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The primary aim of this study was to extend existing theory on the relationship between chance-level performance and the number of alternatives and trials in closed-set, forced-choice speech audiometry and sound localization methods. When calculating chance performance for closed-set, forced-choice experiments with multiple trials, the binomial distribution should be preferred over the simple 1/a probability, as the latter is appropriate only for single trial experiments. The historical use of constant hit rates for determining chance performance has been based upon the assumption that random hits are distributed evenly across multiple trials. For any closed-set, forced-choice task with 2 to 10 alternatives and 2 to 100 trials, we calculated the probability of obtaining any given hit rate due to random guessing alone according to the binomial distribution. Hit rates with probabilities p > 0.05 were interpreted as being likely to occur due to random chance alone, whereas hit rates with probabilities of p ≤ 0.05 were interpreted as being unlikely to occur due to chance alone. For sound localization experiments with speakers at fixed positions, the expected probability of a random hit was also calculated using the binomial distribution. The expected angular root mean square (rms) error in sound localization resulting from the random selection of sound sources was investigated using Monte Carlo simulations. A new aspect in the interpretation of test results was identified for situations in which the observed number of hits is much lower than would be expected due to chance alone. For test methods incorporating a relatively low number of alternatives and a sufficiently high, yet clinically feasible, number of trials, both upper and lower thresholds for chance-level performance could be identified. This lower threshold represents the lowest hit rate which can be expected through random chance alone. Extending interpretation of results to include this lower threshold affords the ability to not only identify performance significantly superior to that of chance, but also that significantly poorer than chance and thereby represents a simple method for the objective detection of malingering.

Background: Tinnitus is a heterogeneous condition which may be associated with moderate to severe disability, but the reasons why only a subset of individuals is burdened by the condition are not fully clear. Ecological momentary assessment (EMA) allows a better understanding of tinnitus by capturing the fluctuations of tinnitus symptoms, such as distress and loudness, and psychological processes, such as emotional arousal, overall stress, mood, and concentration and how these variables interact over time. Whether any of those variables have an influence over the next day, that is, whether any of these variables are auto- or cross-correlated, is still unanswered. Objectives: Assess whether behavioral and symptom-related data from tinnitus users from the TrackYourTinnitus (TYT) mobile app have an impact on tinnitus loudness and distress on subsequent days Methods: Anonymized data was collected from 278 users of the iOS or Android TYT apps between 2014 and 2020. Tinnitus-related distress, tinnitus loudness, concentration level, mood, emotional arousal, and overall stress level were assessed using either a slider or the Wong-Baker Pain FACES scale via a daily survey. Three modelling strategies were used to investigate whether tinnitus loudness and distress are affected by previous days symptoms or psychological processes: auto- and cross correlations, regressions with elastic net regularization, and subgrouping within group iterative multiple model estimation (S-GIMME). Results: No autocorrelation or cross-correlation was observed at the group level between the variables assessed. However, application of the regression models with elastic net regularization identified individualized predictors of tinnitus loudness and distress for most participants, with the models including contemporaneous and lagged information from the previous day. S-GIMME corroborated these findings by identifying individualized predictors of tinnitus loudness and distress from the previous day. Discussion: We showed that tinnitus loudness and tinnitus distress are affected by the contemporaneous and lagged dynamics of behavioral and emotional processes measured through EMA. These effects were seen at the group, and individual levels. The relevance EMA and the implications of the insights derived from it for tinnitus care are discussed, especially considering current trends towards the individualization of tinnitus care.

Introduction: This study aimed to explore whether body mass index (BMI), systolic blood pressure (RR syst), diastolic blood pressure (RR diast) or heart rate (HR) are associated with tinnitus status and/or severity. Methods: To that end, we evaluated the influence of tinnitus status and Tinnitus Handicap Inventory (THI) score on BMI, RR syst, RR diast and HR by comparing data from a large sample of patients presenting to a specialized tertiary referral clinic (N = 1066) with data from a population-based control group (N = 9885) by means of linear models. Results: Tinnitus patients had a significantly lower BMI and higher RR syst, RR diast and HR than non-tinnitus patients; however, the contribution of the case–control status to R2 was very small (0.1%, 0.7%, 1.4% and 0.4%, respectively). BMI had little predictive power for the THI score (higher BMI scores were related to higher THI scores; R2 = 0.5%) and neither RR syst, RR diast, nor HR showed a statistically significant association with THI. Discussion: Our findings suggest that HR, RR and BMI are at most marginally associated with tinnitus status and severity.

Context: Distortion product otoacoustic emissions (DPOAEs) may indicate preclinical noise-induced hearing loss (NIHL) in adolescents from unsafe personal music player (PMP) use. Aims: The objective, therefore, was to observe preclinical signs of NIHL in 9th grade adolescents with clinically normal hearing by comparing DPOAE signals between different levels of A-weighted equivalent PMP exposure. Settings and Design: Subjects were recruited from all secondary-level schools located in the city of Regensburg, Germany during two academic years 2009/2010 and 2010/2011. Subjects and Methods: A-weighted equivalent sound pressure levels (SPLs) for a 40-hour work week (LAeq,40h) were estimated from questionnaire responses on output and duration of PMP use of the previous week. Subjects were then categorized into four levels of exposure: <80, 80-85, >85 to <90, and ≥90 A-weighted Decibel [dB(A)]. DPOAE signals were collected by trained audiological staff, applying a standard optimized protocol, at the Department of Otorhinolaryngology of the University Hospital Regensburg. Statistical Analysis Used: Mean DPOAE signals were compared between levels by unpaired t test. Novel linear regression models adjusting for other leisure noise exposures and with outcome variables DPoutcome and 4 kilo Hertz (kHz) DPOAEs estimated effects between levels. Results: A total of 1468 subjects (56% female, mostly aged 15 or 16 years) were available for analysis. Comparison of DPOAE means by PMP exposure typically showed no greater than 1 dB difference between groups. In fact, comparisons between ≥90 dB(A) and <80 dB(A) presented the least differences in magnitude. Both DPoutcome and 4 kHz linear regression models presented a weak association with the 4-level PMP exposure variable. An expected dose-response to PMP exposure was not observed in any analyses. Conclusions: DPOAE signal strength alone cannot indicate preclinical NIHL in adolescents.

Optimization of dietary intake is an essential component in the multidimensional effort to prevent and manage chronic disease. Recently, demand has increased for nutrition-focused management strategies for chronic tinnitus. The primary aim of this study was to evaluate 10 dietary items for their association with changes in subjective tinnitus severity. A secondary aim was to develop an algorithm to better identify those individuals who might benefit from dietary modification strategies. A total of 5017 anonymous users of the TinnitusTalk forum completed an online survey regarding how various dietary items affected the severity of their tinnitus. Results suggest that, while intake of caffeine [positive effect (PE): 0.4%; negative effect (NE): 16.2%], alcohol (PE: 2.7%; NE: 13.3%, and salt (PE: 0.1%; NE: 9.9%) was most likely to influence tinnitus severity, it did so only for a small proportion of participants and reported effects were most commonly mild. Further, though a classification algorithm was able to leverage participant demographic, comorbidity, and tinnitus characteristics to identify those individuals most likely to benefit from dietary modification above chance levels, further efforts are required to achieve significant clinical utility. Taken together, these results do not support dietary modification as a primary treatment strategy for chronic tinnitus in the general population, though clinically meaningful effects might be observable in certain individuals.

Distortion product otoacoustic emission (DPOAE) amplitude is sensitive to the primary tone level separation effective within the cochlea. Despite potential for middle ear sound transmission characteristics to affect this separation, no primary tone level optimization formula accounts for its influence. This study was conducted to determine if inclusion of ear- and frequency-specific immittance features improves primary tone level optimization formula performance beyond that achieved using a univariate, L2-based formula. For 30 adults with normal hearing, DPOAE, wideband absorbance, and 226-Hz tympanometry measures were completed. A mixed linear modeling technique, incorporating both primary tone and acoustic immittance features, was used to generate a multivariable formula for the middle ear-specific recommendation of primary tone level separations for f2 = 1-6 kHz. The accuracy with which L1OPT, or the L1 observed to maximize DPOAE level for each given L2, could be predicted using the multivariable formula was then compared with that of a traditional, L2-based univariate formula for each individual ear. Use of the multivariable formula L1 = 0.47L2 + 2.40A + f2param + 38 [dB SPL] resulted in significantly more accurate L1OPT predictions than did the univariate formula L1 = 0.49L2 + 41 [dB SPL]. Although average improvement was small, meaningful improvements were identified within individual ears, especially for f2 = 1 and 6 kHz. Incorporation of a wideband absorbance measure into a primary tone level optimization formula resulted in a minor average improvement in L1OPT prediction accuracy when compared with a traditional univariate optimization formula. Further research is needed to identify characteristics of ears that might disproportionately benefit from the additional measure.

PurposeAn objective statement about the annoyance of snoring can be made with the Psychoacoustic Snore Score (PSS). The PSS was developed based on subjective assessments and is strongly influenced by observed sound pressure levels. Robustness against day-to-day interfering noises is a fundamental requirement for use at home. This study investigated whether or not the PSS is suitable for use in the home environment.MethodsThirty-six interfering noises, which commonly occur at night, were played in the acoustic laboratory in parallel with 5 snoring sounds. The interfering noises were each presented at sound pressure levels ranging from 25 to 55 dB(A), resulting in 3255 distinct recordings. Annoyance was then assessed using the PSS.ResultsIn the case of minimally annoying snoring sounds, interfering noises with a sound pressure level of 25 dB(A) caused significant PSS changes from 40 to 55 dB(A) for annoying snoring sounds. If the interfering noise was another snoring sound, the PSS was more robust depending on the sound pressure level of the interfering noise up to 10 dB(A). Steady (no-peak) interfering noises influenced the PSS more strongly than peak noises.ConclusionsThe PSS is significantly distorted by quiet interfering noises. Its meaningfulness therefore depends strongly on the acoustic environment. It may therefore be assumed that scores dependent on sound pressure level are suitable for measurements when there is minimal ambient noise, as in the sleep laboratory. However, for measurements where noise is incalculable, as in the home environment, interfering noises may distort the results.

Appropriate management of hereditary hemorrhagic telangiectasia (HHT) is of particular importance in females, as HHT-mediated modifications of the vascular bed and circulation are known to increase the risk of complications during pregnancy and delivery. This study was undertaken to evaluate female HHT patients’ awareness of and experience with HHT during pregnancy and delivery, with a focus on epistaxis. In this retrospective study, 46 females (median age: 60 years) with confirmed HHT completed a 17-item questionnaire assessing knowledge of HHT and its pregnancy-associated complications, the severity of epistaxis during past pregnancies and deliveries, and the desire for better education and counselling regarding HHT and pregnancy. Results revealed that 85% of participants were unaware of their disease status prior to the completion of all pregnancies. Further, 91% reported no knowledge of increased pregnancy-related risk due to HHT. In regard to epistaxis, 61% of respondents reported experiencing nosebleeds during pregnancy. Finally, approximately a third of respondents suggested that receiving counseling on the risks of HHT in pregnancy could have been helpful. Findings suggest that awareness of HHT and its potential for increasing pregnancy-related risk is poor. Best practices in HHT management should be followed to minimize negative effects of the disorder.

Tinnitus is defined as the conscious awareness of a tonal or composite noise in the absence of a corresponding external acoustic source. This international multicentre, parallel-arm, superiority, randomised controlled trial investigated whether combination therapies are superior to single interventions in the treatment of chronic subjective tinnitus. Tinnitus patients were recruited from five clinical sites across the EU and randomly assigned using a web-based system, stratified by their hearing and distress level, to single or combination treatment of 12 weeks. Cognitive-behavioural therapy, hearing aids, app-based structured counselling, or app-based sound therapy were administered either alone or as a combination of two treatments resulting in ten treatment arms. App-based treatments were delivered without direct contact or guidance from clinicians. The primary outcome was the difference in the change from baseline to week 12 in the total score of the Tinnitus Handicap Inventory (THI) between single and combination treatments in the intention-to-treat population. All statistical analysis were performed blinded to treatment allocation. 674 patients of both sexes aged between 18 and 80 years were screened for eligibility. 461 participants (190 females) with chronic subjective tinnitus and at least mild tinnitus handicap were enroled, 230 of which were randomly assigned to single and 231 to combination treatment. Least-squares mean changes from baseline to week 12 were −11.7 for single treatment (95% confidence interval [CI], −14.4 to −9.0) and −14.9 for combination treatments (95% CI, −17.7 to −12.1), with a statistically significant group difference ( p  = 0.034). Cognitive-behavioural therapy and hearing aids alone had large effect sizes, which could not be further increased by combination treatment. No serious adverse events occurred. In this trial involving patients with chronic tinnitus, all treatment arms showed improvement in THI scores from baseline to week 12. Combination treatments showed a stronger clinical effect than single treatment, however, no clear synergistic effect was observed when combining treatments. Instead, we observed a compensatory effect, where a more effective treatment offsets the clinical effects of a less effective treatment. ClinicalTrials.gov Identifier: NCT04663828. Chronic tinnitus is often treated with cognitive-behavioural therapy, hearing aids, counselling, or sound therapy, but their combined benefit is unclear. Here, the authors show, in a multicentre randomised trial, that combination treatments improve tinnitus scores more than single therapies, though benefits appear compensatory rather than synergistic.