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OBJECTIVE: Visual reinforcement audiometry (VRA) is a well-established behavioural test used to assess hearing in infants and young children. This scoping review aimed to summarise the evidence for different approaches to optimising and improving the effectiveness of VRA for clinical practice. DESIGN: A pre-registered scoping review was conducted. STUDY SAMPLE: Fifty-nine original articles were included in the review. RESULTS: The review identified a number of factors which improved response behaviour, such as increased variety and complexity of visual reinforcers, short reinforcer durations, and providing breaks. Intermittent conditioning, where as few as 50% of conditioning trials were rewarded, did not have an impact on response behaviour, and neither did the (suprathreshold) presentation level used during conditioning. More responses were achieved for younger (around 12 months) than older (around 18-24 months) infants. Once infants were developmentally ready to condition to play audiometry, this allowed for a more comprehensive hearing evaluation. CONCLUSIONS: VRA is a successful behavioural hearing test for most infants of developmental age around 7-24 months, with well-established protocols describing its clinical implementation. Further evidence is needed to assess potential benefits of different reinforcers, different auditory stimuli (e.g. filtered familiar sounds), and technologies to assist response detection.

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OBJECTIVE: Hearing aid use is lowest in 0-3-year-olds with hearing loss, placing spoken language development at risk. Existing interventions lack effectiveness and are typically not based on a theoretically driven, comprehensive understanding of the factors influencing infant hearing aid use. The present study is the first to address this gap in understanding. DESIGN AND STUDY SAMPLE: A 55-item online survey based on the Theoretical Domains Framework (TDF) was completed by 56 parents of 0-3-year-old hearing aid users. RESULTS: Participants reported a wide range of barriers across TDF domains, which were associated with parent-reported hearing aid use and more pronounced in parents of lower hearing aid users. The most strongly reported domains across participants were "emotion" (e.g. feelings of worry when using hearing aids), "beliefs about capabilities" (e.g. belief in ability to use hearing aids consistently), and "environmental context and resources" (e.g. child removing hearing aids). CONCLUSIONS: Parents report a wider range of barriers to infant hearing aid use than existing investigations suggest and current interventions address. Interventions would benefit from: (i) targeting a wider range of TDF domains in their design; and (ii) implementing the present TDF survey to identify and target family-specific barriers to infant hearing aid use.

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OBJECTIVES: The cortical auditory evoked potential (CAEP) test is a candidate for supplementing clinical practice for infant hearing aid users and others who are not developmentally ready for behavioral testing. Sensitivity of the test for given sensation levels (SLs) has been reported to some degree, but further data are needed from large numbers of infants within the target age range, including repeat data where CAEPs were not detected initially. This study aims to assess sensitivity, repeatability, acceptability, and feasibility of CAEPs as a clinical measure of aided audibility in infants. DESIGN: One hundred and three infant hearing aid users were recruited from 53 pediatric audiology centers across the UK. Infants underwent aided CAEP testing at age 3 to 7 months to a mid-frequency (MF) and (mid-)high-frequency (HF) synthetic speech stimulus. CAEP testing was repeated within 7 days. When developmentally ready (aged 7-21 months), the infants underwent aided behavioral hearing testing using the same stimuli, to estimate the decibel (dB) SL (i.e., level above threshold) of those stimuli when presented at the CAEP test sessions. Percentage of CAEP detections for different dB SLs are reported using an objective detection method (Hotellings T 2 ). Acceptability was assessed using caregiver interviews and a questionnaire, and feasibility by recording test duration and completion rate. RESULTS: The overall sensitivity for a single CAEP test when the stimuli were ≥0 dB SL (i.e., audible) was 70% for the MF stimulus and 54% for the HF stimulus. After repeat testing, this increased to 84% and 72%, respectively. For SL >10 dB, the respective MF and HF test sensitivities were 80% and 60% for a single test, increasing to 94% and 79% for the two tests combined. Clinical feasibility was demonstrated by an excellent >99% completion rate, and acceptable median test duration of 24 minutes, including preparation time. Caregivers reported overall positive experiences of the test. CONCLUSIONS: By addressing the clinical need to provide data in the target age group at different SLs, we have demonstrated that aided CAEP testing can supplement existing clinical practice when infants with hearing loss are not developmentally ready for traditional behavioral assessment. Repeat testing is valuable to increase test sensitivity. For clinical application, it is important to be aware of CAEP response variability in this age group.

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OBJECTIVE: To understand the impact of face coverings on hearing and communication. DESIGN: An online survey consisting of closed-set and open-ended questions distributed within the UK to gain insights into experiences of interactions involving face coverings, and of the impact of face coverings on communication. SAMPLE: Four hundred and sixty members of the general public were recruited via snowball sampling. People with hearing loss were intentionally oversampled to more thoroughly assess the effect of face coverings in this group. RESULTS: With few exceptions, participants reported that face coverings negatively impacted hearing, understanding, engagement, and feelings of connection with the speaker. Impacts were greatest when communicating in medical situations. People with hearing loss were significantly more impacted than those without hearing loss. Face coverings impacted communication content, interpersonal connectedness, and willingness to engage in conversation; they increased anxiety and stress, and made communication fatiguing, frustrating and embarrassing - both as a speaker wearing a face covering, and when listening to someone else who is wearing one. CONCLUSIONS: Face coverings have far-reaching impacts on communication for everyone, but especially for people with hearing loss. These findings illustrate the need for communication-friendly face-coverings, and emphasise the need to be communication-aware when wearing a face covering.

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The aim of this study was to assess the suitability of using cortical auditory evoked potentials (CAEPs) as an objective tool for predicting behavioral hearing thresholds in cochlear implant (CI) users. Nine experienced adult CI users of Cochlear(™) devices participated. Behavioral thresholds were measured in CI users across apical, mid and basal electrodes. CAEPs were measured for the same stimuli (50 ms pulse trains of 900-pps rate) at a range of input levels across the individual's psychophysical dynamic range (DR). Amplitude growth functions using global field power (GFP) were plotted, and from this the CAEP thresholds were extrapolated and compared to the behavioral thresholds. Increased amplitude and decreased latency of the N1-P2 response was seen with increasing input level. A strong correlation was found between CAEP and behavioral thresholds (r = 0.93), implying that the cortical response may be more useful as an objective programming tool for cochlear implants than the auditory nerve response.

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Perception of a target voice in the presence of a competing talker, of same or different gender as the target, was investigated in cochlear implant users, in implant-alone and bimodal (acoustic hearing in the non-implanted ear) conditions. Recordings of two male and two female talkers acted as targets and maskers, to investigate whether bimodal benefit increased for different compared to same gender target/maskers due to increased ability to perceive and utilize fundamental frequency and spectral-shape differences. In both listening conditions participants showed benefit of target/masker gender difference. There was an overall bimodal benefit, which was independent of target/masker gender difference.

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This study investigated which acoustic cues within the speech signal are responsible for bimodal speech perception benefit. Seven cochlear implant (CI) users with usable residual hearing at low frequencies in the non-implanted ear participated. Sentence tests were performed in near-quiet (some noise on the CI side to reduce scores from ceiling) and in a modulated noise background, with the implant alone and with the addition, in the hearing ear, of one of four types of acoustic signals derived from the same sentences: (1) a complex tone modulated by the fundamental frequency (F0) and amplitude envelope contours; (2) a pure tone modulated by the F0 and amplitude contours; (3) a noise-vocoded signal; (4) unprocessed speech. The modulated tones provided F0 information without spectral shape information, whilst the vocoded signal presented spectral shape information without F0 information. For the group as a whole, only the unprocessed speech condition provided significant benefit over implant-alone scores, in both near-quiet and noise. This suggests that, on average, F0 or spectral cues in isolation provided limited benefit for these subjects in the tested listening conditions, and that the significant benefit observed in the full-signal condition was derived from implantees' use of a combination of these cues.

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