Poster Session

Abstract:

Listening effort reflects the cognitive resources required for speech processing and it helps explain communication difficulties in older adults and people with hearing impairment. This study examines how attention and working memory demands interact to shape Listening effort in young and older adults with normal hearing. Participants complete a dual-task paradigm designed to approximate real-world cognitive load, with task conditions that vary working memory load and attentional demands. Behavioral performance was quantified using recall accuracy and dichotic listening scores, while peak pupil dilation served as the physiological index of listening effort. The specific aims are to test the attention by working memory interaction on Listening effort and to evaluate the reliability of the Listening effort measurement approach across conditions. 

Normal-hearing native English speakers completed the behavioral experiment (14 younger adults aged 19-28 years and 10 older adults aged 50-63 years). Pupillometry data were available for 19 participants (9 young and 10 older adults). Working memory load was individualized using the Word Auditory Recognition and Recall Measure threshold, with low and high Working memory levels set at n - 1 and n + 1. Attention demand was manipulated using a dichotic digits task requiring selective attention (right ear report) or divided attention (both ears report). Pupil diameter was recorded with a Tobii T60 XL screen-based eye tracker and PPD was extracted during the recall segment.

Behavioral data revealed significant main effects and interactions between working memory and attention demands on recall and dichotic performance. Increased cognitive load led to decreased accuracy, with evidence of a ceiling effect under high dual-task conditions, supporting theories of limited cognitive capacity. Older adults showed significantly lower dichotic scores than younger adults, indicating age-related differences in attentional processing. In contrast, no significant differences were observed in recall scores across age groups. Additionally, the Test?retest analysis indicated excellent reliability across all behavioral measures. 

Findings suggest the importance of task design in eliciting measurable listening in complex cognitive tasks. This study highlights the need for more ecologically valid paradigms to better understand cognitive load in everyday listening and provides a foundation for refining research and clinical tools.
 

Learning Outcomes:
After this course, participants will be able to:

• Describe  a dual-task paradigm that manipulates working memory and attention demands and compute recall accuracy and dichotic listening scores as behavioral indices of listening effort.
• Interpret main effects and working memory by attention interactions on recall and dichotic performance and identify age-related differences in dichotic listening outcomes.
• Evaluate test–retest reliability for behavioral measures and peak pupil dilation and apply these findings to select outcome measures and refine task design for more ecologically valid listening effort assessment.

Abstract:

Detecting signals (speech) in noise requires special processing in the brain. Hearing loss damages those processes and, consequently, increases the difficulty of understanding speech in noisy conditions. The degree of detection difficulty depends on the properties of the background noise (e.g., speech background, traffic noises, running water).

The purpose of the study is to determine what properties of background noise determine the degree of difficulty in normal hearing subjects (NH) and in sensory-neural hearing loss (SNHL)
Approach: Compare speech detection performance of NHs and SNHL subjects across noises with varying content of spectral and temporal envelope modulations.

Findings: Backgrounds with low spectral modulations (widely spaced frequency peaks) appear to be the most favorable condition for speech detection compared to more steady-state noises. However, this advantage is effectively lost in SNHL subjects with mild to moderate hearing loss. 

Conclusion: Backgrounds with low spectral and temporal modulations, compared to steady-state noises, are most sensitive for early detection of signal-in-noise processing difficulties.
 

Learning Outcomes:
After this course, participants will be able to:

• Explain the dependence of speech understanding on different types of noise.
• Explain how subjects with normal hearing differ from those with hearing loss in understanding speech in different noise types
• Identify which aspects of noise cause the least difficulty in speech in noise performance

Abstract:

Objective: Over-the-counter (OTC) hearing aids were introduced by the U.S. Food and Drug Administration in 2022 to improve access to hearing care. These devices are available online and in retail settings without the involvement of a hearing care professional. Despite their increasing availability, the real-world electroacoustic performance of OTC hearing aids has not been well established. The present study aimed to verify the acoustic output of selected OTC hearing aids using real-ear measurements (REM) and to determine whether frequency-specific amplification meets prescriptive targets across varying degrees of hearing loss. 

Methods: Five OTC hearing aids - Lucid Engage, Apple AirPods (2nd generation), Lexie (B Series), Boya SoundControl, and Sony CRE-10 - were evaluated on a KEMAR (Knowles Electronics Manikin for Acoustic Research). Probe microphones were positioned in each ear to record the Real-Ear Aided Response (REAR). Devices were paired to a smartphone and adjusted via the manufacturers' apps. Three audiometric configurations were simulated: (1) flat mild (35 dB HL), (2) flat moderate (50 dB HL), and (3) sloping moderately-severe hearing loss. When available, additional manufacturer programs were tested. The primary outcome was frequency-specific deviation from target (measured minus target in dB) across 250-8000 Hz.

Results: Across all configurations, most devices demonstrated under-amplification relative to prescriptive targets, particularly in the high-frequency range (4000-8000 Hz). For flat mild hearing loss, the Lucid Engage "Mild" program most closely approximated targets, remaining within approximately ±5 dB at most frequencies. For flat moderate loss, the Lucid Engage "Max Boost" and "Bass Boost" programs provided the closest approximation in the low-to-mid frequencies (250-2000 Hz), but did not meet high frequency targets. None of the OTC devices achieved adequate gain for the sloping moderately-severe configuration. 

Conclusion:  In standardized manikin testing, the evaluated OTC hearing aids did not consistently meet prescriptive gain targets, particularly in the high frequencies and for greater degrees of hearing loss. These findings highlight limitations in target-matched amplification using manufacturer default programming and underscore the need for further evaluation of functional outcomes in human users.
 

Learning Outcomes:
After this course, participants will be able to:

• Compare the accuracy and variability of REM results from five popular brands of over-the-counter hearing aids.
• Identify the hearing loss configurations for which over-the-counter hearing aids struggle the most to provide sufficient amplification.
• Describe the performance of over-the-counter hearing aids at high frequency regions compared to low frequencies. 

Abstract:

Effective communication is foundational to patient-centered care, yet Deaf and Hard-of-Hearing (DHH) individuals frequently experience communication barriers in healthcare settings. These barriers contribute to misunderstandings, reduced health literacy, increased anxiety, and inequitable health outcomes. Many early-career healthcare providers report limited training and low confidence in communicating with patients with hearing loss. The purpose of this study was to evaluate the effectiveness of a brief interprofessional educational intervention designed to improve knowledge, confidence, and attitudes toward communication with Hard-of-Hearing patients.

Participants included graduate students from Dental, Nursing, Speech-Language Pathology, and Physician Assistant programs at the University of the Pacific. The intervention consisted of an interactive lecture and discussion led by audiology faculty and students. Content addressed barriers to care for DHH patients, clinician and patient perspectives, recognition of hearing-related communication challenges, verbal and non-verbal communication strategies, assistive listening technologies, and practical clinical implementation strategies for waiting rooms and consultation spaces.

Participants completed a 10-item Likert-scale survey immediately before and after the session assessing confidence in recognizing when patients are struggling to hear, comfort communicating with patients with hearing loss, knowledge of verbal and non-verbal strategies, awareness of assistive technologies, perceived adequacy of training, and intention to incorporate communication strategies into future patient care.

Pre/post comparisons demonstrated statistically significant improvements across most domains, including increased confidence in recognizing communication barriers, greater knowledge of communication strategies and assistive listening technologies, and stronger intention to implement inclusive practices. Interdisciplinary differences were observed across training programs.

These findings suggest that a brief, scalable educational intervention can meaningfully enhance early-career healthcare providers? preparedness to communicate effectively with patients with hearing loss. Expanding audiology-led interprofessional training models may represent an important strategy for reducing communication-related healthcare disparities and promoting equitable, accessible care across clinical settings.
 

Learning Outcomes:
After this course, participants will be able to:

• Describe documented gaps in early-career healthcare providers’ preparedness to communicate effectively with patients with hearing loss.
• Explain how an audiology-led interprofessional educational model can improve provider confidence, knowledge, and intent to implement communication strategies.
• Discuss the role of audiology in advancing scalable, cross-disciplinary training initiatives that promote accessible and equitable patient care.

Abstract:

Background: Over-the-counter (OTC) hearing devices have expanded access to amplification, yet real-world user experience, comfort, and performance remain highly variable. Understanding adverse events, usability challenges, and perceived benefit is critical for informing clinical guidance, device design, and consumer adoption.

Objective: To characterize user-reported adverse events, device-related issues, and perceived benefits associated with short-term use of an OTC hearable device in adults with self-reported hearing difficulties.

Methods: Feedback was taken from participants regarding their experience with research OTC devices. Key themes are being extracted and further analyzed to assess purchasing intent, desired improvements, and qualitative feedback on device performance.

Currently, 16 participants have responded. Participants are being asked to identify primary areas for device improvement, and give open-ended feedback regarding their preference for OTC devices versus traditional hearing aids.

Results: Participants reported mixed experiences. Common adverse events included ear discomfort, soreness with prolonged wear, headaches, and pressure related to earbud size and fit. Acoustic challenges were frequently noted, including excessive feedback, over-amplification of environmental sounds, difficulty distinguishing speech from background noise, and discomfort with impulse sounds. Several users described sound quality as artificial or tinny and reported a sensation of occlusion or dissociation. Device-related issues included intermittent connectivity, random disconnections affecting one or both earbuds, short battery life, charging difficulties, and unintentional device shutoff due to touch controls.

Despite these challenges, many participants reported meaningful benefits. Improvements were noted for television viewing, speech understanding at a distance, and increased awareness of environmental sounds. Some users described improved quality of life and greater engagement in daily activities. However, willingness to adopt the device long term was strongly influenced by comfort, feedback control, and signal processing performance. Several participants expressed preference for traditional hearing aids.

Conclusions: OTC hearable devices may provide functional benefit for some users, particularly in quiet listening scenarios and media consumption. However, high rates of user-reported discomfort, feedback, and signal processing limitations highlight important gaps in current device design. These findings underscore the need for improved fit options, refined noise management, and clearer clinical guidance to support safe and effective OTC hearing aid use.
 

Learning Outcomes:
After this course, participants will be able to:

• Identify common user-reported adverse events and comfort-related challenges associated with short-term use of OTC hearing aid devices in adults with hearing difficulties.
• Describe key acoustic and signal processing limitations of OTC hearing aid devices that impact speech understanding, feedback management, and listening comfort in real-world environments.
• Apply user experience insights to clinical counseling and device selection, including setting realistic expectations for patients considering OTC hearing solutions.

Abstract:

Aging is associated with declines in speech discrimination, yet the onset and progression of neural changes underlying these declines remain unclear. Most prior research has compared only younger and older adults, limiting insight into how auditory processing evolves across adulthood. This study examined lifespan changes in automatic speech discrimination using mismatch negativity, an electrophysiological marker of pre attentive auditory processing.

Fifty adults aged 18 to 74, including English monolinguals and Spanish English bilinguals, were divided into five age groups. Participants passively listened to sequences of standard and deviant nonword stimuli that differed in vowel duration while neural activity was recorded using a 32 channel EEG system. MMN amplitude and latency were analyzed at frontal and central scalp regions. Hearing thresholds, language background, and fatigue were examined as additional factors influencing neural efficiency.

Preliminary findings demonstrate age related shifts in MMN topography. Younger adults exhibited larger frontal MMN responses, whereas older adults showed greater central activation. Differences were also observed by language background. Older monolingual adults demonstrated stronger frontal responses, while older bilingual adults exhibited larger central responses. Younger groups showed minimal regional differences between monolingual and bilingual listeners.

Participants in their twenties displayed the smallest language related differences, those in their thirties showed modest divergence, and the oldest group demonstrated the largest differences across frontal, central, and hemispheric regions. These findings suggest that neural resource allocation shifts with age. Older monolingual adults may increasingly recruit frontal regions to compensate for reduced auditory processing efficiency, while bilingual adults may engage central regions in a pattern consistent with neural resilience associated with language experience.

Importantly, neural changes in speech discrimination appear to emerge in midlife, prior to clinically significant hearing loss. By examining five age ranges rather than relying on dichotomous group comparisons, this study provides a more detailed trajectory of auditory aging. Electrophysiological measures such as MMN may offer a sensitive tool for early detection of subtle neural decline and inform earlier intervention strategies in hearing care.
 

Learning Outcomes:
After this course, participants will be able to:

• Explain how language background and fatigue influence MMN responses and auditory processing efficiency.
• Describe how electrophysiologic measures such as MMN change with age and how these changes relate to speech processing.
• Analyze how lifespan changes in MMN responses may inform earlier intervention strategies in adult hearing care.

Abstract:

Sudden sensorineural hearing loss (SSNHL) is defined as a rapid hearing loss of 30 dB or greater across at least three consecutive frequencies occurring within a 72-hour period. Although SSNHL affects approximately 30 per 100,000 individuals annually, the etiology remains idiopathic in the majority of cases and delayed, or inappropriate management can result in permanent auditory deficits. This case study examines two patients with SSNHL to highlight the critical role of timely diagnosis, interprofessional communication, and evidence-based intervention. Audiometric findings for both patients were consistent with SSNHL, with normal middle ear function bilaterally. These cases illustrate how delayed recognition, fragmented care, and insufficient provider awareness contribute to suboptimal outcomes. The findings emphasize the necessity for increased education among emergency medicine providers, primary care physicians, and allied health professionals regarding SSNHL as an otologic emergency. Improved diagnostic consistency, timely referral, and standardized treatment protocols are essential to preserve residual hearing and optimize patient outcomes.

Learning Outcomes:
After this course, participants will be able to:

• Assess the needs for immediate action when patients come show signs of sudden sensorineural hearing loss.
• Discuss with patients and other healthcare professionals the importance of acting in a timely manner
• Demonstrate clear comprehension of the role as an audiologist to not only recommend immediate care, but to also counsel and teach all patients and health care professionals. 

Abstract:

Students learn theory, method, and protocol in class. There are classes and lectures on everything from the physics of sound, to how to properly take a pure tone threshold, to the science behind the fitting formulas. Classes, however, do not always have the time or opportunity to go in depth into soft skills or direct and indirect application of the methods and theories. Even the classes that focus on counseling do not have the capacity to offer hands-on experiences that fine tune the softer, interpersonal skills. This is where clinical precepting comes in. Clinical experience is crucial to the successful development of new audiologists and can also positively benefit the hosting clinic and clinicians. Clinical precepting allows the integration of didactic work, teaches the ways to maximize the tests, and fine tunes counseling.

Currently, there is one preceptor training course and that class has not been updated to reflect the changes in today's students and our world. This presentation is designed to explore tips and tricks to becoming a better preceptor. This will discuss the needs of our community with 6 open and active programs in the state. Historical data includes discussions about changes in the student population and education since the COVID-19 pandemic.

Teaching students of different grade levels will be discussed. This presentation will mostly focus on the earlier years of education and not the final or “extern” year. The presentation will discuss learning styles and provide suggestions for maximizing the learning experience both with and without patients.
Methods of effective precepting that will be discussed include tips for breaking down questions students ask and helping them answer the questions themself. Extending grace, building trust, finding learning opportunities in the most mundane of tasks, understanding your students’ education, knowing your own mastery of the literature, and teaching the subtle art of communicating.

We learn from our students just as our students learn from us. The students are our future and have their fingers on the pulse of the up-and-coming evidence and protocols. Our responsibility is to them just as it is to our patients.

Learning Outcomes:
After this course, participants will be able to:

• Analyze broad questions asked by students and formulate discussions that  allow a student to answer their own questions and their refine critical thinking skills.
• Classify different styles of learning and name different teaching techniques for each style of learning in a clinical setting.
• Explain the clinical resource needs in California withsix Au.D. programs open and active.

Abstract:

Sound localization is the ability to identify the direction of a sound source, a skill essential for effective communication, learning and maintaining safety in everyday environments. Accurate localization depends on cues such as interaural time difference (ITD), interaural level difference (ILD) and spectral cues. These mechanisms are also fundamental to speech-in-noise comprehension, allowing the auditory system to spatially segregate speech from competing background noise, a phenomenon known as spatial release from masking. While laboratory-based measures exist to evaluate and test localization abilities, many require specialized, expensive sound-field equipment. To address this limitation, simplified and more accessible assessments, such as the Localization Clock Test (LCT), have been developed.  For any test to be clinically meaningful, it must demonstrate both reliability and convergent validity. However, the LCT has yet to be systematically examined for test-retest reliability and convergent validity. Establishing these properties is a necessary step towards its integration into research and clinical practice. The primary objective of this research is to assess the test-retest reliability of the LCT in adults with normal hearing. The secondary objective is to evaluate the convergent validity, examining the correlation between objective test performance and self-reported localization ability.  By addressing this critical gap in the literature, we aim to establish the foundation for a feasible and accessible method of evaluating spatial hearing in broader populations. In this study, we administer the LCT in participants with normal hearing with both normal and impaired localization performance, and repeat the test at the 1-week and 1-month mark after the initial test. Further, participants also complete the Spatial section of the Speech, Spatial and Qualities Scale to self-report their spatial hearing ability. In our poster, we will present results describing the test-retest reliability of the LCT and the convergent validity of the LCT with the SSQ scale. The outcomes of this study have the potential to enable more efficient evaluations of spatial processing, thereby supporting the development of standardized and accessible testing protocols across diverse clinical and research environments.
 

Learning Outcomes:
After this course, participants will be able to:

• Describe how the Localization Clock Test is administered and scored.
• Outline the methodology used to assess the test?retest reliability and convergent validity of the Localization Clock Test.
• Evaluate the potential clinical implications of establishing reliability and convergent validity for the Localization Clock Test.

Abstract:

Early identification of childhood hearing loss is critical for supporting optimal speech, language, and developmental outcomes. While newborn hearing screening programs have significantly improved early detection rates, some children experience delayed-onset or progressive hearing loss, and others may not receive timely diagnostic follow-ups after screening. As a result, hearing loss may go unrecognized during important periods of early development. Parents often play a critical role in noticing early behavioral or communication changes, yet limited research has explored how parents interpret these signs and decide when to seek audiologic care.

This qualitative study explores how parents of children aged 0-6 years with hearing loss describe their experiences recognizing and responding to potential early signs of hearing loss. This study includes parents of children with either congenital or later-onset hearing loss to capture a range of identification experiences. Semi-structured interviews are used to allow parents to describe their observations, interpretations, and decision-making process in their own words. Interview questions focus on parents' initial observations of early signs, how they understood or interpreted those behaviors at the time, the actions they took in response, and how their understanding of hearing loss evolved following diagnosis.

Interviews are conducted in person or virtually, audio-recorded, and transcribed verbatim. Data are analyzed using thematic analysis to identify recurring patterns related to parental awareness, interpretation of early signs, and barriers or facilitators to seeking audiologic evaluation and early intervention services.

By centering parents' lived experiences, this study aims to contribute to a deeper understanding of the parental role in early hearing identification. Findings may support improved family-centered education strategies, enhanced communication between parents and professionals, and support strategies that promote earlier recognition and intervention for childhood hearing loss.
 

Learning Outcomes:
After this course, participants will be able to:

• Discuss common types of behaviors parents report noticing prior to the identification of hearing loss in children aged 0-6 years.
• Describe the types of initial actions parents report taking after suspecting or learning of hearing-related concerns in young children.
• Describe parents' perspectives on how professionals can better support education about early signs of hearing concerns in children.

Abstract:

Introduction: The Auditory Steady-State Response (ASSR) is a sustained electrophysiological response that is phase-locked to the steady characteristics of an auditory stimulus, such as its amplitude modulation frequency or repetition rate. Because the response maintains consistent amplitude and phase throughout stimulation, ASSR allows for frequency-specific estimation of hearing thresholds. Recent advances in ASSR technology, including the use of narrowband CE-chirp stimuli presented at varying repetition rates, have shown promise in improving response detection and reducing overall test time. However, to date, there are no studies that systematically evaluate the benefits of extending recording duration on ASSR thresholds. 

Objective: The purpose of this study is to determine whether longer recording durations improve threshold estimation using next-generation ASSR. Specifically, ASSR thresholds will be compared across recording durations of 6 minutes (default), 9 minutes, and 12 minutes at 500, 1000, 2000, and 4000 Hz.

Hypothesis: Increasing test duration in new-generation ASSR recordings will result in lower and more accurate threshold estimations particularly at 500 Hz and 1000 Hz.

Method: Twenty participants with normal hearing were recruited for the study. Each participant underwent ASSR testing using a fixed protocol that includes recordings at 6 minutes, 9 minutes, and 12 minutes across 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. ASSR thresholds from each recording duration were analyzed to assess whether increased recording time resulted in differences in threshold estimation and to determine the clinical value of extended test durations.

Results: Preliminary analysis of data from participants with normal hearing indicates that ASSR thresholds were generally stable across recording durations. However, reductions in ASSR thresholds were observed in some participants when recording time was extended from 6 to 9 minutes and from 6 to 12 minutes. These improvements occurred more frequently at lower frequencies, particularly at 500 Hz, while thresholds at higher frequencies demonstrated minimal change.

Conclusion: ASSR thresholds obtained using the default 6-minute recording duration were largely comparable to those obtained with extended recording times of up to 12 minutes. While longer recording durations may improve threshold estimation at lower frequencies, particularly at 500 Hz.
 

Learning Outcomes:
After this course, participants will be able to:

• Describe the principles of next-generation Auditory Steady-State Response (ASSR) testing, including the use of narrowband CE-chirp stimuli.
• Compare ASSR threshold estimates obtained at different recording durations (6, 9, and 12 minutes) across frequencies from 500 Hz to 4000 Hz.
• Evaluate the clinical utility of extended ASSR recording times, to determine when longer test durations may or may not add clinical value.

Abstract:

Objectives: Personal noise dosimeters are considered the gold standard for quantifying time-weighted noise exposure. However, their size and visibility may limit feasibility in field-based research requiring unobtrusive monitoring. This study compared a Type 1 dosimeter with a commercially available wearable device (Apple Watch) to evaluate whether the Apple Watch could serve as a practical tool for measuring environmental noise in agricultural settings. Accuracy was assessed across quiet, moderate, and loud environments. Quiet settings included a library, meditation room, home, and empty classroom. Moderate settings included an active classroom during lecture, a campus café, and a dining hall during non-peak hours. Loud environments included a campus concert, high-traffic street or parking lot, and a construction zone.

Design: Simultaneous measurements were collected using an Apple Watch (3-dB exchange rate) and a Type 1 dosimeter (OSHA 90-dB criterion level, 5-dB exchange rate). The Apple Watch was worn on the non-dominant wrist, and the dosimeter microphone was clipped to the lapel on the same side to maintain consistent orientation. The dosimeter was calibrated prior to each trial, and microphone placement was monitored to prevent obstruction.

Results: Preliminary findings indicate that Apple Watch A-weighted averages approximated dosimeter measurements within 5?9 dB. In loud environments, mean levels were 82 dB (Apple Watch) and 87 dB (dosimeter). In quiet environments, averages were 63 dB and 54 dB, respectively. Peak levels exceeding 100 dB were detected only by the dosimeter. Observed differences are consistent with variations in exchange rates, microphone placement, and device sensitivity.

Conclusions:  The Apple Watch demonstrated potential as a feasible alternative for environmental noise monitoring, with comparable overall trends despite discrepancies at higher levels and for peak detection. Further research in agricultural environments is necessary to evaluate long-term accuracy, usability, and feasibility for routine field deployment.
 

Learning Objectives:
Upon completion, participants will be able to:

• Identify barriers to routine noise monitoring in agricultural settings.
• Distinguish methodological differences between Apple Watch and dosimeter noise measurements.
• Evaluate the feasibility of wearable consumer devices for occupational noise monitoring.

Abstract:

This review examines the impact of musical training on otoacoustic emissions (OAE) by comparing the OAE measurements of musically trained adults to non-musicians. OAE measurements, including transient-evoked OAE (TEOAE) and distortion-product OAE (DPOAE), were analyzed to determine differences within the two groups. Results indicated significantly increased OAE amplitudes and signal-to-noise ratios (SNR) in musicians, suggesting enhanced cochlear function. However, some studies reported no significant differences in specific frequency ranges. Additionally, medial olivocochlear reflexes (MOCR) were found to be stronger in musically trained adults, which may contribute to the increased OAE measurements. These findings support the notion that musical training can positively influence cochlear function seen through enhanced OAE measurement s.
 

Learning Outcomes:
After this course, participants will be able to:

• Describe the relationship between musical training and otoacoustic emission (OAE) amplitude in adults with normal hearing.
• Explain how musical training may influence outer hair cell function as measured by OAEs.
• Identify frequency-specific OAE patterns associated with musical training.

Abstract:

Difficulty understanding speech in background noise is one of the most common complaints among individuals with hearing loss, and it is also reported by many adults as they get older. Speech-in-noise tests, especially sentence-based measures like the QuickSIN, are used to better understand how people function in real-world listening situations. Unlike speech testing in quiet, sentence-level tasks require listeners to use not only what they hear acoustically, but also linguistic context and cognitive resources to fill in missing information when noise is present. Because of this, these tests may reveal differences that are not obvious during traditional speech recognition testing in quiet. 

The objective of this study was to examine how sentence recognition changes across adulthood using psychometric functions from QuickSIN performance. Audiologic data from over 200 patients between the ages of 20 and 80 years were collected from the University of the Pacific Hearing and Balance Centers in Stockton and San Francisco. QuickSIN performance was measured across signal-to-noise ratios ranging from 25 to 0 dB SNR, and scores were calculated as the average number of key words correctly repeated per sentence (0-5). 

Psychometric curves showed clear age-related differences in sentence recognition, especially in more difficult listening conditions. At higher SNRs (15-25 dB), performance was near ceiling for all age groups, with very little separation between them. However, as the SNR decreased, performance declined for everyone, and differences between age groups became more noticeable. Older adults showed a steeper slope in their psychometric functions compared to younger adults, indicating that they were more affected by background noise. The decline in performance also appeared to occur earlier and more steeply in the older age groups. 

Overall, these findings suggest that sentence-level speech-in-noise perception declines with age, but the differences are most apparent in challenging listening conditions. Age-related changes were not obvious in easier conditions and became clear only as background noise increased. This highlights the importance of evaluating speech perception across a range of SNRs, since more difficult conditions may better reflect real-world communication challenges across the adult lifespan.
 

Learning Objectives:
Upon completion, participants will be able to:

• Interpret age-related differences in QuickSIN psychometric functions across varying signal-to-noise ratios.
• Describe how sentence-level speech-in-noise performance changes across adulthood.
• Demonstrate the importance of speech-in-noise testing in addressing patients' perceived listening deficits in noisy environments.

Abstract:

Falls are a leading cause of injury in adults, making fall-risk identification critical. The CDC’s STEADI protocol uses validated assessments to predict fall risk. However, limited resources, extended appointment times, and required training hinder STEADI’s clinical implementation. Previously, we evaluated AI hearing aids with inertial sensors (IMU-HAs) for remote fall-risk assessment via smartphone app. These devices incorporated self-administered fall-risk assessments, demonstrating strong agreement between IMU-HA fall-risk scores and clinicians? scores. The next step towards scalable fall prevention is to enable hearing aids to classify fall-risk through gait analysis and passive monitoring of daily movements. Such an approach may address implementation issues with the STEADI protocol. In this study, we validated IMU-HA gait analysis against gold-standard gait sensors (Mobility Lab Clario Sensors) and identified which IMU-HA mobility features best predict fall risk.

Participants (n = 50) were recruited to complete a battery of validated mobility tasks while wearing both IMU-HAs and Clario sensors positioned at the lumbar region and both feet. The Functional Gait Assessment was also administered by a trained clinician to provide a ground-truth classification of the participants? gait and fall risk. Participants were grouped into high- or low-fall risk groups. Performance on mobility tasks was compared against FGA classifications to identify predictive features of fall-risk. Preliminary analyses demonstrate that gait speed, step duration, stride length and cadence are most predictive. Double support time and lateral variability do not appear to be predictive of fall risk in this cohort. Early trends suggest that agreement between the IMU-HA and Clario sensors is strongest for cadence (R2 = 0.953). 

IMU-equipped hearing aids show promising validity for measuring key gait parameters associated with fall risk. Early evidence suggests that these devices can capture clinically meaningful mobility features, providing a path toward passive, unobtrusive fall-risk monitoring in daily life. Continued analysis will clarify which variables best classify individuals as high or low risk, supporting the development of scalable, hearing aid?based fall prevention strategies. In the future, continuous passive monitoring with IMU-HAs could also flag early signs of other 

Learning Outcomes:
After this course, participants will be able to:

• Explain why early identification of fall risk is critical and how the current healthcare model does not support early identification and early intervention for fall-risk. 
• Explain key clinical barriers to implementing the CDC STEADI protocol in routine care and how passive monitoring can address them.
• Describe how IMU-equipped hearing aids and passive monitoring will advance fall-risk identification and promote early intervention through targeted therapies.

Abstract:

The purpose of this study is to identify the optimal combination of stimulus levels (L₁ and L₂) and frequency ratio (f₁/f²) that produce the largest extended-high frequency (EHF) distortion product otoacoustic emission (DPOAE) levels at 2f₁ - f₂ in newborns using swept-level paradigms. Establishing optimal parameters may improve the accuracy and sensitivity of cochlear assessments in newborns, particularly for early detection of changes related to ototoxicity or other auditory risks. Frequently used clinical parameters may not effectively evoke strong or reliable responses at the highest frequencies of hearing because newborn ear canals and middle ear properties differ from those of adults. 

Twenty-three healthy newborns who passed their automated auditory brainstem response hearing screening were recruited for testing. DPOAEs were measured from 2-16 kHz using a swept-level paradigm and simultaneous assessment of two frequency pairs within a single recording (2 and 10 kHz, 4 and 12 kHz, 6 and 14 kHz, and 8 and 16 kHz). Five ratios (f₂/f₁ = 1.10, 1.15, 1.20, 1.25, and 1.30) were evaluated, with stimulus levels where L₁ was fixed and L₂ was varied. Stimuli were generated using an RME Babyface interface connected to an Etymotic Research ER-10X extended-bandwidth probe system. Calibration for the stimulus levels was enhanced using forward pressure level (FPL). For each frequency pair, the combination of stimulus levels and ratio that produced the largest DPOAE level were identified. 

Overall, the largest DPOAE levels were recorded when L₂ was lower than L₁, as has been reported previously. Optimal stimulus ratios (1.21) for eliciting DPOAEs are comparable to other reports examining newborn ears at conventional frequencies. However, at EHFs even narrower ratios (1.15) were required to generate the largest DPOAE levels in newborns compared to younger (1.17) and older children (1.18). DPOAE levels measured with optimal stimulus levels and ratios are larger on average than using typical clinical stimulus parameters. Using optimal stimulus parameters to evoke EHF DPOAEs in newborn ears will enhance our ability to identify the earliest signs of cochlear damage.
 

Learning Outcomes:
After this course, participants will be able to:

• Describe the optimal stimulus frequency ratio (f₂ /f₁ ) that evokes the largest DPOAE levels over an extended bandwidth in newborn ears.
• Discuss how DPOAE levels change across frequency with varied stimulus levels (L₁ and L₂). 
• Compare DPOAE levels evoked with traditional versus optimal stimulus parameters (levels and ratios).