Alyssa Davidson

Auditory gap detection thresholds are an important tool for evaluating temporal processing deficits in human listeners, but current tests are too cumbersome for widespread clinical use. This letter describes the development and validation of a rapid 18-trial test for assessing gap detection based on an earlier binaural tone-in-noise paradigm. Results from 616 normal-hearing listeners show psychometric properties similar to the clinical gaps-in-noise test and provide normative values that support preliminary use as a screener for temporal processing deficits in clinical populations.

Purpose: Artificial intelligence (AI) chatbots based on large language models (LLMs) can deliver medical information, but their performance on specialized topics such as central auditory processing disorder (CAPD) remains unexplored. This study evaluated the accuracy and completeness of three AI chatbots (ChatGPT, Gemini, and Claude) in providing CAPD-related information across varying levels of question complexity. Method: Forty-four questions, categorized into four difficulty levels (patient level, easy, intermediate, and specialized; n = 11 each), were submitted to each chatbot, generating 132 responses. Seven clinical experts, blinded to chatbot identity, independently rated accuracy and completeness on a 1–5 Likert scale. Data were analyzed with analyses of variance, correlations, and interrater comparisons. Results: Chatbot performance was similar, with mean accuracy below 4.0 and completeness about 3.5. Complex questions often scored below 3.0 across experts. Only three of the 44 questions, primarily patient level or relatively simple, received consistently high expert ratings (≥ 4 for both accuracy and completeness) across all three chatbots. Performance declined with question difficulty, although differences were not statistically significant. Accuracy and completeness were correlated across chatbots. Conclusions: Current AI chatbots provided generally accurate CAPD information but fell short of clinical standards, particularly on specialized questions. Their limited performance underscores the need for clinician oversight in CAPD assessment and management. Chatbots may serve as helpful adjuncts but should not replace expert evaluation and guidance in clinical settings. Supplemental Material: https://doi.org/10.23641/asha.31975101

Purpose: This commentary discusses the evolving role of boothless audiometry in hearing conservation programs. It addresses space and access limitations of traditional booth-based testing and explores how boothless solutions offer alternatives for maintaining and boosting service delivery. Method: We present a conceptual discussion on the utility of boothless audiometry for hearing conservation monitoring, followed by a real-world implementation example from Department of Defense (DOD) hearing conservation clinics. Results: DOD hearing conservation programs completed over 40,000 boothless hearing tests between 2021 and May 2025, showing progressive year-over-year adoption. Patient satisfaction surveys from over 800 service members revealed positive ratings for boothless compared to traditional booth-based testing. Implementation feedback emphasized the importance of quiet testing environments and comprehensive staff training. Conclusions: Boothless audiometry represents a viable, and often underutilized, model for conducting audiometric monitoring for hearing conservation programs. Its portability, scalability, and adaptability make it particularly suited to outreach settings, resource-limited clinics, or as a contingency during facility disruptions. This commentary encourages audiologists to explore boothless approaches as complementary, not alternative, methods for increasing access to high-quality care.

Objective: To evaluate the validity of the Wireless Automated Hearing Test System (WAHTS) in comparison to clinically acquired unmasked air conduction thresholds. Design: A cross-sectional study comparing WAHTS and manual audiometry thresholds, with participants at Clinic 1 completing WAHTS followed by manual audiometry, and those at Clinic 2 completed manual audiometry first, followed by WAHTS, both on the same day. Study Sample: Ninety-three thresholds from 28 participants at Clinic 1 and 112 thresholds from 24 participants at Clinic 2 were analyzed. Participants were U.S. Service Members and represented a range of ages and hearing difficulties. Results: The mean absolute difference between repeated WAHTS measurements was 2.21 dB (SD = 2.52 dB). Correlation coefficients for WAHTS and clinical thresholds were 0.95 (R2 = 0.91) at Clinic 1 and 0.94 (R2 = 0.94) at Clinic 2. Kappa agreement within ±10 dB was 90% at Clinic 1 and 87% at Clinic 2. Bland-Altman analysis indicated a slight bias, with WAHTS thresholds averaging 2-3 dB better than clinical thresholds. Conclusions: Wireless Automated Hearing Test System demonstrated strong agreement with clinical audiometry, supporting its use for unmasked threshold evaluations. Its portability and accuracy suggest potential for expanding access to hearing health care, particularly in remote or resource-limited environments.

Purpose: The purpose of this study was to determine the differences between self-reported hearing difficulties, response time, and blast exposure history for those with and without auditory processing deficits, which were classified based on abnormal results on behavioral speech-in-noise and binaural-processing assessments. The study also examined factors that contributed to low-gain hearing aid (LGHA) benefit. Method: Military service members were recruited for the research study. Participants were classified into three groups based on their performance on auditory processing tests: failing two tests (dual deficit [DualDef], n = 47), failing one test (single deficit [SingleDef], n = 207), and failing zero tests (Control, n = 5,046). All participants had normal hearing thresholds (NHTs) defined by ≤ 25 dB HL at frequencies 500–6000 Hz. Results: Participants who failed at least one auditory processing test (DualDef and SingleDef groups) reported significantly more hearing difficulties and had significantly slower response times than the Control group. The DualDef group also had significantly more hearing difficulties relative to the SingleDef group. More than half of the participants in the DualDef and SingleDef groups reported having blast exposure, compared to less than 40% in the control group. Participants who reported blast exposure also reported significantly better LGHA benefit compared to those who reported having no blast exposure. Conclusion: This study appears to validate the use of performance on behavioral listening tests to identify individuals who may be suffering from auditory processing deficits and might benefit from LGHAs, particularly when the symptoms are related to a history of blast exposure.

Background Hearing loss significantly affects an individual's well-being, communication, social interaction, and quality of life. Cochlear implants serve as a viable management option. Given the variability in the impact of impairment, self-report measures are crucial for evaluating the perceived benefits of management options. Purpose The study aims to assess the reliability of the International Outcome Inventory for Cochlear Implants (IOI-CI) and establish evaluative cutoffs. This questionnaire evaluates patient's satisfaction with cochlear implants and contributes to the understanding of their experiences, addressing the increasing interest among cochlear implant clinicians. Research Design The design relies on electronic medical databases within the Veterans Affairs and Department of Defense systems. After identification of eligibility, recruitment was based on participants responding to mailed study documents. This research adopts a descriptive approach of the analysis of questionnaire responses as well as quantitatively evaluating the reliability. Study Sample Forty-nine service members, Veterans, and their dependents, including 32 men and 17 women, participated in the study. The participants had a mean age of 68.0 years, with cochlear implants ranging from 6 months to 2 years postinitial stimulation. The majority had a unilateral cochlear implant with a hearing aid on the contralateral ear. Data Collection and Analysis Data collected involved mailing baseline study packets, including the IOI-CI questionnaire, to potential participants identified through medical databases. Participants indicated consent by returning the study packet. Follow-up packets were sent at a later time. Intraclass correlation coefficients were utilized for test‐retest reliability and generalized linear models (GLM) for exploring the impact of clinical and demographic factors. Data were analyzed using R. Results The ICC revealed a good level of agreement (ICC = 0.84) between baseline and follow-up assessments for the IOI-CI total score. The GLM did not identify significant factors influencing IOI-CI scores. Evaluative values were established, indicating total scores between 18 and 35 as within the range of general satisfaction with a cochlear implant for this questionnaire. Conclusion The study contributes valuable insights into the reliability of the IOI-CI and establishes evaluative cutoffs, aiding clinicians in assessing cochlear implant users' experiences and satisfaction.

Purpose: Clinical audiologists typically assume that headphones and insert phones will produce comparable results when they are used to conduct speech-in-noise or other audiological tests; however, this may not always be the case. Here, we show that there are significant differences in the scores that previous studies have reported for headphone and insert-phone transducers on the Words-in-Noise (WIN) Test, and discuss the possibility that the variations in high-frequency output that are allowable under the speech source specifications of American National Standards Institute S3.6 might be contributing to transducer-dependent differences in performance for the WIN and other tests that are presented through the auxiliary input channels of clinical audiometers. Method: A literature review was conducted to identify articles that reported WIN Test results for both listeners with normal hearing and with hearing impairment and specified the type of transducer (insert or TDH-50) used for the data collection. Results: Among the 19 included studies, participants with normal hearing using inserts exhibited systematically worse WIN Test scores compared to those using TDH-50 headphones, while participants with hearing loss showed comparable average scores across transducer types. Conclusions: The results highlight the importance of considering transducer type when interpreting WIN Test outcomes, particularly when comparing to normative scores obtained from individuals with normal hearing. Although further research is needed to elucidate the underlying mechanisms driving differences in test performance across transducer types, these findings underscore the need for standardized test administration protocols and careful documentation of transducer type when administering speech-in-noise tests for clinical or research applications.

Purpose: The contributions from the central auditory and cognitive systems play a major role in communication. Understanding the relationship between auditory and cognitive abilities has implications for auditory rehabilitation for clinical patients. The purpose of this systematic review is to address the question, “In adults, what is the relationship between central auditory processing abilities and cognitive abilities?” Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify, screen, and determine eligibility for articles that addressed the research question of interest. Medical librarians and subject matter experts assisted in search strategy, keyword review, and structuring the systematic review process. To be included, articles needed to have an auditory measure (either behavioral or electrophysiologic), a cognitive measure that assessed individual ability, and the measures needed to be compared to one another. Results: Following two rounds of identification and screening, 126 articles were included for full analysis. Central auditory processing (CAP) measures were grouped into categories (behavioral: speech in noise, altered speech, temporal processing, binaural processing; electrophysiologic: mismatch negativity, P50, N200, P200, and P300). The most common CAP measures were sentence recognition in speech-shaped noise and the P300. Cognitive abilities were grouped into constructs, and the most common construct was working memory. The findings were mixed, encompassing both significant and nonsignificant relationships; therefore, the results do not conclusively establish a direct link between CAP and cognitive abilities. Nonetheless, several consistent relationships emerged across different domains. Distorted or noisy speech was related to working memory or processing speed. Auditory temporal order tasks showed significant relationships with working memory, fluid intelligence, or multidomain cognitive measures. For electrophysiology, relationships were observed between some cortical evoked potentials and working memory or executive/inhibitory processes. Significant results were consistent with the hypothesis that assessments of CAP and cognitive processing would be positively correlated. Conclusions: Results from this systematic review summarize relationships between CAP and cognitive processing, but also underscore the complexity of these constructs, the importance of study design, and the need to select an appropriate measure. The relationship between auditory and cognitive abilities is complex but can provide informative context when creating clinical management plans. This review supports a need to develop guidelines and training for audiologists who wish to consider individual central auditory and cognitive abilities in patient care. Supplemental Material: https://doi.org/10.23641/asha.24855174

Purpose: The Masking Level Difference (MLD) has been used for decades to evaluate the binaural listening advantage. Although originally measured using Bekesy audiometry, the most common clinical use of the MLD is the CD-based Wilson 500-Hz technique with interleaved N0S0 and N0S pi components. Here, we propose an alternative technique based on manual audiometry as a faster way of measuring the MLD. The article describes the advantages to this administration technique and evaluates if it is a viable alternative for the Wilson technique.Method: Data were retrospectively analyzed on 264 service members (SMs). All SMs completed both the Wilson and Manual MLDs. Descriptive and correlational statistics were applied to evaluate the comparisons between the two techniques and highlight the differences. Equivalence measures were also completed to compare the tests using a standardized cutoff score. Analyses were also made to compare both techniques to subjective and objective measures of hearing performance.Results: Moderate to high positive correlations were determined between Wilson and Manual measures of each threshold (N0S pi and N0S0). Although the Manual and Wilson MLD techniques produced significantly different thresholds, simple linear transformations can be used to obtain approximately equivalent scores on the two tests, and agreement was high for using these transformed scores to identify individuals with substantial MLD deficits. Both techniques had moderate test-retest reliability. The Manual MLD and components had stronger correlations to the subjective and objective hearing measures than the Wilson.Conclusions: The Manual technique is a faster method for obtaining MLD scores that is just as reliable as the CD-based Wilson test. With the significant reduction in assessment time and comparable results, the Manual MLD is a viable alternative for direct use in the clinic.

Hearing difficulties are frequently reported by patients in audiology clinics, including patients with normal audiometric thresholds. However, because all individuals experience some difficulty understanding speech in noisy environments, it can be difficult to assess hearing complaints objectively across patients. Normative values help address this issue by providing an objective cutoff score for determining what is or is not clinically significant. The goal of this study was to establish normative values for the four-item hearing subscale of the Tinnitus and Hearing Survey (THS-H). Respondents completing the THS-H rate the level of difficulty understanding speech in the situations most commonly reported as being difficult: in the presence of noise, on TV or in movies, soft voices and group conversations. In this study, 22,583 US Service Members (SMs) completed the THS-H using an 11-point scale ranging from 0 (not a problem) to 10 (a very big problem). Responses to the four items were summed to produce values between 0 and 40. The distribution of the final scores was analyzed based on severity of hearing loss, age, and sex. Only 5% of SMs with clinically normal hearing scored above 27, so this score was selected as a cutoff for “clinically significant hearing problems.” Due to its ease of administration and interpretation, the THS-H could be a useful tool for identifying patients with subjective hearing difficulty warranting audiological evaluation and management.