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BACKGROUND: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. OBJECTIVE: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. METHODS: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. RESULTS: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. CONCLUSIONS: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician.

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OBJECTIVES: Some adults experience challenges in successfully communicating their listening difficulties to their audiologist, and report feeling that they are not always listened to or understood. This project examined adults' recollections of discussions with their audiologist to explore (1) how adults report describing their listening difficulties and (2) information that adults report they do not communicate, or do not communicate successfully, to their audiologist. DESIGN: Individual semi-structured interviews were conducted. Interview transcripts were analysed using a template analysis approach. STUDY SAMPLE: Fifteen adults who self-report listening difficulties, and who had previously consulted an audiologist. RESULTS: Four themes were identified from adults' recollections of how they describe their listening difficulties: (1) situation or context of listening difficulties, (2) behavioural responses, (3) impacts of listening difficulties and (4) contributing factors. Adults report not always successfully communicating (1) emotional concerns and impacts, (2) descriptions of sound quality and (3) descriptions of changed listening experiences. CONCLUSION: Results provide insights about the times when adults feel that communication with their audiologist is successful, or unsuccessful. The results are useful for informing interventions to help adults and audiologists communicate more effectively together. To further inform interventions, factors affecting adults' communication should be explored.

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OBJECTIVE: This study aimed to investigate the validity and reliability of the Turkish version of the Children's Home Inventory for Listening Difficulties - (C.H.I.L.D) questionnaire. METHODS: The study included 121 children with cochlear implants and their families aged 3-12 years and 171 children with normal hearing and their families. Confirmatory factor analysis (C.F.A.) was used to assess construct validity, Cronbach's alpha was used to analyze internal consistency and test-retest reliability was also investigated. RESULTS: The reliability coefficients of the entire C.H.I.L.D family member (C.H.I.L.D-FM) and children version (C.H.I.L.D-C) were 0.983, 0.978, and Cronbach's coefficients were 0.992, 0.992, and the corrected item-total correlations increased from 0.989 to 0.994 and from 0.988 to 0.994, respectively. The scale's construct validity was excellent, according to the CFA analyses. The goodness-of-fit indexes (for the parent's version 0.892 and for the child's version 0.867) demonstrated a good fit for the single-factor construct, with only the normed fit index revealing an acceptable fit. CONCLUSION: The Turkish version of the C.H.I.L.D is a reliable and valid evaluation test for children and their family members.

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BACKGROUND: Listening difficulties (LiD) present difficulties in listening and paying attention to spoken information despite normal pure tone audiometry. Endolymphatic hydrops (EH) is a common inner ear condition associated with Ménière's disease but may also be present in the asymptomatic ear. OBJECTIVES: Using magnetic resonance imaging, we investigated EH in patients with LiD and assessed whether the severity of EH was related to the results of auditory processing tests (APTs). MATERIALS AND METHODS: 111 patients with no abnormalities on pure tone audiometry, but displaying difficulties in listening, underwent evaluation through APTs and questionnaires. Upon obtaining informed consent, the inner ears of 20 consenting patients were evaluated utilizing a 3-Tesla magnetic resonance imaging. RESULTS: A higher percentage of patients diagnosed with LiD by APTs had significant EH in the cochlea and vestibule than in previously reported control cases. The percentage of correct answers in the speech-in-noise test was significantly lower in patients with than in those without significant EH. CONCLUSION AND SIGNIFICANCE: In this study, significant EH of the cochlea was associated with poor listening to noise. The presence of EH affects the functioning of the auditory processing system, even in ears that test normally on standard audiometric tests.

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BACKGROUND: Auditory processing disorders (APD) may be one of the problems experienced by children with listening difficulties (LiD). The combination of auditory behavioural and electrophysiological tests could help to provide a better understanding of the abilities/disabilities of children with LiD. The current study aimed to quantify the auditory processing abilities and function in children with LiD. METHODS: Twenty children, ten with LiD (age = 8.46; SD = 1.39) and ten typically developing (TD) (age = 9.45; SD = 1.57) participated in this study. All children were evaluated with auditory processing tests as well as with attention and phonemic synthesis tasks. Electrophysiological measures were also conducted with click and speech auditory brainstem responses (ABR). RESULTS: Children with LiD performed significantly worse than TD children for most behavioural tasks, indicating shortcomings in functional auditory processing. Moreover, the click-ABR wave I amplitude was smaller, and the speech-ABR waves D and E latencies were longer for the LiD children compared to the results of TD children. No significant difference was found when evaluating neural correlates between groups. CONCLUSIONS: Combining behavioural testing with click-ABR and speech-ABR can highlight functional and neurophysiological deficiencies in children with learning and listening issues, especially at the brainstem level.

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INTRODUCTION: Recent studies have reported poor cognition, such as attention and working memory, in adults with listening difficulties (LiD). However, they do not adequately describe the actual state of poor attention ability in adults with LiD. We examined the state of auditory attention in adults with and without LiD in tasks requiring multiple attention controls. METHODS: Twenty-one adults who had normal hearing but complained about LiD encountered during everyday life and 22 healthy controls were included. We presented a target detection task using an odd-ball format for one ear and a sentence repetition task for the other ear. In the target detection task, participants listened to the 1,000-Hz tone served as the standard stimulus, while they had to accept a 2,000-Hz tone presented as the deviant stimulus. In the sentence repetition task, short sentences were presented. The stimuli presented to them were played on a personal computer at the most comfortable level. The participants heard these stimuli through headphones. They were required to press a key for standard stimuli in the target detection task and repeat what they heard immediately in the repetition task. We compared the response accuracy for each ear task between adults with and without LiD. RESULTS: Our results showed that there were significant differences between the participant groups in the auditory dual-task under the dichotic listening situation. When examined individually, four adults with LiD had decreased scores in both the sentence repetition and target detection task, while the other nine participants showed a bias toward either task. Furthermore, the analysis of reaction time for pressing button revealed that the standard deviation of reaction time was extended in participants who scored poorly in either of the ear tasks. On the other hand, all adults without LiD were able to conduct the auditory dual-task exactly and promptly. CONCLUSION: The results suggest that adults with LiD have difficulties in appropriately allocating various cognitive abilities required for each task. We concluded that auditory attention is an important ability to conduct the auditory dual-task, and this is applicable for adults with LiD. Therefore, we believe that it is necessary to use auditory tests that require complex attentional abilities in listening, such as those required in daily life, to assess adults with LiD.

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Listening difficulties (LiD) in people who have normal audiometry are a widespread but poorly understood form of hearing impairment. Recent research suggests that childhood LiD are cognitive rather than auditory in origin. We examined decoding of sentences using a novel combination of behavioral testing and fMRI with 43 typically developing children and 42 age matched (6-13 years old) children with LiD, categorized by caregiver report (ECLiPS). Both groups had clinically normal hearing. For sentence listening tasks, we found no group differences in fMRI brain cortical activation by increasingly complex speech stimuli that progressed in emphasis from phonology to intelligibility to semantics. Using resting state fMRI, we examined the temporal connectivity of cortical auditory and related speech perception networks. We found significant group differences only in cortical connections engaged when processing more complex speech stimuli. The strength of the affected connections was related to the children's performance on tests of dichotic listening, speech-in-noise, attention, memory and verbal vocabulary. Together, these results support the novel hypothesis that childhood LiD reflects difficulties in language rather than in auditory or phonological processing.

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INTRODUCTION: Auditory challenges are both common and disruptive for autistic children and evidence suggests that listening difficulties may be linked to academic underachievement (Ashburner, Ziviani & Rodger, 2008). Such deficits may also contribute to issues with attention, behavior, and communication (Ashburner et al., 2008; Riccio, Cohen, Garrison & Smith, 2005). The present study aims to summarize the auditory challenges of autistic children with normal pure-tone hearing thresholds, and perceived listening difficulties, seen at auditory-ASD clinics in the US and Australia. METHODS: Data were compiled on a comprehensive, auditory-focused test battery in a large clinical sample of school-age autistic children with normal pure-tone hearing to date (N = 71, 6-14 years). Measures included a parent-reported auditory sensory processing questionnaire and tests of speech recognition in noise, binaural integration, attention, auditory memory and listening comprehension. Individual test performance was compared to normative data from children with no listening difficulties. RESULTS: Over 40% of patients exhibited significantly reduced speech recognition in noise and abnormal dichotic integration that were not attributed to deficits in attention. The majority of patients (86%) performed abnormally on at least one auditory measure, suggesting that functional auditory issues can exist in autistic patients despite normal pure-tone sensitivity. CONCLUSION: Including functional listening measures during audiological evaluations may improve clinicians' ability to detect and manage the auditory challenges impacting this population. Learner Outcomes: 1) Readers will be able to describe the auditory difficulties experienced by some autistic patients (ASD). 2) Readers will be able to describe clinical measures potentially useful for detecting listening difficulties in high-functioning autistic children.

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Children with auditory processing disorder (APD) experience hearing difficulties, particularly in the presence of competing sounds, despite having normal audiograms. There is considerable debate on whether APD symptoms originate from bottom-up (e.g., auditory sensory processing) and/or top-down processing (e.g., cognitive, language, memory). A related issue is that little is known about whether functional brain network topology is altered in APD. Therefore, we used resting-state functional magnetic resonance imaging data to investigate the functional brain network organization of 57 children from 8 to 14 years old, diagnosed with APD (n = 28) and without hearing difficulties (healthy control, HC; n = 29). We applied complex network analysis using graph theory to assess the whole-brain integration and segregation of functional networks and brain hub architecture. Our results showed children with APD and HC have similar global network properties -i.e., an average of all brain regions- and modular organization. Still, the APD group showed different hub architecture in default mode-ventral attention, somatomotor and frontoparietal-dorsal attention modules. At the nodal level -i.e., single-brain regions-, we observed decreased participation coefficient (PC - a measure quantifying the diversity of between-network connectivity) in auditory cortical regions in APD, including bilateral superior temporal gyrus and left middle temporal gyrus. Beyond auditory regions, PC was also decreased in APD in bilateral posterior temporo-occipital cortices, left intraparietal sulcus, and right posterior insular cortex. Correlation analysis suggested a positive association between PC in the left parahippocampal gyrus and the listening-in-spatialized-noise -sentences task where APD children were engaged in auditory perception. In conclusion, our findings provide evidence of altered brain network organization in children with APD, specific to auditory networks, and shed new light on the neural systems underlying children's listening difficulties.

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Following the outbreak of the COVID-19 pandemic, public-health measures introduced to stem the spread of the disease caused profound changes to patterns of daily-life communication. This paper presents the results of an online survey conducted to document adult cochlear-implant (CI) users' perceived listening difficulties under four communication scenarios commonly experienced during the pandemic, specifically when talking: with someone wearing a facemask, under social/physical distancing guidelines, via telephone, and via video call. Results from ninety-four respondents indicated that people considered their in-person listening experiences in some common everyday scenarios to have been significantly worsened by the introduction of mask-wearing and physical distancing. Participants reported experiencing an array of listening difficulties, including reduced speech intelligibility and increased listening effort, which resulted in many people actively avoiding certain communication scenarios at least some of the time. Participants also found listening effortful during remote communication, which became rapidly more prevalent following the outbreak of the pandemic. Potential solutions identified by participants to ease the burden of everyday listening with a CI may have applicability beyond the context of the COVID-19 pandemic. Specifically, the results emphasized the importance of visual cues, including lipreading and live speech-to-text transcriptions, to improve in-person and remote communication for people with a CI.

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Objective: Listening difficulties in noise are common, even in those with clinically normal hearing. There is a suggestion that subjective assessment of hearing difficulties may be more closely associated with listening effort and fatigue rather than objective measures of hearing and/or speech perception. The aim of this study was to better understand these perceptual deficits and experiences of this population.Design: An exploratory survey was distributed to participants with self-reported listening-in-noise difficulties. The primary aim of the survey was to gather information about challenging listening environments, its impact, and preferred rehabilitation strategies. Secondly, responses were compared to their performance on behavioural tasks.Study sample: Fifty adults aged 33-55 (22 females, with normal or near-normal hearing thresholds), completed the survey, and 45 of these performed behavioural tasks.Results: Background noise with conversational content was the most common source of hearing difficulties. Participants expended higher concentration and attention when communicating in noise, and correlations with previously published behavioural data was reported. Social impacts varied, few had sought treatment, and respondents preferred training over devices.Conclusions: Insights gained may provide clinicians and researchers with an understanding of the situations, impacts and non-auditory factors associated with listening-in-noise difficulties, and preferred rehabilitation for these clients.

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OBJECTIVES: This study examined the subjective psychological and social effects of highly asymmetric hearing loss (single-sided deafness [SSD]) in adults. DESIGN: Three group interviews were conducted using the critical incident technique and analysed using an inductive thematic analysis. STUDY SAMPLE: Eight adults with a clinical diagnosis of a moderately severe hearing loss or greater in one ear and normal or near-normal hearing in the other ear. RESULTS: A range of functional hearing difficulties associated with SSD including impaired speech in background noise and reduced spatial awareness were reported to affect social and psychological well-being. Social consequences of SSD resulted from activity limitations and participation restrictions including withdrawal from and within situations. Participants reported psychological effects including worrying about losing the hearing in their other ear, embarrassment related to the social stigma attached to hearing loss and reduced confidence and belief in their abilities to participate. CONCLUSIONS: Single-sided deafness can be associated with many negative consequences. Counselling may help overcome the psychological consequences of hearing loss regardless of whether technological support such as a hearing aid is prescribed. The audiological management of these individuals should support the development of listening strategies and set appropriate expectations for participation in everyday listening situations.

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Current notions of "hearing impairment," as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as "Auditory Processing Disorder" (APD) or "Central Auditory Processing Disorder" is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus.

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OBJECTIVE: This paper explores the pass or fail cut-off criteria, the number of test fails, and the nature of tests that are most appropriate in predicting listening difficulties (LiD) in children with suspected APD (SusAPD). METHODS: One hundred and nine English-speaking children (67 males, 42 females) aged between 6 and 11 years with SusAPD were assessed. The Children's Auditory Performance Scale (CHAPS) scores 2 SD below the mean were taken as markers of LiD in different listening conditions. Binary logistic regression analyses were carried out to evaluate the cut-off criterion (2 SD or 1.5 SD or 1 SD below the mean) of failing at least two tests, from the SCAN-C and IMAP test batteries, which significantly predicted LiD. Analyses were also carried out to assess if the group of auditory processing (AP) or cognitive or combination of AP plus cognitive tests were significant in predicting LiD. Receiver Operative Characteristic (ROC) curves were also explored to evaluate how the sensitivity and specificity in confirming LiD varied with the number of test fails. RESULTS: Filtered Words, Competing Words, Competing Sentences, VCV in ICRA noise, Digit Span, Sight Word Reading and the Cued Auditory Attention tests correlated with one or more of the CHAPS domains. Failing at least two of these tests 1.5 SD below the mean significantly predicted (p<.05) CHAPS Ideal scores 2 SD below the mean, and failing at least two of the tests 1 SD below the mean significantly predicted (p<.05) CHAPS Memory and CHAPS Attention scores 2 SD below the mean. The combination of AP plus cognitive tests had significantly higher ability to predict CHAPS Ideal, Memory and Attention scores, compared to the group of AP or cognitive tests separately. ROC curves showed that failing at least two of the tests was associated with the best sensitivity and specificity in predicting LiD. CONCLUSION: Of the different CHAPS domains only the CHAPS Ideal, Memory and Attention correlated with the APD tests. Failing at least two APD tests from a combination of AP and cognitive tests 1 SD and 1.5 SD below the mean, but not 2 SD, is more appropriate in confirming LiD.

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INTRODUCTION: The purpose of the present study was to identify biomarkers of listening difficulties by investigating white matter microstructure in children suspected of auditory processing disorder (APD) using diffusion tensor imaging (DTI). Behavioral studies have suggested that impaired cognitive and/or attention abilities rather than a pure sensory processing deficit underlie listening difficulties and auditory processing disorder (APD) in children. However, the neural signature of listening difficulties has not been investigated. METHODS: Twelve children with listening difficulties and atypical left ear advantage (LEA) in dichotic listening and twelve age- and gender-matched typically developing children with typical right ear advantage (REA) were tested. Using voxel-based analysis, fractional anisotropy (FA), and mean, axial and radial diffusivity (MD, AD, RD) maps were computed and contrasted between the groups. RESULTS: Listening difficulties were associated with altered white matter microstructure, reflected by decreased FA in frontal multifocal white matter regions centered in prefrontal cortex bilaterally and left anterior cingulate. Increased RD and decreased AD accounted for the decreased FA, suggesting delayed myelination in frontal white matter tracts and disrupted fiber organization in the LEA group. Furthermore, listening difficulties were associated with increased MD (with increase in both RD and AD) in the posterior limb of the internal capsule (sublenticular part) at the auditory radiations where auditory input is transmitted between the thalamus and the auditory cortex. CONCLUSIONS: Our results provide direct evidence that listening difficulties in children are associated with altered white matter microstructure and that both sensory and supramodal deficits underlie the differences between the groups.

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