Publications by authors named "André Goedegebure"

64 Publications

Language lateralization in very preterm children: associating dichotic listening to interhemispheric connectivity and language performance.

Pediatr Res 2021 Aug 18. Epub 2021 Aug 18.

Division of Neonatology, Department of Pediatrics at UMCU-Wilhelmina Children's Hospital, Utrecht, Netherlands.

Background: Language difficulties of very preterm (VPT) children might be related to weaker cerebral hemispheric lateralization of language. Language lateralization refers to the development of an expert region for language processing in the left hemisphere during the first years of life. Children born VPT might not develop such a dominant left hemisphere for language processing. A dichotic listening task may be a functional task to show the dominance of the left hemisphere during language processing. During this task, different acoustic events are simultaneously presented to both ears. Due to crossing fibers in the brain, right ear stimuli are transferred directly to the left hemisphere, and left ear stimuli are transferred first to the right hemisphere and then, through the corpus callosum (CC), to the left hemisphere. Dichotic listening typically shows a right ear advantage, assuming to reflect left hemispherical language dominance. The CC, in particular the splenium, is associated with auditory processing and is considered important for language lateralization. The objective of this work was to explore whether dichotic listening performance in school-aged VPT children are associated with language performance and interhemispheric connectivity.

Methods: This is a cross-sectional study of 58 VPT children and 30 full term controls at age 10 years. Language performance and dichotic digit test (DDT) were assessed. In 44 VPT children, additionally diffusion weighted imaging (DWI) was performed using a 3 T MRI scanner. Fractional anisotropy (FA) and mean diffusivity (MD) values of the splenium of the CC were extracted.

Results: Poorer right ear DDT scores were associated with poorer language performance in VPT children only (p = 0.015). Association between right ear DDT scores and MD of the splenium approached the level of significance (p = 0.051).

Conclusions: These results support the hypothesis that poor language performance in VPT children may be a consequence of weaker lateralized language organization, due to a poorly developed splenium of the CC. Dichotic listening may reflect the level of language lateralization in VPT children.

Impact: Poor language performance in VPT children may be a consequence of weaker lateralized language organization, due to a poorly developed splenium of the CC. Dichotic listening performance may reflect the level of language lateralization in VPT children and right ear scores of a dichotic listening task are associated with both the splenium of the corpus callosum and language performance. If our results could be validated in future research, it suggests that poor CC development may indicate VPT children at risk for long-term language problems.
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http://dx.doi.org/10.1038/s41390-021-01671-8DOI Listing
August 2021

Correction to: A smartphone application to objectively monitor music listening habits in adolescents.

J Otolaryngol Head Neck Surg 2021 Aug 12;50(1):50. Epub 2021 Aug 12.

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

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http://dx.doi.org/10.1186/s40463-021-00532-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361637PMC
August 2021

Macrolide-associated ototoxicity: a cross-sectional and longitudinal study to assess the association of macrolide use with tinnitus and hearing loss.

J Antimicrob Chemother 2021 Sep;76(10):2708-2716

Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.

Background: Macrolides are widely prescribed antibiotics for many different indications. However, there are concerns about adverse effects such as ototoxicity.

Objectives: To investigate whether macrolide use is associated with tinnitus and hearing loss in the general population.

Methods: Cross-sectional (n = 4286) and longitudinal (n = 636) analyses were performed within the population-based Rotterdam Study. We investigated with multivariable logistic regression models the association between macrolides and tinnitus, and with multivariable linear regression models the association between macrolides and two different hearing thresholds (both ears, averaged over 0.25, 0.5, 1, 2, 4 and 8 kHz and 2, 4 and 8 kHz). Both regression models were adjusted for age, sex, systolic blood pressure, alcohol, smoking, BMI, diabetes, education level, estimated glomerular filtration rate and other ototoxic or tinnitus-generating drugs. Cumulative exposure to macrolides was categorized according to the number of dispensed DDDs and duration of action.

Results: In the fully adjusted model, ever use of macrolides was associated with a 25% higher likelihood of prevalent tinnitus (OR = 1.25; 95% CI 1.07-1.46). This association was more prominent in participants with a cumulative dose of more than 14 DDDs and among users of intermediate- or long-acting macrolides. Macrolide use in between both assessments was associated with more than a 2-fold increased risk on incident tinnitus. No general association between macrolides and hearing loss was observed. A borderline significant higher hearing threshold in very recent users (≤3 weeks) was found.

Conclusions: Macrolide use was significantly associated with both prevalent and incident tinnitus. Macrolide-associated tinnitus was likely cumulative dose-dependent.
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http://dx.doi.org/10.1093/jac/dkab232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446930PMC
September 2021

Cross-sectional and Longitudinal Associations Between Tinnitus and Mental Health in a Population-Based Sample of Middle-aged and Elderly Persons.

JAMA Otolaryngol Head Neck Surg 2021 Aug;147(8):708-716

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.

Importance: Tinnitus is a common disorder, but its impact on daily life varies widely in population-based samples. It is unclear whether this interference in daily life is associated with mental health problems that are commonly detected in clinical populations.

Objective: To investigate the association of tinnitus and its interference in daily life with symptoms of depression and anxiety and poor sleep quality in a population-based sample of middle-aged and elderly persons in a cross-sectional analysis and during a 4-year follow-up.

Design, Setting, And Participants: This cohort study evaluated data from the population-based Rotterdam Study of individuals 40 years or older living in Rotterdam, the Netherlands. Between 2011 and 2016, data on tinnitus were obtained during a home interview at least once for 6128 participants. Participants with information on depressive and anxiety symptoms and self-rated sleep quality, with Mini-Mental State Examination scores indicating unimpaired cognition, and with repeatedly obtained tinnitus and mental health outcome data were included. Data analyses were conducted between September 2019 and April 2020.

Main Outcomes And Measures: The presence of tinnitus and its interference with daily life were assessed during a home interview. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression, anxiety symptoms with the Hospital Anxiety and Depression Scale, and sleep quality with the Pittsburgh Sleep Quality Index. Linear regression analyses and linear mixed models adjusted for relevant confounders were used to assess the cross-sectional and longitudinal association of tinnitus with mental health.

Results: Of 5418 complete-case participants (mean [SD] age, 69.0 [9.8] years; 3131 [57.8%] women), 975 (mean [SD] age, 71.7 [4.5] years; 519 [53.2%] women) had repeated measurements available for follow-up analyses. Compared with participants without tinnitus and participants with nonbothersome tinnitus, participants with tinnitus interfering with daily life reported more depressive (difference, 0.20; 95% CI, 0.11-0.28) and anxiety (difference, 0.15; 95% CI, 0.08-0.22) symptoms and poorer sleep quality (difference, 0.10; 95% CI, 0.03-0.16). Compared with participants without tinnitus, participants with nonbothersome tinnitus also reported more depressive (difference, 0.06; 95% CI, 0.03-0.09) and anxiety (difference, 0.05; 95% CI, 0.02-0.07) symptoms and poorer sleep quality (difference, 0.05; 95% CI, 0.03-0.08). Individuals indicating more interference with daily life reported having more mental health problems. During a mean follow-up of 4.4 years (range, 3.5-5.1 years), participants with tinnitus reported more anxiety symptoms and poorer sleep quality than those without tinnitus.

Conclusions And Relevance: Findings of this population-based cohort study indicate that tinnitus was associated with more mental health problems in middle-aged and elderly persons in the general population, in particular when tinnitus interfered with daily life but not solely. Over time, more severe tinnitus was associated with an increase in anxiety symptoms and poor sleep quality. This outcome suggests that mental health problems may be part of the burden of tinnitus, even among individuals who do not report their tinnitus interfering with daily life.
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http://dx.doi.org/10.1001/jamaoto.2021.1049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193541PMC
August 2021

Tinnitus and Its Central Correlates: A Neuroimaging Study in a Large Aging Population.

Ear Hear 2021 03 26;42(5):1428-1435. Epub 2021 Mar 26.

Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Objectives: To elucidate the association between tinnitus and brain tissue volumes and white matter microstructural integrity.

Design: Two thousand six hundred sixteen participants (mean age, 65.7 years [SD: 7.5 years]; 53.9% female) of the population-based Rotterdam Study underwent tinnitus assessment (2011 to 2014) and magnetic resonance imaging of the brain (2011 to 2014). Associations between tinnitus (present versus absent) and total, gray, and white matter volume and global white matter microstructure were assessed using multivariable linear regression models adjusting for demographic factors, cardiovascular risk factors, depressive symptoms, Mini-Mental State Examination score, and hearing loss. Finally, potential regional gray matter density and white matter microstructural volume differences were assessed on a voxel-based level again using multivariable linear regression.

Results: Participants with tinnitus (21.8%) had significantly larger brain tissue volumes (difference in SD, 0.09; 95% confidence interval, 0.06 to 0.13), driven by larger white matter volumes (difference, 0.12; 95% confidence interval, 0.04 to 0.21) independent of hearing loss. There was no association between tinnitus and gray matter volumes nor with global white matter microstructure. On a lobar level, tinnitus was associated with larger white matter volumes in each lobe, not with gray matter volume. Voxel-based results did not show regional specificity.

Conclusions: We found that tinnitus in older adults was associated with larger brain tissue volumes, driven by larger white matter volumes, independent of age, and hearing loss. Based on these results, it may be hypothesized that tinnitus potentially has a neurodevelopmental origin in earlier life independent of aging processes.
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http://dx.doi.org/10.1097/AUD.0000000000001042DOI Listing
March 2021

Assessment of hearing screening programmes across 47 countries or regions III: provision of childhood hearing screening after the newborn period.

Int J Audiol 2021 Apr 9:1-8. Epub 2021 Apr 9.

Department of Otorhinolaryngology and Head, Neck Surgery and Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Objective: To inventory provision and features of childhood hearing screening after the newborn period (CHS), primarily in Europe.

Design: From each participating country or region, experts provided information through an extensive questionnaire: implementation year, age at screening, test method, pass criteria, screening location, screener profession, and quality indicators: coverage, referral, follow-up and detection rates, supplemented by literature sources.

Study Sample: Forty-two European countries or regions, plus Russia, Malawi, Rwanda, India, and China.

Results: CHS was performed universally with pure-tone audiometry screening (PTS) in 17 countries or regions, whereas non-universal CHS was performed in eight with PTS or whisper tests. All participating countries with universal PTS had newborn hearing screening. Coverage rate was provided from three countries, detection rate from one, and referral and follow-up rate from two. In four countries, universal PTS was performed at two ages. Earliest universal PTS was performed in a (pre)school setting by nurses ( = 9, median age: 5 years, range: 3-7), in a healthcare setting by doctors and nurses ( = 7, median age: 4.5 years, range: 4-7), or in both ( = 1).

Conclusions: Within universal CHS, PTS was mostly performed at 4-6 years by nurses. Insufficient collection of data and monitoring with quality indicators impedes evaluation of screening.
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http://dx.doi.org/10.1080/14992027.2021.1897170DOI Listing
April 2021

Assessment of hearing screening programmes across 47 countries or regions I: provision of newborn hearing screening.

Int J Audiol 2021 Mar 10:1-10. Epub 2021 Mar 10.

Department of Otorhinolaryngology and Head, Neck Surgery and Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Objectives: Newborn hearing screening (NHS) varies regarding number and type of tests, location, age, professionals and funding. We compared the provision of existing screening programmes.

Design: A questionnaire containing nine domains: demography, administration, existing screening, coverage, tests, diagnosis, treatment, cost and adverse effects, was presented to hearing screening experts. Responses were verified. Clusters were identified based on number of screening steps and use of OAE or aABR, either for all infants or for well and high-risk infants (dual-protocol).

Study Sample: Fifty-two experts completed the questionnaire sufficiently: 40 European countries, Russia, Malawi, Rwanda, India and China.

Results: It took considerable effort to find experts for all countries with sufficient time and knowledge. Data essential for evaluation are often not collected. Infants are first screened in maternity wards in most countries. Human development index and health expenditure were high among countries with dual protocols, three screening steps, including aABR, and low among countries without NHS and countries using OAE for all infants. Nationwide implementation of NHS took 6 years, on average.

Conclusion: The extent and complexity of NHS programmes are primarily related to health expenditure and HDI. Data collection should be improved to facilitate comparison of NHS programmes across borders.
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http://dx.doi.org/10.1080/14992027.2021.1886350DOI Listing
March 2021

Assessment of hearing screening programmes across 47 countries or regions II: coverage, referral, follow-up and detection rates from newborn hearing screening.

Int J Audiol 2021 Mar 9:1-10. Epub 2021 Mar 9.

CLINTEC, Karolinska Institutet, Stockholm, Sweden.

Objectives: To assess the performance of newborn hearing screening (NHS) programmes, through selected quality measures and their relationship to protocol design.

Design: NHS coverage, referral, follow-up and detection rates were aggregated. Referral rates were compared to age at screening step 1, number of steps, and test method: OAE or aABR.

Study Sample: A questionnaire on existing hearing screening was completed by experts from countries in Europe, plus Russia, Malawi, Rwanda, India and China.

Results: Out of 47 countries or regions, NHS coverage rates were reported from 26, referral rates from 23, follow up from 12 and detection rates from 13. Median coverage rate for step 1 was 96%. Referral rate from step 1 was 6-22% where screening may be performed <24 h from birth, 2-15% for >24 h, and 4% for >72 h. Referral rates to diagnostic assessment averaged 2.1% after one to two steps using OAE only, 1.7% after two steps including aABR, and 0.8% after three to four steps including aABR. Median detection rate for bilateral permanent hearing impairment ≥40dB was 1 per 1000 infants.

Conclusion: Referral rates were related to age, test method and number of screening steps. Quality measures were not available for many NHS programmes.
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http://dx.doi.org/10.1080/14992027.2021.1886351DOI Listing
March 2021

A smartphone application to objectively monitor music listening habits in adolescents : Personal listening device usage and the accuracy of self-reported listening habits.

J Otolaryngol Head Neck Surg 2021 Feb 15;50(1):11. Epub 2021 Feb 15.

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

Background: Listening to music through personal listening devices (PLDs) has become more prevalent during last decades. The aim of this study was to evaluate music listening habits through PLDs in adolescents with a smartphone application, and to assess the accuracy of self-reported listening habits.

Methods: This study was embedded in the Generation R Study, a population-based prospective birth cohort in Rotterdam, the Netherlands. A smartphone application for Android operating systems was developed to objectively monitor music listening habits for a period of 35 days. A postal questionnaire was used to subjectively assess listening habits. The level of agreement between the objectively measured and self-reported listening habits were evaluated using weighted kappa coefficients. Data were collected from May 2017 to March 2019.

Results: A total of 311 adolescents aged 12 to 15 years were included, of whom 237 (76.2%) completed the postal questionnaire. The results of the smartphone application showed that the median listening frequency was 2.1 days a week (IQR 1.0-3.4), the median listening time 21.1 min a day (IQR 9.1-53.7), and the mean listening level 54.5% (SD 18.1%). There was a slight to fair agreement between the objectively measured, and self-reported listening habits according to the weighted kappa coefficients (k = 0.179 to 0.364).

Conclusions: The results of the current study suggest that self-reported measures of listening habits are not always accurate. We consider a smartphone application to monitor listening habits of added value in future research investigating the possible damaging effects of PLDs on hearing acuity.
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http://dx.doi.org/10.1186/s40463-020-00488-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885602PMC
February 2021

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss.

Ear Hear 2021 Jul-Aug 01;42(4):973-981

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, the Netherlands.

Objectives: Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss.

Design: We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs.

Results: The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list.

Conclusion: The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.
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http://dx.doi.org/10.1097/AUD.0000000000000989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221724PMC
August 2021

Cost-Effectiveness of Neonatal Hearing Screening Programs: A Micro-Simulation Modeling Analysis.

Ear Hear 2021 Jul-Aug 01;42(4):909-916

Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.

Objectives: Early detection of neonatal hearing impairment moderates the negative effects on speech and language development. Universal neonatal hearing screening protocols vary in tests used, timing of testing and the number of stages of screening. This study estimated the cost-effectiveness of various protocols in the preparation of implementation of neonatal hearing screening in Albania.

Design: A micro-simulation model was developed using input on demography, natural history of neonatal hearing impairment, screening characteristics and treatment. Parameter values were derived from a review of the literature and expert opinion. We simulated multiple protocols using otoacoustic emissions (OAE) and automated auditory brainstem response (aABR), varying the test type, timing and number of stages. Cost-effectiveness was analyzed over a life-time horizon.

Results: The two best protocols for well infants were OAE followed by aABR (i.e., two-stage OAE-aABR) testing in the maternity ward and single-aABR testing. Incremental cost-effectiveness ratios were €4181 and €78,077 per quality-adjusted life-year gained, respectively. Single-aABR screening led to more cases being detected compared to a two-stage screening program. However, it also resulted in higher referral rates, which increased the total costs of diagnostics. Multi-staged screening decreased referral rates but may increase the number of missed cases due to false-negative test results and nonattendance.

Conclusions: Only the 2-stage OAE-aABR (maternity ward) protocol was below the willingness-to-pay threshold of €10,413 for Albania, as suggested by the World Health Organization, and was found to be cost-effective. This study is among the few to assess neonatal hearing screening programs over a life-time horizon and the first to predict the cost-effectiveness of multiple screening scenarios.
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http://dx.doi.org/10.1097/AUD.0000000000000981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221716PMC
August 2021

Prevalence of Tinnitus in an Aging Population and Its Relation to Age and Hearing Loss.

Otolaryngol Head Neck Surg 2021 04 29;164(4):859-868. Epub 2020 Sep 29.

Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

Objectives: Tinnitus is a common hearing-related disorder, which may have a large impact on daily life. With aging populations worldwide, it is important to gain insight in the occurrence of tinnitus at older ages and to understand its relationship with age-related hearing loss. We investigated the prevalence of tinnitus among a general aging population, across age strata and hearing status.

Study Design: Cross-sectional.

Setting: The population-based Rotterdam Study.

Methods: A total of 6098 participants underwent tinnitus assessment, and 4805 had additional hearing assessment. We determined tinnitus prevalence per 5-year age groups. Hearing impairment was defined as ≥25-dB HL worse ear pure tone average (0.5, 1, 2, 4 kHz). We investigated with multivariable logistic regression the association between hearing impairment and tinnitus. Tinnitus handicap was assessed in 663 participants with daily tinnitus via the Tinnitus Handicap Inventory-screening version (THI-s).

Results: Tinnitus was prevalent in 21.4% (n = 1304). Prevalent tinnitus was evenly distributed over 5-year age groups. Participants with hearing impairment were more likely to have tinnitus (odds ratio, 2.27; 95% CI, 1.92-2.69) as compared with those without hearing impairment. The median THI-s score was 4 (interquartile range, 0-10), indicating a slight handicap, and 14.6% of the participants reported a moderate or severe handicap (THI-s ≥16).

Conclusions: In a general elderly population, 1 in 5 persons has tinnitus. Of those with tinnitus, for 1 per 10 persons, the presence of tinnitus interfered with daily life. Participants with hearing impairment were twice as likely to have tinnitus. Despite the age-dependent occurrence of hearing impairment, no such age dependency was found for tinnitus.
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http://dx.doi.org/10.1177/0194599820957296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027937PMC
April 2021

Association of Speech Recognition Thresholds With Brain Volumes and White Matter Microstructure: The Rotterdam Study.

Otol Neurotol 2020 10;41(9):1202-1209

Department of Epidemiology.

Objectives: Brain volumetric declines may underlie the association between hearing loss and dementia. While much is known about the peripheral auditory function and brain volumetric declines, poorer central auditory speech processing may also be associated with decreases in brain volumes.

Methods: Central auditory speech processing, measured by the speech recognition threshold (SRT) from the Digits-in-Noise task, and neuroimaging assessments (structural magnetic resonance imaging [MRI] and fractional anisotropy and mean diffusivity from diffusion tensor imaging), were assessed cross-sectionally in 2,368 Rotterdam Study participants aged 51.8 to 97.8 years. SRTs were defined continuously and categorically by degrees of auditory performance (normal, insufficient, and poor). Brain volumes from structural MRI were assessed on a global and lobar level, as well as for specific dementia-related structures (hippocampus, entorhinal cortex, parahippocampal gyrus). Multivariable linear regression models adjusted by age, age-squared, sex, educational level, alcohol consumption, intracranial volume (MRI only), cardiovascular risk factors (hypertension, diabetes, obesity, current smoking), and pure-tone average were used to determine associations between SRT and brain structure.

Results: Poorer central auditory speech processing was associated with larger parietal lobe volume (difference in mL per dB increase= 0.24, 95% CI: 0.05, 0.42), but not with diffusion tensor imaging measures. Degrees of auditory performance were not associated with brain volumes and white matter microstructure.

Conclusions: Central auditory speech processing in the presence of both vascular burden and pure-tone average may not be related to brain volumes and white matter microstructure. Longitudinal follow-up is needed to explore these relationships thoroughly.
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http://dx.doi.org/10.1097/MAO.0000000000002739DOI Listing
October 2020

Tinnitus Affects Speech in Noise Comprehension in Individuals With Hearing Loss.

Otol Neurotol 2020 10;41(9):e1074-e1081

Department of Otorhinolaryngology, Head and Neck Surgery.

Background: Tinnitus is a prevalent auditory disorder that frequently co-occurs with hearing loss. It is suggested that tinnitus might have negative impact on speech perception. However, studies thus far have not been able to disentangle tinnitus, hearing loss, and speech in noise intelligibility. We therefore investigated whether there is an association between tinnitus and speech understanding in noise, independent of hearing loss.

Methods: Of 4,211 participants from the population-based Rotterdam Study (mean age 67.8 [SD 8.9], 57.3% female) data was available on tinnitus, pure-tone audiometry, and digits in noise test. We compared the speech reception threshold in noise (SRTn) in participants with and without tinnitus for the whole population as well as for subgroups stratified for average hearing threshold in 10-dB strata. Additionally, we regressed tinnitus on SRTn with a multivariable regression model, adjusting for sex, age, highest achieved education, and cognitive function.

Results: Participants with tinnitus (20.8%) had a higher SRTn (-3.6 dB [SD 3.7] versus -4.6 dB [SD 3.1]). This difference remained only in the subgroups of participants with hearing loss, between 0.6 and 0.8 dB difference in the SRTn for the different subgroups. In the fully adjusted model tinnitus was associated with 0.2 dB (95% CI 0.00, 0.39) SRTn increase.

Conclusion: We have shown that tinnitus is associated with speech intelligibility in noise, but it is a small effect, only found in people with co-occurring hearing loss.
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http://dx.doi.org/10.1097/MAO.0000000000002733DOI Listing
October 2020

Hearing loss and cognitive decline in the general population: a prospective cohort study.

J Neurol 2021 Mar 10;268(3):860-871. Epub 2020 Sep 10.

Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Background: Previous studies identifying hearing loss as a promising modifiable risk factor for cognitive decline mostly adjusted for baseline age solely. As such a faster cognitive decline at a higher age, which is expected considering the non-linear relationship between cognition and age, may have been overlooked. Therefore it remains uncertain whether effects of hearing loss on cognitive decline extend beyond age-related declines of cognitive function.

Methods: 3,590 non-demented participants were eligible for analysis at baseline, and a maximum of 837 participants were eligible for the longitudinal analysis. Hearing loss was defined at baseline. Cognitive function was measured at baseline and at follow-up (4.4 years [SD: 0.2]). Multivariable linear regression analysis was used for the cross-sectional analysis. Linear mixed models were used to assess the longitudinal association between hearing loss and cognitive decline over time while adjusting for confounders and the interaction of age and follow-up time.

Results: Hearing loss was associated with lower cognitive function at baseline. Moreover, hearing loss was associated with accelerated cognitive decline over time on a memory test. After additionally adjusting for the interaction between age and follow-up time, we found that hearing loss did not accelerate cognitive decline anymore.

Conclusions: Hearing loss was associated with lower cognitive function at baseline and accelerated cognitive decline on a memory test. The association between hearing loss and accelerated cognitive decline was non-significant after additional adjustment for non-linear age effects. More evidence is needed to ensure the role of hearing loss as a modifiable risk factor for cognitive decline.
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http://dx.doi.org/10.1007/s00415-020-10208-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914236PMC
March 2021

Hearing loss and microstructural integrity of the brain in a dementia-free older population.

Alzheimers Dement 2020 11 2;16(11):1515-1523. Epub 2020 Aug 2.

Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Introduction: As hearing loss has been identified as an important risk factor for dementia, we aimed to assess the association between hearing loss and microstructural integrity of the brain.

Methods: A total of 1086 dementia-free participants (mean age = 75.2 [standard deviation: 4.9], 61.4% female) of the population-based Atherosclerosis Risk in Communities (ARIC) study underwent hearing assessment (2016-2017) and magnetic resonance imaging of the brain (2011-2013). Microstructural integrity was determined with diffusion tensor imaging. Multivariable linear regression was used to investigate associations between hearing loss and microstructural integrity of different brain regions and white matter (WM) tracts.

Results: Hearing loss was associated with lower WM microstructural integrity in the temporal lobe, lower gray matter integrity of the hippocampus, and with lower WM microstructural integrity of the limbic tracts and the uncinate fasciculus.

Conclusion: Our results demonstrate that hearing loss is indepedently associated with lower microstructural integrity in brain regions that are important for different cognitive processes.
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http://dx.doi.org/10.1002/alz.12151DOI Listing
November 2020

Discrimination of degrees of auditory performance from the digits-in-noise test based on hearing status.

Int J Audiol 2020 12 16;59(12):897-904. Epub 2020 Jul 16.

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

Objective: To discriminate among degrees of auditory performance of the Digits-in-Noise (DIN) test.

Design: We performed Pearson's correlations and age- and sex-adjusted linear regression models to examine the correlation between pure-tone average (PTA) from pure-tone audiometric tests and speech recognition thresholds (SRT) from the DIN test. Then, optimal SRT cut-points by PTA-defined hearing status (0-25 dB HL [normal], 26-40 dB HL [mild hearing loss], 41-50 dB HL [moderate hearing loss]) were compared across three methods: Youden, Nearest, and Liu. SRT-defined categories of auditory performance were compared to PTA-defined hearing categories to examine the convergence of similar categories. 3422 Rotterdam Study participants aged 51-98 years between 2011 and 2014.

Results: The correlation between SRT and PTA was 0.65 (95% Confidence Interval: 0.63, 0.67) in the overall sample. The variability of SRT explained by PTA after age and sex adjustment was 54%. Optimal cut-points for the overall sample across the three methods were: ≤ -5.55 dB SNR (normal); > -5.55 to ≤ -3.80 dB SNR (insufficient performance); > -3.80 dB SNR (poor performance). When comparing the SRT- or PTA-defined categories, 59.8% had concordant hearing categories and 40.2% had discordant hearing categories.

Conclusions: Discrimination of degrees of auditory performance may add greater utility of the DIN test.
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http://dx.doi.org/10.1080/14992027.2020.1787531DOI Listing
December 2020

Objectives, design and main findings until 2020 from the Rotterdam Study.

Eur J Epidemiol 2020 May 4;35(5):483-517. Epub 2020 May 4.

Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.

The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.
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http://dx.doi.org/10.1007/s10654-020-00640-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250962PMC
May 2020

Implementation of a neonatal hearing screening programme in three provinces in Albania.

Int J Pediatr Otorhinolaryngol 2020 Jul 8;134:110039. Epub 2020 Apr 8.

Erasmus University Medical Center Rotterdam, Department of Ophthalmology, Rotterdam, the Netherlands.

Objectives: The EUSCREEN study compares the cost-effectiveness of paediatric hearing screening programmes and aims to develop a cost-effectiveness model for this purpose. Alongside and informed by the development of the model, neonatal hearing screening (NHS) is implemented in Albania. We report on the first year.

Methods: An implementation plan was made addressing objectives, target population, screening protocol, screener training, screening devices, care pathways and follow up. NHS started January 1st, 2018 in four maternity hospitals: two in Tirana, one in Pogradec and one in Kukës, representing both urban and rural areas. OAE-OAE-aABR was used to screen well infants in maternity hospitals, whereas aABR-aABR was used in neonatal intensive care units and in mountainous Kukës for all infants. Screeners' uptake and attitudes towards screening and quality of screening were assessed by distributing questionnaires and visiting the maternity hospitals. The result of screening, diagnostics, follow up and entry into early intervention were registered in a database and monitored.

Results: Screeners were keen to improve their skills in screening and considered NHS valuable for Albanian health care. The number of "fail" outcomes after the first screen was high initially but decreased to less than 10% after eight months. In 2018, 11,507 infants were born in the four participating maternity hospitals, 10,925 (94.9%) of whom were screened in the first step. For 486 infants the result of screening was not registered. For the first screen, ten parents declined, eight infants died and one infant was discharged before screening could be performed. In 1115 (10.2%) infants the test either could not be performed or the threshold was not reached; 361 (32,4%) of these did not attend the second screen. For the third screen 31 (34.4%) out of 90 did not attend. Reasons given were: parents declined (124), lived too far from screening location (95), their infant died (11), had other health issues (7), or was screened in private clinic (17), no reason given (138).

Conclusions: Implementation of NHS in Albania is feasible despite continuing challenges. Acceptance was high for the first screen. However, 32.4% of 1115 infants did not attend the second screen, after a "fail" outcome for the first test.
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http://dx.doi.org/10.1016/j.ijporl.2020.110039DOI Listing
July 2020

The relation of hearing-specific patient-reported outcome measures with speech perception measures and acceptable noise levels in cochlear implant users.

Int J Audiol 2020 06 24;59(6):416-426. Epub 2020 Feb 24.

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.

To investigate the relation of a hearing-specific patient-reported outcome measure (PROM) with speech perception and noise tolerance measurements. It was hypothesised that speech intelligibility in noise and noise tolerance may explain a larger part of the variance in PROM scores than speech intelligibility in quiet. This cross-sectional study used the Speech, Spatial, Qualities (SSQ) questionnaire as a PROM. Speech recognition in quiet, the Speech Reception Threshold in noise and noise tolerance as measured with the acceptable noise level (ANL) were measured with sentences. A group of 48 unilateral post-lingual deafened cochlear implant (CI) users. SSQ scores were moderately correlated with speech scores in quiet and noise, and also with ANLs. Speech scores in quiet and noise were strongly correlated. The combination of speech scores and ANL explained 10-30% of the variances in SSQ scores, with ANLs adding only 0-9%. The variance in the SSQ as hearing-specific PROM in CI users was not better explained by speech intelligibility in noise than by speech intelligibility in quiet, because of the remarkably strong correlation between both measures. ANLs made only a small contribution to explain the variance of the SSQ. ANLs seem to measure other aspects than the SSQ.
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http://dx.doi.org/10.1080/14992027.2020.1727033DOI Listing
June 2020

Prevalence of permanent neonatal hearing impairment: systematic review and Bayesian meta-analysis.

Int J Audiol 2020 06 3;59(6):475-485. Epub 2020 Feb 3.

Department of Otorhinolaryngology and Head and Neck Surgery and Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands.

To investigate the variance in reported prevalence rates of permanent neonatal hearing impairment (HI) worldwide. A systematic review and meta-analysis was performed on reported prevalence rates of sensorineural and permanent conductive or mixed HI worse than 40 dB in neonates, detected as a result of a screening programme or audiometric study. For meta-analysis, 35 articles were selected, 25 from high-income countries and 10 from middle-income countries according to the world bank classification system. The prevalence rate of permanent uni- and bilateral HI worse than 40 dB in neonates varied from 1 to 6 per 1000, the overall prevalence was 2.21 per 1000 [1.71, 2.8]. In NICU populations the prevalence rate was higher with a larger fraction of bilateral cases. Although not significant, prevalence rates were slightly higher in Asia compared to Europe and the number of infants lost to follow-up appeared higher in countries with lower gross national income. Substantial variations exist in prevalence rates of neonatal permanent HI across countries and regions. There is a strong need for more data from low-income countries to identify demographic factors that account for this variability in reported prevalence rates. Reporting these data in a uniform way is advocated.
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http://dx.doi.org/10.1080/14992027.2020.1716087DOI Listing
June 2020

Assessing hearing loss in older adults with a single question and person characteristics; Comparison with pure tone audiometry in the Rotterdam Study.

PLoS One 2020 27;15(1):e0228349. Epub 2020 Jan 27.

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, The Netherlands.

Introduction: Hearing loss (HL) is a frequent problem among the elderly and has been studied in many cohort studies. However, pure tone audiometry-the gold standard-is rather time-consuming and costly for large population-based studies. We have investigated if self-reported hearing loss, using a multiple choice question, can be used to assess HL in absence of pure tone audiometry.

Methods: This study was performed within 4,906 participants of the Rotterdam Study. The question (in Dutch) that was investigated was: 'Do you have any difficulty with your hearing (without hearing aids)?'. The answer options were: 'never', 'sometimes', 'often' and 'daily'. Mild hearing loss or worse was defined as PTA0.5-4(Pure Tone Average 0.5, 1, 2 & 4 kHz) ≥20dBHL and moderate HL or worse as ≥35dBHL. A univariable linear regression model was fitted with the PTA0.5-4 and the answer to the question. Subsequently, sex, age and education were added in a multivariable linear regression model. The ability of the question to classify HL, accounting for sex, age and education, was explored through logistic regression models creating prediction estimates, which were plotted in ROC curves.

Results: The variance explained (R2) by the univariable regression was 0.37, which increased substantially after adding age (R2 = 0.60). The addition of sex and educational level, however, did not alter the R2 (0.61). The ability of the question to classify hearing loss, reflected in the area under the curve (AUC), was 0.70 (95% CI 0.68, 0.71) for mild hearing loss or worse and 0.86 (95% CI 0.85, 0.87) for moderate hearing loss or worse. The AUC increased substantially when sex, education and age were taken into account (AUC mild HL: 0.73 (95%CI 0.71, 0.75); moderate HL 0.90 (95%CI 0.89, 0.91)).

Conclusion: Self-reported hearing loss using a single question has a good ability to detect hearing loss in older adults, especially when age is accounted for. A single question cannot substitute audiometry, but it can assess hearing loss on a population level with reasonable accuracy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228349PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984733PMC
April 2020

Genome-wide association meta-analysis identifies five novel loci for age-related hearing impairment.

Sci Rep 2019 10 23;9(1):15192. Epub 2019 Oct 23.

Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.

Previous research has shown that genes play a substantial role in determining a person's susceptibility to age-related hearing impairment. The existing studies on this subject have different results, which may be caused by difficulties in determining the phenotype or the limited number of participants involved. Here, we have gathered the largest sample to date (discovery n = 9,675; replication n = 10,963; validation n = 356,141), and examined phenotypes that represented low/mid and high frequency hearing loss on the pure tone audiogram. We identified 7 loci that were either replicated and/or validated, of which 5 loci are novel in hearing. Especially the ILDR1 gene is a high profile candidate, as it contains our top SNP, is a known hearing loss gene, has been linked to age-related hearing impairment before, and in addition is preferentially expressed within hair cells of the inner ear. By verifying all previously published SNPs, we can present a paper that combines all new and existing findings to date, giving a complete overview of the genetic architecture of age-related hearing impairment. This is of importance as age-related hearing impairment is highly prevalent in our ageing society and represents a large socio-economic burden.
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http://dx.doi.org/10.1038/s41598-019-51630-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811684PMC
October 2019

Carotid Atherosclerosis Is Associated With Poorer Hearing in Older Adults.

J Am Med Dir Assoc 2019 12 6;20(12):1617-1622.e1. Epub 2019 Aug 6.

Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Objectives: Cardiovascular disease may be linked to hearing loss through narrowing of the nutrient arteries of the cochlea, but large-scale population-based evidence for this association remains scarce. We investigated the association of carotid atherosclerosis as a marker of generalized cardiovascular disease with hearing loss in a population-based cohort.

Design: Cross-sectional.

Setting: A population-based cohort study.

Participants: 3724 participants [mean age: 65.5 years, standard deviation (SD): 7.5, 55.4% female].

Methods: Ultrasound and pure-tone audiograms to assess carotid atherosclerosis and hearing loss.

Results: We investigated associations of carotid plaque burden and carotid intima-media thickness (IMT) (overall and side-specific carotid atherosclerosis) with hearing loss (in the best hearing ear and side-specific hearing loss) using multivariable linear and ordinal regression models. We found that higher maximum IMT was related to poorer hearing in the best hearing ear [difference in decibel hearing level per 1-mm increase in IMT: 2.09 dB, 95% confidence interval (CI): 0.08, 4.10]. Additionally, third and fourth quartile plaque burden as compared to first quartile was related to poorer hearing in the best hearing ear (difference: 1.06 dB, 95% CI: 0.04, 2.08; and difference: 1.55 dB, 95% CI: 0.49, 2.60, respectively). Larger IMT (difference: 2.97 dB, 95% CI: 0.79, 5.14), third quartile plaque burden compared to first quartile (difference: 1.24 dB, 95% CI: 0.14, 2.35), and fourth plaque quartile compared to first quartile (difference: 2.12 dB, 95% CI: 0.98, 3.26) in the right carotid were associated with poorer hearing in the right ear.

Conclusions And Implications: Carotid atherosclerosis is associated with poorer hearing in older adults, almost exclusively with poorer hearing in the right ear. Based on our results, it seems that current therapies for the prevention of cardiovascular disease may also prove beneficial for hearing loss in older adults by promoting and maintaining inner ear health.
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http://dx.doi.org/10.1016/j.jamda.2019.06.022DOI Listing
December 2019

The Important Role of Contextual Information in Speech Perception in Cochlear Implant Users and Its Consequences in Speech Tests.

Trends Hear 2019 Jan-Dec;23:2331216519838672

1 Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

This study investigated the role of contextual information in speech intelligibility, the influence of verbal working memory on the use of contextual information, and the suitability of an ecologically valid sentence test containing contextual information, compared with a CNC (Consonant-Nucleus-Consonant) word test, in cochlear implant (CI) users. Speech intelligibility performance was assessed in 50 postlingual adult CI users on sentence lists and on CNC word lists. Results were compared with a normal-hearing (NH) group. The influence of contextual information was calculated from three different context models. Working memory capacity was measured with a Reading Span Test. CI recipients made significantly more use of contextual information in recognition of CNC words and sentences than NH listeners. Their use of contextual information in sentences was related to verbal working memory capacity but not to age, indicating that the ability to use context is dependent on cognitive abilities, regardless of age. The presence of context in sentences enhanced the sensitivity to differences in sensory bottom-up information but also increased the risk of a ceiling effect. A sentence test appeared to be suitable in CI users if word scoring is used and noise is added for the best performers.
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http://dx.doi.org/10.1177/2331216519838672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472157PMC
October 2019

The association between obesity, diet quality and hearing loss in older adults.

Aging (Albany NY) 2019 01;11(1):48-62

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

Background: With the aging population, the prevalence of age-related hearing loss will increase substantially. Prevention requires more knowledge on modifiable risk factors. Obesity and diet quality have been suggested to play a role in the etiology of age-related hearing loss. We aimed to investigate independent associations of body composition and diet quality with age-related hearing loss.

Methods: We performed cross-sectional and longitudinal analyses (follow-up: 4.4 years) in the population-based Rotterdam Study. At baseline (2006-2014), 2,906 participants underwent assessment of body composition, diet, and hearing. Of these 2,906 participants, 636 had hearing assessment at follow-up (2014-2016). Association of body composition and of diet quality with hearing loss were examined using multivariable linear regression models.

Results: Cross-sectionally, higher body mass index and fat mass index were associated with increased hearing thresholds. These associations did not remain statistically significant at follow-up. We found no associations between overall diet quality and hearing thresholds.

Conclusions: This study shows that a higher body mass index, and in particular a higher fat mass index, is related to age-related hearing loss. However, whether maintaining a healthy body composition may actually reduce the effects of age-related hearing loss in the aging population requires further longitudinal population-based research.
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http://dx.doi.org/10.18632/aging.101717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339793PMC
January 2019

Efficient Adaptive Speech Reception Threshold Measurements Using Stochastic Approximation Algorithms.

Trends Hear 2019 Jan-Dec;23:2331216520919199

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.

This study examines whether speech-in-noise tests that use adaptive procedures to assess a speech reception threshold in noise () can be optimized using stochastic approximation (SA) methods, especially in cochlear-implant (CI) users. A simulation model was developed that simulates intelligibility scores for words from sentences in noise for both CI users and normal-hearing (NH) listeners. The model was used in Monte Carlo simulations. Four different SA algorithms were optimized for use in both groups and compared with clinically used adaptive procedures. The simulation model proved to be valid, as its results agreed very well with existing experimental data. The four optimized SA algorithms all provided an efficient estimation of the . They were equally accurate and produced smaller standard deviations (SDs) than the clinical procedures. In CI users, estimates had a small bias and larger SDs than in NH listeners. At least 20 sentences per condition and an initial signal-to-noise ratio below the real were required to ensure sufficient reliability. In CI users, bias and SD became unacceptably large for a maximum speech intelligibility score in quiet below 70%. In conclusion, SA algorithms with word scoring in adaptive speech-in-noise tests are applicable to various listeners, from CI users to NH listeners. In CI users, they lead to efficient estimation of the as long as speech intelligibility in quiet is greater than 70%. SA procedures can be considered as a valid, more efficient, and alternative to clinical adaptive procedures currently used in CI users.
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http://dx.doi.org/10.1177/2331216520919199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238302PMC
November 2020

Progression of Hearing Loss in the Aging Population: Repeated Auditory Measurements in the Rotterdam Study.

Audiol Neurootol 2018 11;23(5):290-297. Epub 2018 Dec 11.

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

We quantified changes in the auditory acuity of 675 aging adults (mean age 71.1 years, 52.0% female, mean follow-up 4.4 years ± 0.2) of an ongoing cohort study with a pure-tone audiogram and a speech-in-noise test. Generalized estimating equation models were used to study the association between hearing loss and the progression with age, sex, education, cognition, BMI, blood pressure, having type 2 diabetes mellitus, cholesterol ratio, smoking and alcohol consumption. The mean progression of hearing loss was 0.29 and 1.35 dB/year (low and high frequencies). Progression of hearing loss was associated with baseline hearing thresholds. Besides, the presence of type 2 diabetes, smoking, age, sex and time were associated with worse hearing at baseline, but there was no statistical evidence that the tested determinants were associated with progression of hearing loss. This finding indicates that the 4-year progression of hearing loss in older adults in this study is not influenced by the measured determinants. More research with multiple follow-up rounds is desired.
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http://dx.doi.org/10.1159/000492203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428155PMC
September 2019

Comparing the Effect of Different Hearing Aid Fitting Methods in Bimodal Cochlear Implant Users.

Am J Audiol 2019 Mar;28(1):1-10

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.

Purpose The aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit. Method This prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study. Results No differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization. Conclusion Our results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.
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http://dx.doi.org/10.1044/2018_AJA-18-0067DOI Listing
March 2019

A directional remote-microphone for bimodal cochlear implant recipients.

Int J Audiol 2018 11 27;57(11):858-863. Epub 2018 Sep 27.

a ENT-Department , Erasmus Medical Center , Rotterdam , The Netherlands.

To evaluate whether speech recognition in noise differs according to whether a wireless remote microphone is connected to just the cochlear implant (CI) or to both the CI and to the hearing aid (HA) in bimodal CI users. The second aim was to evaluate the additional benefit of the directional microphone mode compared with the omnidirectional microphone mode of the wireless microphone. This prospective study measured Speech Recognition Thresholds (SRT) in babble noise in a 'within-subjects repeated measures design' for different listening conditions. Eighteen postlingually deafened adult bimodal CI users. No difference in speech recognition in noise in the bimodal listening condition was found between the wireless microphone connected to the CI only and to both the CI and the HA. An improvement of 4.1 dB was found for switching from the omnidirectional microphone mode to the directional mode in the CI only condition. The use of a wireless microphone improved speech recognition in noise for bimodal CI users. The use of the directional microphone mode led to a substantial additional improvement of speech perception in noise for situations with one target signal.
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http://dx.doi.org/10.1080/14992027.2018.1508896DOI Listing
November 2018
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