiogram, which included ear canal calibration, would produce more accurate thresholds measurements than those obtained from clinical audiometry.
2) How much threshold variability is due to self-generated noise in 3- to 5-year-olds? We predicted that self-generated noise would affect 500 Hz thresholds the most, and the greatest variability in noise levels would be in the youngest group.
Methods: All participants had normal hearing and used spoken English to communicate. Parents did not report permanent hearing loss, developmental delays, or visual impairments. Parents completed an intake form regarding the child’s hearing history and the Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P) (Gioia et al., 2003). Examiners assessed 36 children with normal hearing, ages 3-5 years. Hearing function was confirmed during laboratory testing with immittance, distortion product otoacoustic emissions (DPOAE), and clinical CPA audiometry. The audiometric testing protocol included otoscopy, tympanometry, DPOAE screening, a FASTRAK audiogram, and a clinical audiogram. Audiometric thresholds were measured using CPA at 0.5, 1, 2, 4 kHz for each. The FASTRAK audiogram was administered via computer-based software that included monitoring of ear-canal sound levels and ear canal acoustics. The goal of the FASTRAK audiogram is to provide clinical validation of hearing thresholds while monitoring patient’s self-generated noise and variation in ear canal acoustics.
Results and
Conclusion: We performed a linear mixed effects model to compare thresholds by condition, controlling for noise level, age, and listener sex. Significant predictors of thresholds were age, with thresholds improving by 4.5 dB per year of age, and noise, with noise level increasing by 1.7 dB per year of age. The clinical implications of this research are significant in that accounting for differences in ear canal acoustics and self-generated noise may improve the accuracy of threshold measures in children.