The SCAN-C is a test for auditory processing disorders in children developed in the USA. There ar... more The SCAN-C is a test for auditory processing disorders in children developed in the USA. There are concerns that the SCAN-C may over diagnose auditory processing disorder in UK children. There are also questions concerning the impact of language level and interpretation of SCAN-C results. SCAN-C results from 99 Oxfordshire school children aged 6 to 10 were compared to US-based normative data. Across all age bands, the UK sample scored significantly worse on two subtests: the Filtered Words (FW) and
To clarify the impact of hearing aids on mental health, social engagement, cognitive function, an... more To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. We assessed hearing handicap (hearing handicap inventory for the elderly; HHIE-S), cognition (mini mental state exam, trail making, auditory verbal learning, digit-symbol substitution, verbal fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities), and mental health (SF-12 mental component) at baseline, five years prior to baseline, and five and 11 years after baseline. Community-dwelling older adults with hearing impairment (N = 666) from the epidemiology of hearing loss study cohort. There were no significant differences between hearing-aid users and non-users in cognitive, social engagement, or mental health outcomes at any time point. Aided HHIE-S was significa...
Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite ... more Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite a normal audiogram. APD is becoming ever more widely diagnosed in children, though there is a controversy over definition, diagnosis and aetiology. This study sought to describe presenting features and investigate aeitological factors for children diagnosed with APD compared to those for whom APD was excluded. Methods: Medical notes for children referred to a specialist hospital-based APD clinic were reviewed in relation to presenting features and potential aetiological factors. Results: 32 children diagnosed with APD and 57 non-APD children were compared. They reported similar symptoms and similarly had high rates of co-morbid learning problems. No aetiological factor (including history of otitis media, adverse obstetric history or familial history of listening problems) predicted APD group membership. Conclusions: Children identified with APD on the basis of commonly used APD tests cannot be distinguished on the basis of presenting features or the aetiological factors examined here. One explanation is that learning problems exist independently of auditory processing difficulties and the aetiological factors do not have a strong causal role in APD. However, no gold standard for APD testing exists and an alternative explanation is that the commonly used APD tests used as selection criteria in this study may be unreliable. #
The Journal of the Acoustical Society of America, 2014
The aim of this study was to investigate changes in central auditory processing following unilate... more The aim of this study was to investigate changes in central auditory processing following unilateral and bilateral hearing aid fitting using a combination of physiological and behavioral measures: late auditory event-related potentials (ERPs) and speech recognition in noise, respectively. The hypothesis was that for fitted ears, the ERP amplitude would increase over time following hearing aid fitting in parallel with improvement in aided speech recognition. The N1 and P2 ERPs were recorded to 500 and 3000 Hz tones presented at 65, 75, and 85 dB sound pressure level to either the left or right ear. New unilateral and new bilateral hearing aid users were tested at the time of first fitting and after 12 weeks hearing aid use. A control group of long-term hearing aid users was tested over the same time frame. No significant changes in the ERP were observed for any group. There was a statistically significant 2% improvement in aided speech recognition over time for all groups, although this was consistent with a general test-retest effect. This study does not support the existence of an acclimatization effect observable in late ERPs following 12 weeks' hearing aid use.
International Journal of Pediatric Otorhinolaryngology, 2008
Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite ... more Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite a normal audiogram. APD is becoming ever more widely diagnosed in children, though there is a controversy over definition, diagnosis and aetiology. This study sought to describe presenting features and investigate aeitological factors for children diagnosed with APD compared to those for whom APD was excluded. Methods: Medical notes for children referred to a specialist hospital-based APD clinic were reviewed in relation to presenting features and potential aetiological factors. Results: 32 children diagnosed with APD and 57 non-APD children were compared. They reported similar symptoms and similarly had high rates of co-morbid learning problems. No aetiological factor (including history of otitis media, adverse obstetric history or familial history of listening problems) predicted APD group membership. Conclusions: Children identified with APD on the basis of commonly used APD tests cannot be distinguished on the basis of presenting features or the aetiological factors examined here. One explanation is that learning problems exist independently of auditory processing difficulties and the aetiological factors do not have a strong causal role in APD. However, no gold standard for APD testing exists and an alternative explanation is that the commonly used APD tests used as selection criteria in this study may be unreliable. #
Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2014
Vision and hearing impairments are known to increase in middle age. In this study we describe the... more Vision and hearing impairments are known to increase in middle age. In this study we describe the prevalence of vision impairment and dual sensory impairment in UK adults aged 40-69 years in a very large and recently ascertained data set. The associations between vision impairment, age, sex, socioeconomic status, and ethnicity are reported. This research was conducted using the UK Biobank Resource, with subsets of UK Biobank data analysed with respect to self-report of eye problems and glasses use. Better-eye visual acuity with habitually worn refractive correction was assessed with a logMAR chart (n = 116,682). Better-ear speech reception threshold was measured with an adaptive speech in noise test, the Digit Triplet Test (n = 164,770). Prevalence estimates were weighted with respect to UK 2001 Census data. Prevalence of mild visual impairment (VA >0.1 logMAR (6/7.5, 20/25) and ≥0.48 (6/18, 20/60)) and low vision (VA >0.48 (6/18, 20/60) and ≥1.3 (6/120, 20/400)) was estimated...
Healthy hearing depends on sensitive ears and adequate brain processing. Essential aspects of bot... more Healthy hearing depends on sensitive ears and adequate brain processing. Essential aspects of both hearing and cognition decline with advancing age, but it is largely unknown how one influences the other. The current standard measure of hearing, the pure-tone audiogram is not very cognitively demanding and does not predict well the most important yet challenging use of hearing, listening to speech in noisy environments. We analysed data from UK Biobank that asked 40-69 year olds about their hearing, and assessed their ability on tests of speech-in-noise hearing and cognition. About half a million volunteers were recruited through NHS registers. Respondents completed 'whole-body' testing in purpose-designed, community-based test centres across the UK. Objective hearing (spoken digit recognition in noise) and cognitive (reasoning, memory, processing speed) data were analysed using logistic and multiple regression methods. Speech hearing in noise declined exponentially with age...
The impact of dietary factors on tinnitus has received limited research attention, despite being ... more The impact of dietary factors on tinnitus has received limited research attention, despite being a considerable concern among people with tinnitus and clinicians. The objective was to examine the link between dietary factors and presence and severity of tinnitus. This study used the UK Biobank resource, a large cross-sectional study of adults aged 40-69. 171,722 eligible participants were asked questions specific to tinnitus (defined as noises such as ringing or buzzing in the head or ears). Dietary factors included portions of fruit and vegetables per day, weekly fish consumption (oily and non-oily), bread type, cups of caffeinated coffee per day, and avoidance of dairy, eggs, wheat and sugar. We controlled for lifestyle, noise exposure, hearing, personality and comorbidity factors. Persistent tinnitus, defined as present at least a lot of the time, was elevated with increased: (i) fruit/vegetable intake (OR = 1.01 per portion/day), (ii) bread (wholemeal/wholegrain, OR = 1.07; othe...
Objectives/Hypothesis: Age-related hearing loss has a genetic component, but there have been limi... more Objectives/Hypothesis: Age-related hearing loss has a genetic component, but there have been limited genetic studies in this field. Both N-acetyltransferase 2 and apolipoprotein E genes have previously been associated. However, these studies have either used small sample sizes, examined a limited number of polymorphisms, or have produced conflicting results. Here we use a haplotype tagging approach to determine association with age-related hearing loss and investigate epistasis between these two genes.
Following previous research suggesting hearing-aid experience may induce functional plasticity at... more Following previous research suggesting hearing-aid experience may induce functional plasticity at the peripheral level of the auditory system, click-evoked auditory brainstem response was recorded at first fitting and 12 weeks after hearing-aid use by unilateral and bilateral hearing-aid users. A control group of experienced hearing-aid users was tested over a similar time scale. No significant alterations in auditory brainstem response latency or amplitude were identified in any group. This does not support the hypothesis of plastic changes in the peripheral auditory system induced by hearing-aid use for 12 weeks.
The Journal of the Acoustical Society of America, 2013
Spatial release from masking (SRM) was tested within the first week of fitting and after 12 weeks... more Spatial release from masking (SRM) was tested within the first week of fitting and after 12 weeks hearing aid use for unilateral and bilateral adult hearing aid users. A control group of experienced hearing aid users completed testing over a similar time frame. The main research aims were i) to examine auditory acclimatization effects on SRM performance for unilateral and bilateral hearing aid users, ii) to examine whether hearing aid use, level of hearing loss, age or cognitive ability mediate acclimatization, and iii) to compare and contrast the outcome of unilateral versus bilateral aiding on SRM. Hearing aid users were tested with and without hearing aids, with SRM calculated as the 50% speech recognition threshold advantage when maskers and target are spatially separated at +/-90 o azimuth to the listener compared to a co-located condition. The conclusions were i) on average there was no improvement over time in familiar aided listening conditions, ii) there was large testretest variability which may overshadow small average acclimatization effects; greater improvement was associated with better cognitive ability and younger age, but not associated with hearing aid use, iii) overall, bilateral aids facilitated better SRM performance than unilateral aids.
Objective: There is growing interest in the concepts of listening effort and fatigue associated w... more Objective: There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity refl ects both the relative immaturity of the fi eld and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. Design: This discussion paper provides working defi nitions for listening effort and listeningrelated fatigue. Using these defi nitions as a framework, methodologies to assess these constructs are reviewed. Results: Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. Conclusion: We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue.
The SCAN-C is a test for auditory processing disorders in children developed in the USA. There ar... more The SCAN-C is a test for auditory processing disorders in children developed in the USA. There are concerns that the SCAN-C may over diagnose auditory processing disorder in UK children. There are also questions concerning the impact of language level and interpretation of SCAN-C results. SCAN-C results from 99 Oxfordshire school children aged 6 to 10 were compared to US-based normative data. Across all age bands, the UK sample scored significantly worse on two subtests: the Filtered Words (FW) and
Objective: To report population-based prevalence of hearing impairment based on speech 18 recogni... more Objective: To report population-based prevalence of hearing impairment based on speech 18 recognition in noise testing in a large and inclusive sample of UK adults aged 40 to 69 years. 19
Objective: Auditory processing disorder (APD) is diagnosed on the basis of listening difficulties... more Objective: Auditory processing disorder (APD) is diagnosed on the basis of listening difficulties despite normal audiogram, although the cause is unknown. This study examined the hypothesis that the underlying cause of APD is a modality-specific deficit in auditory temporal processing and also considered how far the auditory impairments in APD differ from those in children with dyslexia.
The SCAN-C is a test for auditory processing disorders in children developed in the USA. There ar... more The SCAN-C is a test for auditory processing disorders in children developed in the USA. There are concerns that the SCAN-C may over diagnose auditory processing disorder in UK children. There are also questions concerning the impact of language level and interpretation of SCAN-C results. SCAN-C results from 99 Oxfordshire school children aged 6 to 10 were compared to US-based normative data. Across all age bands, the UK sample scored significantly worse on two subtests: the Filtered Words (FW) and
To clarify the impact of hearing aids on mental health, social engagement, cognitive function, an... more To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. We assessed hearing handicap (hearing handicap inventory for the elderly; HHIE-S), cognition (mini mental state exam, trail making, auditory verbal learning, digit-symbol substitution, verbal fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities), and mental health (SF-12 mental component) at baseline, five years prior to baseline, and five and 11 years after baseline. Community-dwelling older adults with hearing impairment (N = 666) from the epidemiology of hearing loss study cohort. There were no significant differences between hearing-aid users and non-users in cognitive, social engagement, or mental health outcomes at any time point. Aided HHIE-S was significa...
Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite ... more Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite a normal audiogram. APD is becoming ever more widely diagnosed in children, though there is a controversy over definition, diagnosis and aetiology. This study sought to describe presenting features and investigate aeitological factors for children diagnosed with APD compared to those for whom APD was excluded. Methods: Medical notes for children referred to a specialist hospital-based APD clinic were reviewed in relation to presenting features and potential aetiological factors. Results: 32 children diagnosed with APD and 57 non-APD children were compared. They reported similar symptoms and similarly had high rates of co-morbid learning problems. No aetiological factor (including history of otitis media, adverse obstetric history or familial history of listening problems) predicted APD group membership. Conclusions: Children identified with APD on the basis of commonly used APD tests cannot be distinguished on the basis of presenting features or the aetiological factors examined here. One explanation is that learning problems exist independently of auditory processing difficulties and the aetiological factors do not have a strong causal role in APD. However, no gold standard for APD testing exists and an alternative explanation is that the commonly used APD tests used as selection criteria in this study may be unreliable. #
The Journal of the Acoustical Society of America, 2014
The aim of this study was to investigate changes in central auditory processing following unilate... more The aim of this study was to investigate changes in central auditory processing following unilateral and bilateral hearing aid fitting using a combination of physiological and behavioral measures: late auditory event-related potentials (ERPs) and speech recognition in noise, respectively. The hypothesis was that for fitted ears, the ERP amplitude would increase over time following hearing aid fitting in parallel with improvement in aided speech recognition. The N1 and P2 ERPs were recorded to 500 and 3000 Hz tones presented at 65, 75, and 85 dB sound pressure level to either the left or right ear. New unilateral and new bilateral hearing aid users were tested at the time of first fitting and after 12 weeks hearing aid use. A control group of long-term hearing aid users was tested over the same time frame. No significant changes in the ERP were observed for any group. There was a statistically significant 2% improvement in aided speech recognition over time for all groups, although this was consistent with a general test-retest effect. This study does not support the existence of an acclimatization effect observable in late ERPs following 12 weeks' hearing aid use.
International Journal of Pediatric Otorhinolaryngology, 2008
Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite ... more Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite a normal audiogram. APD is becoming ever more widely diagnosed in children, though there is a controversy over definition, diagnosis and aetiology. This study sought to describe presenting features and investigate aeitological factors for children diagnosed with APD compared to those for whom APD was excluded. Methods: Medical notes for children referred to a specialist hospital-based APD clinic were reviewed in relation to presenting features and potential aetiological factors. Results: 32 children diagnosed with APD and 57 non-APD children were compared. They reported similar symptoms and similarly had high rates of co-morbid learning problems. No aetiological factor (including history of otitis media, adverse obstetric history or familial history of listening problems) predicted APD group membership. Conclusions: Children identified with APD on the basis of commonly used APD tests cannot be distinguished on the basis of presenting features or the aetiological factors examined here. One explanation is that learning problems exist independently of auditory processing difficulties and the aetiological factors do not have a strong causal role in APD. However, no gold standard for APD testing exists and an alternative explanation is that the commonly used APD tests used as selection criteria in this study may be unreliable. #
Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2014
Vision and hearing impairments are known to increase in middle age. In this study we describe the... more Vision and hearing impairments are known to increase in middle age. In this study we describe the prevalence of vision impairment and dual sensory impairment in UK adults aged 40-69 years in a very large and recently ascertained data set. The associations between vision impairment, age, sex, socioeconomic status, and ethnicity are reported. This research was conducted using the UK Biobank Resource, with subsets of UK Biobank data analysed with respect to self-report of eye problems and glasses use. Better-eye visual acuity with habitually worn refractive correction was assessed with a logMAR chart (n = 116,682). Better-ear speech reception threshold was measured with an adaptive speech in noise test, the Digit Triplet Test (n = 164,770). Prevalence estimates were weighted with respect to UK 2001 Census data. Prevalence of mild visual impairment (VA >0.1 logMAR (6/7.5, 20/25) and ≥0.48 (6/18, 20/60)) and low vision (VA >0.48 (6/18, 20/60) and ≥1.3 (6/120, 20/400)) was estimated...
Healthy hearing depends on sensitive ears and adequate brain processing. Essential aspects of bot... more Healthy hearing depends on sensitive ears and adequate brain processing. Essential aspects of both hearing and cognition decline with advancing age, but it is largely unknown how one influences the other. The current standard measure of hearing, the pure-tone audiogram is not very cognitively demanding and does not predict well the most important yet challenging use of hearing, listening to speech in noisy environments. We analysed data from UK Biobank that asked 40-69 year olds about their hearing, and assessed their ability on tests of speech-in-noise hearing and cognition. About half a million volunteers were recruited through NHS registers. Respondents completed 'whole-body' testing in purpose-designed, community-based test centres across the UK. Objective hearing (spoken digit recognition in noise) and cognitive (reasoning, memory, processing speed) data were analysed using logistic and multiple regression methods. Speech hearing in noise declined exponentially with age...
The impact of dietary factors on tinnitus has received limited research attention, despite being ... more The impact of dietary factors on tinnitus has received limited research attention, despite being a considerable concern among people with tinnitus and clinicians. The objective was to examine the link between dietary factors and presence and severity of tinnitus. This study used the UK Biobank resource, a large cross-sectional study of adults aged 40-69. 171,722 eligible participants were asked questions specific to tinnitus (defined as noises such as ringing or buzzing in the head or ears). Dietary factors included portions of fruit and vegetables per day, weekly fish consumption (oily and non-oily), bread type, cups of caffeinated coffee per day, and avoidance of dairy, eggs, wheat and sugar. We controlled for lifestyle, noise exposure, hearing, personality and comorbidity factors. Persistent tinnitus, defined as present at least a lot of the time, was elevated with increased: (i) fruit/vegetable intake (OR = 1.01 per portion/day), (ii) bread (wholemeal/wholegrain, OR = 1.07; othe...
Objectives/Hypothesis: Age-related hearing loss has a genetic component, but there have been limi... more Objectives/Hypothesis: Age-related hearing loss has a genetic component, but there have been limited genetic studies in this field. Both N-acetyltransferase 2 and apolipoprotein E genes have previously been associated. However, these studies have either used small sample sizes, examined a limited number of polymorphisms, or have produced conflicting results. Here we use a haplotype tagging approach to determine association with age-related hearing loss and investigate epistasis between these two genes.
Following previous research suggesting hearing-aid experience may induce functional plasticity at... more Following previous research suggesting hearing-aid experience may induce functional plasticity at the peripheral level of the auditory system, click-evoked auditory brainstem response was recorded at first fitting and 12 weeks after hearing-aid use by unilateral and bilateral hearing-aid users. A control group of experienced hearing-aid users was tested over a similar time scale. No significant alterations in auditory brainstem response latency or amplitude were identified in any group. This does not support the hypothesis of plastic changes in the peripheral auditory system induced by hearing-aid use for 12 weeks.
The Journal of the Acoustical Society of America, 2013
Spatial release from masking (SRM) was tested within the first week of fitting and after 12 weeks... more Spatial release from masking (SRM) was tested within the first week of fitting and after 12 weeks hearing aid use for unilateral and bilateral adult hearing aid users. A control group of experienced hearing aid users completed testing over a similar time frame. The main research aims were i) to examine auditory acclimatization effects on SRM performance for unilateral and bilateral hearing aid users, ii) to examine whether hearing aid use, level of hearing loss, age or cognitive ability mediate acclimatization, and iii) to compare and contrast the outcome of unilateral versus bilateral aiding on SRM. Hearing aid users were tested with and without hearing aids, with SRM calculated as the 50% speech recognition threshold advantage when maskers and target are spatially separated at +/-90 o azimuth to the listener compared to a co-located condition. The conclusions were i) on average there was no improvement over time in familiar aided listening conditions, ii) there was large testretest variability which may overshadow small average acclimatization effects; greater improvement was associated with better cognitive ability and younger age, but not associated with hearing aid use, iii) overall, bilateral aids facilitated better SRM performance than unilateral aids.
Objective: There is growing interest in the concepts of listening effort and fatigue associated w... more Objective: There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity refl ects both the relative immaturity of the fi eld and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. Design: This discussion paper provides working defi nitions for listening effort and listeningrelated fatigue. Using these defi nitions as a framework, methodologies to assess these constructs are reviewed. Results: Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. Conclusion: We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue.
The SCAN-C is a test for auditory processing disorders in children developed in the USA. There ar... more The SCAN-C is a test for auditory processing disorders in children developed in the USA. There are concerns that the SCAN-C may over diagnose auditory processing disorder in UK children. There are also questions concerning the impact of language level and interpretation of SCAN-C results. SCAN-C results from 99 Oxfordshire school children aged 6 to 10 were compared to US-based normative data. Across all age bands, the UK sample scored significantly worse on two subtests: the Filtered Words (FW) and
Objective: To report population-based prevalence of hearing impairment based on speech 18 recogni... more Objective: To report population-based prevalence of hearing impairment based on speech 18 recognition in noise testing in a large and inclusive sample of UK adults aged 40 to 69 years. 19
Objective: Auditory processing disorder (APD) is diagnosed on the basis of listening difficulties... more Objective: Auditory processing disorder (APD) is diagnosed on the basis of listening difficulties despite normal audiogram, although the cause is unknown. This study examined the hypothesis that the underlying cause of APD is a modality-specific deficit in auditory temporal processing and also considered how far the auditory impairments in APD differ from those in children with dyslexia.
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