Showing papers in "Ear and Hearing in 2010"

Auditory brain stem response to complex sounds: a tutorial.

Abstract: This tutorial provides a comprehensive overview of the methodological approach to collecting and analyzing auditory brainstem responses to complex sounds (cABRs). cABRs provide a window into how behaviorally relevant sounds such as speech and music are processed in the brain. Because temporal and spectral characteristics of sounds are preserved in this subcortical response, cABRs can be used to assess specific impairments and enhancements in auditory processing. Notably, subcortical function is neither passive nor hardwired but dynamically interacts with higher-level cognitive processes to refine how sounds are transcribed into neural code. This experience-dependent plasticity, which can occur on a number of time scales (e.g., life-long experience with speech or music, short-term auditory training, online auditory processing), helps shape sensory perception. Thus, by being an objective and non-invasive means for examining cognitive function and experience-dependent processes in sensory activity, cABRs have considerable utility in the study of populations where auditory function is of interest (e.g., auditory experts such as musicians, persons with hearing loss, auditory processing and language disorders). This tutorial is intended for clinicians and researchers seeking to integrate cABRs into their clinical and/or research programs.

Audit Office Size, Audit Quality and Audit Pricing

Abstract: SUMMARY: Using a large sample of U.S. audit client firms over the period 2000–2005, this paper investigates whether and how the size of a local practice office within an audit firm (hereafter, office size) is a significant, engagement-specific factor determining audit quality and audit fees over and beyond audit firm size at the national level and auditor industry leadership at the city or office level. For our empirical tests, audit quality is measured by unsigned abnormal accruals, and the office size is measured in two different ways: one based on the number of audit clients in each office and the other based on a total of audit fees earned by each office. Our results show that the office size has significantly positive relations with both audit quality and audit fees, even after controlling for national-level audit firm size and office-level industry expertise. These positive relations support the view that large local offices provide higher-quality audits compared with small local offices, and that s...

Pupil response as an indication of effortful listening: the influence of sentence intelligibility.

Abstract: Objectives The aim of this study was to evaluate the influence of sentence intelligibility on the pupil dilation response during listening. Task-induced pupil-dilation reflects explicit effortful processing load. Therefore, pupillometry can be used to examine the listening effort during speech perception in difficult listening conditions. We expected to find increasing pupil dilation as a function of decreasing speech intelligibility. Design Thirty-eight young participants (mean age = 23 yrs, SD = 3.2 yrs) with normal hearing were included. They performed three speech reception threshold (SRT) tests in which they listened to sentences in stationary noise. A one-up-one-down, two-up-one-down, or four-up-one-down adaptive procedure was applied, resulting in the correct rehearsal of 50, 71, or 84% of the sentences (SRT(50%), SRT(71%), and SRT(84%), respectively). We examined the peak dilation amplitude, the latency of the peak dilation amplitude, and the mean pupil dilation during the processing of the speech in each of these conditions. The peak dilation amplitude and mean pupil dilation were calculated relative to the baseline pupil diameter during listening to noise alone. For each SRT condition, participants rated the experienced listening effort and estimated their performance level. Results The signal to noise ratios (SNRs) in the SRT(50%), SRT(71%), and SRT(84%) conditions increased as a function of the speech intelligibility level. The subjective effort ratings decreased, and the estimated performance increased with increasing speech intelligibility level. Repeated measures analyses of variance indicated that peak dilation amplitude and mean pupil dilation were higher in the SRT(50%) condition as compared with the SRT(71%) and SRT(84%) conditions. The peak dilation amplitude, mean pupil dilation, and peak latency increased with decreasing SNR of the speech in noise, but no effect of noise level by itself on the baseline pupil diameter was observed. Irrespective of SNR, the pupil response was higher for incorrectly repeated sentences than for correctly repeated sentences. The analyses also indicated condition-order effects on the peak dilation amplitude and mean pupil dilatation: the pupil response was higher in the first SRT test than in the second and third tests. Within the first and third test, the baseline pupil diameter and the mean pupil dilation decreased as a function of the sentence number within the test. Spearman correlation coefficients showed no relations among the SNRs at the SRTs, subjective ratings, and the pupil response. Conclusions The peak dilation amplitude, peak latency, and mean pupil dilation systematically increase with decreasing speech intelligibility. These results support that listening effort, as indicated by the pupil response, increases with decreasing speech intelligibility. This study indicates that pupillometry can be used to examine how listeners reach a certain performance level. Application of this technique to study listening effort can yield valuable insight into the processing resources required across listening conditions and into the factors related to interindividual differences in speech perception in noise.

Development of a Scale to Measure Professional Skepticism

Abstract: SUMMARY: Professional skepticism is an important concept in audit practice, as evidenced by its prominence throughout the auditing standards. In this paper I propose that professional skepticism is...

Auditory development in early amplified children: factors influencing auditory-based communication outcomes in children with hearing loss.

Abstract: Objective:The purpose of this study was to determine the influence of selected predictive factors, primarily age at fitting of amplification and degree of hearing loss, on auditory-based outcomes in young children with bilateral sensorineural hearing loss.Design:Forty-four infants and toddlers, firs

Processing of temporal fine structure as a function of age

Abstract: Objectives:The purpose of this study was to determine whether the processing of temporal fine structure diminishes with age, even in the presence of relatively normal audiometric hearing. Temporal fine structure processing was assessed by measuring the discrimination of interaural phase differences

Combined effects of noise and reverberation on speech recognition performance of normal-hearing children and adults.

Abstract: Objectives:The purpose of this study is to determine how combinations of noise levels and reverberation typical of ranges found in current classrooms will affect speech recognition performance of typically developing children with normal speech, language, and hearing and to compare their performance

Information from the voice fundamental frequency (F0) region accounts for the majority of the benefit when acoustic stimulation is added to electric stimulation.

Abstract: Objectives:The aim of this study was to determine the minimum amount of low-frequency acoustic information that is required to achieve speech perception benefit in listeners with a cochlear implant in one ear and low-frequency hearing in the other ear.Design:The recognition of monosyllabic words in

Cochlear Implantation in Children with Auditory Neuropathy Spectrum Disorder

Abstract: Objective:To report the patient's characteristics, preoperative audiological profiles, surgical outcomes, and postoperative performance for children with auditory neuropathy spectrum disorder (ANSD) who ultimately received cochlear implants (CIs).Design:Prospective, longitudinal study of children wi

Evidence for the expansion of adult cochlear implant candidacy.

Abstract: Objectives The primary objective of this study was to determine whether a revision and/or expansion of current audiologic cochlear implant candidacy criteria is warranted. Design The study design was a retrospective review of postoperative speech perception performance for 22 adult cochlear implant recipients who demonstrated preoperative Consonant Nucleus Consonant word recognition scores of 30% or higher in the best-aided condition. This criterion was chosen to exceed that specified by the North American clinical trial of the Nucleus Freedom cochlear implant system. Results The mean preoperative best-aided monosyllabic word score for the 22 patients was 41% correct. The degree of postoperative benefit for the best postoperative condition (electric only or bimodal) ranged from 10 to 68 percentage points with a mean benefit of 27 percentage points for the electric-only condition and 40 percentage points for the bimodal condition. Statistical analyses revealed highly significant differences between preoperative-aided, implant-only, and bimodal performance on Consonant Nucleus Consonant monosyllabic word recognition performance. That is, both postoperative scores--electric only and bimodal--were significantly different from one another and from the preoperative best-aided performance. Conclusions The current results suggest that a large-scale reassessment of manufacturer and Medicare preoperative audiologic candidacy criteria for adults is warranted to allow more hearing-impaired individuals to take advantage of the benefits offered by cochlear implantation.

Neuroanatomical Characteristics and Speech Perception in Noise in Older Adults

Abstract: Objectives Previous research has attributed older adult’s difficulty with perceiving speech in noise to peripheral hearing loss. Recent studies have suggested a more complex picture, however, and implicate the central nervous system in sensation and sensory deficits. This study examines the relationship between the neuroanatomical structure of cognitive regions and the ability to perceive speech in noise in older adults. In particular, the neuroanatomical characteristics of the left ventral and dorsal prefrontal cortex are considered relative to standard measures of hearing in noise.

Drug delivery for treatment of inner ear disease: current state of knowledge.

Abstract: Delivery of medications to the inner ear has been an area of considerable growth in both the research and clinical realms over the past several decades. Systemic delivery of medication destined for treatment of the inner ear is the foundation upon which newer delivery techniques have been developed. Due to systemic side effects, investigators and clinicians have begun developing and utilizing techniques to deliver therapeutic agents locally. Alongside the now commonplace use of intratympanic gentamicin for Meniere's disease and the emerging use of intratympanic steroids for sudden sensorineural hearing loss, novel technologies, such as hydrogels and nanoparticles, are being explored. At the horizon of inner ear drug delivery techniques, intracochlear devices that leverage recent advances in microsystems technology are being developed to apply medications directly into the inner ear. Potential uses for such devices include neurotrophic factor and steroid delivery with cochlear implantation, RNA interference technologies, and stem cell therapy. The historical, current, and future delivery techniques and uses of drug delivery for treatment of inner ear disease serve as the basis for this review.

Short-Term Accruals and the Pricing and Production of Audit Services

Abstract: SUMMARY: This study investigates how risk associated with increased levels of accruals that might be indicative of earnings management affects the pricing and production of audit services. Francis and Krishnan (1999) suggest that auditors can deal with the risk of earnings management in five ways: (1) screen out high-risk clients; (2) charge a premium to riskier clients; (3) increase audit effort; (4) negotiate adjustments to the financial statements; and/or (5) report more conservatively (e.g., by issuing a modified report). Using a unique data set, the current study investigates two of these options: charging a fee premium and increasing audit effort. Based on previous research on audit pricing and production, we construct models for audit fees, total audit effort, labor mix (extent of experienced auditor effort), and engagement profit margin including an accruals measure that could indicate earnings management. We test these models on a sample of 119 audit engagements from one Big 6 audit firm in The N...

Sound localization skills in children who use bilateral cochlear implants and in children with normal acoustic hearing

Abstract: Objectives To measure sound source localization in children who have sequential bilateral cochlear implants (BICIs); to determine if localization accuracy correlates with performance on a right-left discrimination task (i.e., spatial acuity); to determine if there is a measurable bilateral benefit on a sound source identification task (i.e., localization accuracy) by comparing performance under bilateral and unilateral listening conditions; to determine if sound source localization continues to improve with longer durations of bilateral experience.

Comparison of bimodal and bilateral cochlear implant users on speech recognition with competing talker, music perception, affective prosody discrimination, and talker identification.

Abstract: AB Objectives: Despite excellent performance in speech recognition in quiet, most cochlear implant users have great difficulty with speech recognition in noise, music perception, identifying tone of voice, and discriminating different talkers. This may be partly due to the pitch coding in cochlear implant speech processing. Most current speech processing strategies use only the envelope information; the temporal fine structure is discarded. One way to improve electric pitch perception is to use residual acoustic hearing via a hearing aid on the nonimplanted ear (bimodal hearing). This study aimed to test the hypothesis that bimodal users would perform better than bilateral cochlear implant users on tasks requiring good pitch perception. Design: Four pitch-related tasks were used. 1. Hearing in Noise Test (HINT) sentences spoken by a male talker with a competing female, male, or child talker. 2. Montreal Battery of Evaluation of Amusia. This is a music test with six subtests examining pitch, rhythm and timing perception, and musical memory. 3. Aprosodia Battery. This has five subtests evaluating aspects of affective prosody and recognition of sarcasm. 4. Talker identification using vowels spoken by 10 different talkers (three men, three women, two boys, and two girls). Bilateral cochlear implant users were chosen as the comparison group. Thirteen bimodal and 13 bilateral adult cochlear implant users were recruited; all had good speech perception in quiet. Results: There were no significant differences between the mean scores of the bimodal and bilateral groups on any of the tests, although the bimodal group did perform better than the bilateral group on almost all tests. Performance on the different pitch-related tasks was not correlated, meaning that if a subject performed one task well they would not necessarily perform well on another. The correlation between the bimodal users' hearing threshold levels in the aided ear and their performance on these tasks was weak. Conclusions: Although the bimodal cochlear implant group performed better than the bilateral group on most parts of the four pitch-related tests, the differences were not statistically significant. The lack of correlation between test results shows that the tasks used are not simply providing a measure of pitch ability. Even if the bimodal users have better pitch perception, the real-world tasks used are reflecting more diverse skills than pitch. This research adds to the existing speech perception, language, and localization studies that show no significant difference between bimodal and bilateral cochlear implant users.

Cross-modal plasticity and speech perception in pre- and postlingually deaf cochlear implant users.

Abstract: Objective: A great amount of variability is observed in speech perception outcomes with cochlear implants. The mechanisms behind the observed variability need to be elucidated. One possible mechanism contributing to the observed variability is the development of cross-modal plasticity. This study examines the association between visual/ auditory cross-modal plasticity and speech perception with a cochlear implant in individuals with pre- and postlingual onset of severe to profound hearing loss. Design: The N1 visual evoked potential (VEP) in response to peripheral visual motion stimuli was recorded in individuals with pre- (N = 10) and postlingual (N = 12) onset of severe to profound hearing loss who use a cochlear implant. The association between the amplitude of the N1 VEP response over the right temporal lobe and sentence and word perception scores obtained with the cochlear implant was examined through linear regression analyses. In addition, the association between the duration of auditory deprivation and the amplitude of the N1 VEP response was examined. Results: As the amplitude of the N1 VEP recorded over the right temporal lobe increased, speech perception scores in individuals with prelingual onset of severe to profound hearing loss decreased. However, a clear association between the amplitude of the N1 VEP over the right temporal lobe and speech perception scores was not observed for individuals with postlingual onset of severe to profound hearing loss. Neither group demonstrated an association between the amplitude of the VEP over the right temporal lobe and the duration of auditory deprivation before cochlear implantation. Conclusion: The results suggest that cross-modal plasticity accounts for a significant amount of the variability observed in speech perception performance with a cochlear implant in individuals with prelingual onset of severe to profound hearing loss but not in individuals who acquire severe to profound hearing loss later in life. Furthermore, the results suggest that the influence of cross-modal plasticity on speech perception ability is more greatly influenced by when (pre- or postlingually) a person acquires a severe to profound hearing impairment rather than the duration of auditory deprivation before receipt of a cochlear implant.

Audit Partner Tenure and Audit Planning and Pricing

Abstract: SUMMARY: This paper investigates the association between audit engagement partner tenure and audit planning and pricing. Prior archival research from countries requiring partner signature on the audit opinion provides mixed results on the implications of partner tenure for audit quality. While variation in audit quality based on partner tenure implies some difference in the conduct of the engagement, prior research has not yet addressed whether engagement processes differ based on partner tenure. Using proprietary data from a large audit firm, we find that planned engagement effort increases following partner rotation, suggesting that new partners invest effort to gain client knowledge in the first year on the engagement. We also examine planned realization rates, finding them to be lower following partner rotation. This implies that new partners’ investments in client knowledge are not compensated by clients. We also find higher planned realization rates on audits having the same engagement partner for m...

Identifying cochlear implant channels with poor electrode-neuron interface: partial tripolar, single-channel thresholds and psychophysical tuning curves.

Abstract: Objectives The goal of this study was to evaluate the ability of a threshold measure, made with a restricted electrode configuration, to identify channels exhibiting relatively poor spatial selectivity. With a restricted electrode configuration, channel-to-channel variability in threshold may reflect variations in the interface between the electrodes and auditory neurons (i.e., nerve survival, electrode placement, tissue impedance). These variations in the electrode-neuron interface should also be reflected in psychophysical tuning curve measurements. Specifically, it is hypothesized that high single-channel thresholds obtained with the spatially focused partial tripolar electrode configuration are predictive of wide or tip-shifted psychophysical tuning curves.

Guest editorial: accessible and affordable hearing health care for adults with mild to moderate hearing loss.

Abstract: The National Institute on Deafness and Other Communication Disorders/National Institutes of Health (NIDCD/NIH) sponsored a research working group on Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss on August 25 - 27, 2009 in Bethesda, Maryland. The purpose of the working group was to develop a research agenda to increase accessibility and affordability of hearing health care for adults with mild to moderate hearing loss, including accessible and low cost hearing aids. For the purposes of the working group, mild HL was defined as 26-40 dB HL averaged across 0.5 - 4.0 kHz, and moderate HL was defined as 41-60 dB HL averaged across 0.5 - 4.0 kHz. Why is this working group important at this time? Hearing loss (HL) is a public health issue and is among the leading public health concerns. Approximately 17% of American adults, or 36 million people, report some degree of HL1. HL is the third most prevalent chronic health condition facing seniors2. Yet, fewer than 20% of those with HL who require intervention and treatment seek help for their condition3. Untreated HL has social and economic ramifications. Most hearing aid users have lived with HL for over 10 years and their impairments have progressed to moderate-to-severe levels before seeking a hearing aid4. For many reasons, the current hearing health care (HHC) system in the United States is not meeting the needs of the vast majority of adults with HL. As the lead Federal agency to promote the Nation's HHC, NIDCD has the responsibility and is actively seeking to address this problem from the public health perspective. NIDCD Senate Report Language for FY2010 appropriations “recommends that the NIDCD support research to develop, improve and lower the cost of hearing aids...”5. Further, Healthy People 2020, a U.S. Department of Health and Human Services (HHS) activity that provides science-based, 10-year national objectives for promoting health and preventing disease, includes increasing the adoption rate of hearing aid usage as a Healthy People 2020 goal6. NIDCD is committed to addressing these recommendations and goals through well-developed and targeted research initiatives.

Spatial speech perception benefits in young children with normal hearing and cochlear implants.

Abstract: Objectives Several studies have demonstrated better speech perception performance in children using two rather than one cochlear implant (CI). The extent to which bilaterally implanted children benefit from binaural cues to segregate speech and noise in a spatial configuration is less clear. Although better-ear effects are expected to be similar to adults, it is unknown whether electrical stimulation allows true binaural processing of speech signals in noise. Moreover, little data are available on the binaural hearing abilities of normal-hearing children. This study aimed at (1) developing and evaluating a speech test based on numbers to determine speech reception thresholds (SRTs) fast and accurately in young children, (2) evaluating a setup for measuring benefits of speech perception in a spatial configuration in young children and determining normative values of normal-hearing children, and (3) measuring spatial speech benefits in cochlear-implanted children with good sound localization abilities. Design The speech test was conducted using the Leuven Intelligibility Number Test (LINT) data base. The test was limited to the numbers 1 to 10 spoken by one female speaker ("LittleLINT"). The LINT speech-weighted noise was used as a masker. Perception of this speech material was evaluated at fixed signal-to-noise ratios (SNRs) through monaural presentation via headphones in 34 normal-hearing children of 4 and 5 yrs of age and 20 normal-hearing adults. Subsequently, spatial speech perception benefits were measured in 50 normal-hearing children between 4 and 8 yrs of age, 15 normal-hearing adults, and eight children with bilateral CIs. An adaptive procedure was used for estimating unilateral and bilateral SRTs for different spatial configurations of speech and noise. Speech was always presented at 0 degrees azimuth (the front) and noise at the front, 90 degrees to the right, or 90 degrees to the left. Results Unilateral headphone SRTs for the LittleLINT were higher for children (-9 dB SNR) than for adults (-13 dB SNR) and were lower than those for the LINT (-10 dB SNR for adults). Slopes (12 to 14%/dB) were comparable with that of the LINT (15%/dB), suggesting equal efficiency for the limited set of numbers. Normal-hearing subjects demonstrated several benefits of two-ear listening in spatial configurations (spatial release from masking [SRM], head shadow, summation, and squelch). Only SRM was influenced by age. Implanted children clearly benefited from bilateral implantation, as shown by SRM (3 dB) and head shadow effects (4 to 6 dB) comparable with normal-hearing children, but no summation or binaural squelch was established. The first CI seemed to contribute most to spatial speech perception. Conclusions The steep slope, the familiarity to children, and the repeatability of lists make the LittleLINT suitable for fast and accurate SRT estimation in children. Spatial speech perception benefits were observed in normal-hearing subjects from the age of 4 yrs. Cochlear-implanted children showed better-ear effects but there was no evidence of true binaural processing.

Auditor Conservatism after Enron

Abstract: SUMMARY: Corporate scandals and the resulting passage of the Sarbanes-Oxley Act (SOX) in 2002 significantly affected the auditing profession. The quality of financial statement audits was called into questioned and the media and regulators held audit firms responsible. Several studies found evidence of an increase in the issuance of going-concern opinions after the passage of SOX relative to earlier time periods (Geiger et al. 2005; Nogler 2008; Myers et al. 2008). Auditors, it appears, behave more conservatively when the profession is in the headlines. We replicate and extend this research to determine whether the heightened conservatism continues or whether it fades as time passes. We examine audit opinions issued 12 months or less prior to a bankruptcy filing for 565 companies from 2000–2008. Our findings indicate that while the proportion of going-concern modifications increases sharply in 2002–2003 compared to 2000–2001, it declines in the periods that follow, ultimately returning to its pre-Enron level.

The Association between Financial Reporting Risk and Audit Fees before and after the Historic Events Surrounding SOX

Abstract: SUMMARY: This study investigates whether the association between financial reporting risk and audit fees changed during 2000–2003: a time period marked by momentous and historic events for auditors. We find a positive statistically and economically significant relationship between financial reporting risk and audit fees paid to Big 4 auditors. More importantly, we predict and find that the relation between financial reporting risk and audit fees strengthened significantly in 2002 and 2003, consistent with a shift in the way auditors priced risk, likely in response to the events surrounding the Sarbanes-Oxley Act of 2002. Finally, we provide evidence that a commercially developed, comprehensive risk measure effectively proxies for an element of risk beyond what has traditionally been captured by various risk measures in audit fee models: namely, the risk that financial statements have been intentionally misstated. We believe this risk measure will be of interest to future researchers.

Market Reaction to Auditor Switching from Big 4 to Third-Tier Small Accounting Firms

Abstract: SUMMARY: After the demise of Arthur Andersen, the public accounting industry has witnessed a significant migration of public clients to second-tier (Grant Thornton and BDO Seidman) and smaller third-tier accounting firms. While prior literature documents that smaller auditors are perceived by the stock market as an inferior substitute for a Big 4 auditor, this perception appears to have changed in recent years. In this paper, we analyze market responses to auditor switching from Big 4 to smaller accounting firms during 2002 to 2006. We break our sample period into two separate periods (Periods 1 and 2) based on when regulatory changes occurred. These changes included Sarbanes-Oxley (SOX) 404 implementation, Public Company Accounting Oversight Board (PCAOB) inspections, and a tightened Form 8-K filing deadline. We find a relatively more positive stock market reaction to clients switching from a Big 4 to a smaller third-tier auditor in Period 2. This relatively more positive reaction in Period 2 reflects co...

Wideband reflectance in newborns: Normative regions and relationship to hearing screening results

Abstract: Objectives To develop normative data for wideband middle-ear reflectance in a newborn hearing-screening population and to compare test performance with 1-kHz tympanometry for prediction of otoacoustic emission (OAE) screening outcome. Design Wideband middle-ear reflectance (using both tone and chirp stimuli from 0.2 to 6 kHz), 1-kHz tympanometry, and distortion-product (DP) OAEs were measured in 324 infants at two test sites. Ears were categorized into DP pass and DP refer groups. Results Normative reflectance values were defined over various frequency regions for both tone and chirp stimuli in ambient pressure conditions, and for reflectance area indices integrated over various frequency ranges. Receiver operating characteristic analyses showed that reflectance provides the best discriminability of DP status in frequency ranges involving 2 kHz and greater discriminability of DP status than 1-kHz tympanometry. Repeated-measures analyses of variance established that (a) there were significant differences in reflectance as a function of DP status and frequency but not sex or ear; (b) tone and chirp stimulus reflectance values are essentially indistinguishable; and (c) newborns from two geographic sites had similar reflectance patterns above 1 kHz. Birth type and weight did not contribute to differences in reflectance. Conclusions Referrals in OAE-based infant hearing screening were strongly associated with increased wideband reflectance, suggesting middle-ear dysfunction at birth. Reflectance improved significantly during the first 4 days after birth with normalization of middle-ear function. Reflectance scores can be achieved within seconds using the same equipment used for OAE screening. Newborns with high reflectance scores at stage I screening should be rescreened within a few hours to a few days, because most middle-ear problems are transient and resolve spontaneously. If reflectance and OAE are not passed upon stage II screening, referral to an otologist for ear examination is suggested along with diagnostic testing. Newborns with normal reflectance and a refer result for the OAE screen should be referred immediately to an audiologist for diagnostic testing with threshold auditory brainstem response because of higher risk for permanent hearing loss.

The effects of smoking and alcohol consumption on age-related hearing loss: the Blue Mountains Hearing Study.

Abstract: OBJECTIVES We aimed to investigate the temporal association between smoking or alcohol consumption and hearing loss, and to confirm previously published cross-sectional associations. DESIGN The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss conducted in a defined suburban area, west of Sydney. Hearing loss was measured in 2956 participants (aged 50+ yrs) and was defined as the pure-tone average of frequencies 0.5, 1.0, 2.0, and 4.0 kHz >25 dB HL in the better ear (bilateral hearing loss). Alcohol consumption and smoking status were measured using an interviewer-administered questionnaire. Logistic regression was used to obtain odds ratios (OR) with 95% confidence intervals (95% CI) that compared the chances of having hearing loss in participants who did or did not smoke or consume alcohol, after adjusting for other factors previously reported to be associated with hearing loss. RESULTS The prevalence of hearing loss at baseline was 33.0% (N = 929) and the 5-year incidence of hearing loss was 17.9% (N = 156). Cross-sectional analysis demonstrated a significant protective association between the moderate consumption of alcohol (>1 but < or =2 drinks/day) and hearing function in older adults (compared with nondrinkers), OR 0.75 (95% CI, 0.57 to 0.98). Current smokers not exposed to occupational noise had a significantly higher likelihood of hearing loss after adjusting for multiple variables, OR 1.63 (95% CI, 1.01 to 2.64). A formal likelihood ratio test demonstrated that the interaction between smoking and noise exposure was not significant (p = 0.23). When the joint effects of alcohol consumption and smoking on hearing were explored, there was a trend for alcohol to have a protective relationship with hearing loss in smokers, but this was not statistically significant. However, the 5-year incidence of hearing loss was not predicted by either smoking or alcohol consumption. CONCLUSIONS This study confirms previously reported associations between alcohol consumption or smoking and prevalent hearing loss, but these were not demonstrated in temporal data. Other risk factors could confer greater vulnerability or cause the initial damage to hearing. Future large population-based studies, exploring the influence of other risk factors on the development of age-related hearing loss are warranted.

Wideband reflectance in normal Caucasian and Chinese school-aged children and in children with otitis media with effusion.

Abstract: Objectives:Wideband reflectance (WBR) is a middle ear analysis technique that quantifies frequency-specific sound conduction over a wide range of frequencies. One shortcoming of WBR is that there is limited normative data, particularly for pediatric populations and children with middle ear pathology

Longitudinal development of phonology and morphology in children with late-identified mild-moderate sensorineural hearing loss.

Abstract: Studies of language development in young children with mild-moderate sensorineural hearing loss (MMHL) are relatively rare. Existing studies suggest that some children with MMHL are at risk for language delays, particularly in areas such as phonology, morphology, and advanced vocabulary and syntax production (Borg, Edquist, Reinholdson, et al., 2007; Delage & Tuller, 2007; Elfenbein, Hardin-Jones, & Davis, 1994; Kennedy, McCann, Campbell, et al., 2006; Kiese-Himmel & Reeh, 2006; Wake, Hughes, Poulakis, et al., 2004). Most studies in the extant literature involve children whose hearing losses were identified late compared to contemporary standards (see Moeller, Tomblin, Yoshinaga-Itano, et al., 2007 for a review). These children presumably experienced varying periods of reduced or degraded input prior to the fitting of amplification, and this factor exerts influence on outcomes (Norbury, Bishop, & Briscoe, 2001). To date, the impact of these differences in early auditory experience on language development is not well understood. Prospective longitudinal analyses may be helpful in understanding how delayed access to amplification affects language, and whether children with MMHL may “recover” from initial delays once interventions are provided. Such questions remain relevant in the era of newborn hearing screening, because findings may provide indirect support for early identification and guide the management of children with MMHL who continue to be identified late. There is some disagreement in the literature about the persistence of language delays associated with MMHL. Some suggest that even mild hearing loss places a child at risk for lasting language delays (Davis, Elfenbein, Schum, & Bentler, 1986), while others conclude that peripheral hearing impairment is ‘compensated for’ in many children with MMHL (Borg, et al., 2007). Delage and Tuller (2007) reported that 19 adolescents with MMHL were found to be at greater risk for language impairment than peers with NH, indicating that language delays do not necessarily normalize with age in this group. There also is disagreement about the prevalence of co-morbid language disabilities in this group of children (Borg, et al., 2007; Delage & Tuller, 2007; Gilbertson & Kamhi, 1995), but there is a consensus that their existence influences outcome. The overall pattern of equivocal results may be related to differences in characteristics of the samples (e.g., variation in periods without amplification, presence of co-morbid conditions) and measurement factors (e.g., ages examined, constructs measured, and sensitivity of measurement tools). A point of agreement across studies is the wide individual variation in outcomes, which speaks to the need for a better understanding of variables that influence outcomes over time in children with MMHL. Selected aspects of speech and language may be particularly susceptible to the presence of MMHL and delayed access to amplification. Delage and Tuller (2007) drew upon the literature on critical periods (e.g., Newport, Bavelier & Neville, 2001 cited in Delage & Tuller, 2007) to suggest that formal aspects of language (phonology and morphosyntax) are more vulnerable in the face of protracted language development than vocabulary or semantics. Children with late-identified hearing loss spend a portion of critical language acquisition periods with degraded or partial language input, which may differentially affect phonology and morphology. There are consistent reports in the literature of delays in phonological skills (Elfenbein, et al., 1994; see Eisenberg, 2007 for a review) and verb morphology in this population of children (Delage & Tuller, 2007; Elfenbein, et al., 1994; McGuckian & Henry, 2007; Norbury, et al., 2001), which may lend support to the notion that these areas are vulnerable. Elfenbein and colleagues (1994) conducted a cross-sectional study of 40 students with mild to severe HL that included articulation measures. The common persistent errors observed in the speech of the children involved the production of fricatives and affricates. Delays in mastery of verb tense marking also have been identified in children with MMHL (Delage & Tuller, 2007; Elfenbein, et al., 1994; McGuckian & Henry, 2007), but it is unclear if such delays resolve with age. Delage & Tuller (2007) identified disorders in phonology and morphosyntax in half of their French-speaking adolescents (n = 19) with MMHL, suggesting persistent difficulties in these susceptible areas. Norbury, et al. (2001) found that children with mild-moderate HL (ages 5–10; n = 19) performed similarly to children with NH on verb morphology tasks. However the youngest children with HL in their sample (n = 6) demonstrated difficulty with third person singular –s and past tense markers. The average age of hearing aid fitting for this sample was 48.2 months. The authors concluded that “disrupted auditory input during the time of normal language acquisition may delay the development of a number of different linguistic skills, including verb tense marking (p 175).” In addition to atypical early auditory experience, limitations in audibility following intervention may continue to influence the development of both phonology and morphosyntax for children with MMHL. The limited bandwidth of hearing aids is known to affect perception and production of consonants in the fricative class (Moeller, Hoover, Putman, et al., 2007; Stelmachowicz, Pittman, Hoover, & Lewis, 2001, 2002). Children with MMHL (5–13 years of age) demonstrated highly variable perception of –s marking plurality compared to 3–5 year olds with NH (Stelmachowicz, et al., 2002). Because of reduced audibility, particularly in contexts of noise and reverberation, children with MMHL may receive inconsistent input about obligatory contexts for using morphological endings in English, complicating the process of rule formation. This may be particularly true for verb tense markers like third person singular (She needs help), that often occur in phrase-medial positions of sentences, which can reduce the overall amplitude of final consonants (Song, Sundara, & Demuth, 2009). If this is the case, it is hypothesized that forms like third person singular (/3s) will be more delayed than other tense markers for children with MMHL. The order in which children with MMHL begin to mark for verb tense may hold clues to the contributions of audibility in morphological development. The onset and consistent use of verb tense marking has been studied extensively in children with NH, including both typically developing and those with language impairments. Researchers have been particularly interested in a small group of verb tense markers that form a coherent set in development and are sensitive to the identification of language impairment in children (Leonard, Miller & Gerber, 1999; Rice & Wexler, 1996). They include forms of the following verbs: (1) copula BE (My hat is red), (2) third person singular present tense (/3s - Joey runs), (3) auxiliary verb BE (The girl is jumping), (4) auxiliary DO (Does he like it?), and (5) past tense regular –ed (We walk/ed) (Hadley & Short, 2005). According to Hadley (2006), this group of morphemes is important because they share the role of marking the underlying grammatical feature of tense in sentences, even though they differ in their surface forms. In typical development, tense marking begins between two and one half years of age (Rispoli, Hadley & Holt, 2009), and all of the forms are present by three years for the majority of children with NH (Hadley, 2006; Hadley & Short, 2005; Hadley & Rice, 1996). It is of interest for the current analysis that third person singular (/3s) is among the earliest appearing tense morphemes for children with NH (Hadley, 2006). Delays in use of verb tense marking and use of other morphological markers also may reflect instability in the children’s phonological mastery of fricatives and production of final blends, like /kt/ in walked or /ts/ in cats (Song, et al., 2009). Phonology and morphology are interdependent aspects of development for all children. If both areas are vulnerable for children with late-identified MMHL, a better understanding of their joint influences on language development is needed. The current study is a longitudinal descriptive analysis of selected aspects of phonology and morphosyntactic development in four children with MMHL who were late identified. Although the sample is small, longitudinal studies from the point of identification of this group of children are particularly rare. These cases represent a unique opportunity to address several questions: (1) What are the effects of a period of unaided MMHL on language development (based on measures at or near the point of identification)? This is of particular interest because it is not ethical to conduct a randomized controlled study where children are assigned to treatment and non-treatment groups. (2) What is the developmental order of verb tense marking and does it suggest influences of audibility on morphology? (3) Do early delays resolve with development and intervention, and if errors persist, are they in areas predicted to be vulnerable?

Bilateral and unilateral cochlear implant users compared on speech perception in noise.

Abstract: Objective:Compare speech performance in noise with matched bilateral cochlear implant (CICI) and unilateral cochlear implant (CI only) users.Design:Thirty CICI and 30 CI-only subjects were tested on a battery of speech perception tests in noise that use an eight-loudspeaker array.Results:On average,

Incidence, persistence, and progression of tinnitus symptoms in older adults: the Blue Mountains Hearing Study.

Abstract: Objective:Temporal population-based data on tinnitus are lacking. We used a representative older population-based cohort to establish 5-yr incidence, persistence, and progression of tinnitus symptoms.Design:Two thousand six participants of the Blue Mountains Hearing Study (1997-1999) had complete ti

Exploring Trust and the Auditor-Client Relationship: Factors Influencing the Auditor’s Trust of a Client Representative

Abstract: SUMMARY: This research examines financial statement auditors’ trust of members of client management in the context of a disagreement. In this descriptive field study involving 48 partners and 23 managers of Canadian offices of international accounting firms, we explore factors that can influence an auditor’s trust of client management. We find that a client representative’s openness of communication and demonstration of concern during an auditor-client disagreement are positively associated with the trust that an auditor feels for that individual. We also find that aspects of the auditor-client relationship are associated with auditor trust. Responses to general questions about trust and auditing indicate that our auditors believe it is important to trust their clients and that they attempt to ensure that trust does not impede professional skepticism, primarily through a rigorous audit process and the adoption of an independent attitude.