Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons

Open Access. Powered by Scholars. Published by Universities.®

Speech and Hearing Science

PDF

2021

Institution
Keyword
Publication
Publication Type

Articles 1 - 30 of 88

Full-Text Articles in Medicine and Health Sciences

Does Whispering Improve Children’S Memory? Comparing Auditory Vigilance And Salience Hypotheses, Christina M. Barnes Dec 2021

Does Whispering Improve Children’S Memory? Comparing Auditory Vigilance And Salience Hypotheses, Christina M. Barnes

Graduate Theses and Dissertations

Oral communication is one of the primary tools children use to learn new information and speech registers can deliver additional meaning to the words someone uses. Cirillo’s (2004) vigilance hypothesis states “Whispering can affect the psychobiological state of recipients, and in particular raise their auditory vigilance” (Cirillo, 2004, p. 76). Building on this theory, the current study investigates the role of whispering and children’s memory by examining a whispering vigilance, whispering salience which focused on the changes between normal and whisper registers, and combined vigilance and salience hypotheses to determine if whispering contributes to the recall of information. Using video …


Verification Of A Mobile Psychoacoustic Test System, Jordana C. Soares, Sangamanatha Veeranna, Vijay Parsa, Chris Allan, Winnie Ly, Minh Duong, Paula Folkeard, Sheila Moodie, Prudence Allen Dec 2021

Verification Of A Mobile Psychoacoustic Test System, Jordana C. Soares, Sangamanatha Veeranna, Vijay Parsa, Chris Allan, Winnie Ly, Minh Duong, Paula Folkeard, Sheila Moodie, Prudence Allen

Faculty Publications

Many hearing difficulties can be explained as a loss of audibility, a problem easily detected and treated using standard audiological procedures. Yet, hearing can be much poorer (or more impaired) than audibility predicts because of deficits in the suprathreshold mechanisms that encode the rapidly changing, spectral, temporal, and binaural aspects of the sound. The ability to evaluate these mechanisms requires well-defined stimuli and strict adherence to rigorous psychometric principles. This project reports on the comparison between a laboratory-based and a mobile system’s results for psychoacoustic assessment in adult listeners with normal hearing. A description of both systems employed is provided. …


Identification Of Opportunity Barriers And Supports For Individuals Using Augmentative And Alternative Communication (Aac) And Stakeholders, Meredith K. Gohsman Dec 2021

Identification Of Opportunity Barriers And Supports For Individuals Using Augmentative And Alternative Communication (Aac) And Stakeholders, Meredith K. Gohsman

Rehabilitation Sciences Theses & Dissertations

Individuals using augmentative and alternative communication (AAC) are supported by many AAC stakeholders and communication partners. Clinical decision making and AAC assessment models consider the capabilities and access needs of the individual using AAC, as well as opportunity barriers and supports imposed by communication partners and environments. The purpose of this research was to investigate opportunity barriers and supports identified by two critical AAC stakeholders: speechlanguage pathologists and caregivers. The first study investigated characteristics of AAC service provision reported by post-professional speech-language pathologists. Speech-language pathologists reported lack of perceived knowledge related to AAC service delivery, inconsistent use of AAC modalities, …


The Role Of Working Memory And Linguistic Knowledge On Language Performance, Theresa Ai Vy Pham Nov 2021

The Role Of Working Memory And Linguistic Knowledge On Language Performance, Theresa Ai Vy Pham

Electronic Thesis and Dissertation Repository

The language system is highly flexible and draws on distinct but interconnected cognitive mechanisms, including verbal working memory and long-term linguistic knowledge. Verbal working memory is the ability to manipulate verbal information in mind. Long-term linguistic knowledge refers to our knowledge of the language (i.e., phonology, semantics, syntax), stored in long-term memory. The close interaction between verbal working memory and linguistic knowledge highlights a pressing need to investigate the construct of verbal working memory, its separability and its relationship with linguistic knowledge. To understand the way working memory influences and interacts with language abilities in children and adults, I ask …


Characteristics And Causal Factors For The Receptive-Expressive Gap In Typically Developed Spanish-English Adult Bilinguals, Rachael Janelle Javaherian Nov 2021

Characteristics And Causal Factors For The Receptive-Expressive Gap In Typically Developed Spanish-English Adult Bilinguals, Rachael Janelle Javaherian

LSU Master's Theses

A receptive-expressive language gap occurs when a standardized receptive score is statistically greater than an expressive score in either a primary or a second language. In bilingual children, gap studies already exist for determining language impairment. In adults, there are few studies; nevertheless, one needs to distinguish between typical language patterns of bilingualism due to non-pathological loss of L1 skills versus problems resulting from accidents, disease, or age. To this end, the present study attempted to expand findings of studies by Gibson et al. (2012 and 2014) that focused on analysis of the gap and possible factors influencing its existence …


Effect Of Flow Phonation Voice Exercises On Vocal And Aerodynamic Measures In Undergraduate Student Singers, Jorge A. Diaz Nov 2021

Effect Of Flow Phonation Voice Exercises On Vocal And Aerodynamic Measures In Undergraduate Student Singers, Jorge A. Diaz

FIU Electronic Theses and Dissertations

This study examined the effects of Flow Phonation Voice Exercises on vocal measures in undergraduate student singers. Whereas these exercises have provided positive outcomes in individuals with vocal hyperfunction, the use of these exercises in potentially enhancing the singing voice has not been explored. A total of 10 participants were randomly assigned into an experimental group (n = 6), that received 5 sessions of the Flow Phonation Voice Exercises across 5 weeks, and a control group (n = 4) which did not receive the treatment. Changes in auditory-perceptual, acoustic, subjective respiratory, quality-of-life and fatigue related measures compared across two groups. …


Examining Early Language And Communication Skills In Children At Elevated Risk For Developmental Delays, Taylor Watters Oct 2021

Examining Early Language And Communication Skills In Children At Elevated Risk For Developmental Delays, Taylor Watters

The Journal of Purdue Undergraduate Research

No abstract provided.


Impact Of Face Masks On Audiovisual Word Recognition In Young Children With Hearing Loss During The Covid-19 Pandemic, Erin Lipps, Jody Caldwell-Kurtzman, Lina Motlagh Zadeh, Chelsea M. Blankenship, David R. Moore, Lisa L. Hunter Oct 2021

Impact Of Face Masks On Audiovisual Word Recognition In Young Children With Hearing Loss During The Covid-19 Pandemic, Erin Lipps, Jody Caldwell-Kurtzman, Lina Motlagh Zadeh, Chelsea M. Blankenship, David R. Moore, Lisa L. Hunter

Journal of Early Hearing Detection and Intervention

Objective: To investigate effects of surgical and transparent face masks during the Covid-19 pandemic on audiovisual speech recognition of words for deaf and hard-of-hearing children.

Design: Recorded Word Intelligibility by Picture Identification test (WIPI) was presented in quiet via a computer monitor to children in a quiet test room. The acoustic power spectra of each mask type were compared to the baseline no mask condition. Percent correct word recognition was recorded for four mask conditions (no mask, surgical mask, transparent apron mask and ClearMask) in counterbalanced order. Repeated measures ANOVA was used to test for significant differences in word recognition …


Teachers’ Views On Preparation For Employment Of Young Autistic People, Biranavan Thavapalan, Emanuele Maria Merlo Oct 2021

Teachers’ Views On Preparation For Employment Of Young Autistic People, Biranavan Thavapalan, Emanuele Maria Merlo

Journal of Mind and Medical Sciences

Background. Contemporary literature indicates that there is significant support and assistance provided by schools for young autistic people, which has had a positive impact on the accessibility of jobs. Nevertheless, the employment rate of autistic people is unacceptably low in the UK. The current study investigated teachers’ views on the preparation for employment of young autistic people in the UK. Methods. Interviews were conducted with individuals from the educational field and thematic analysis was used to explore the teachers’ views regarding the factors that have an impact on the preparation for employment of young autistic people. Results. …


Acoustic Changes Following Clear Speech Intervention, Polina Shuminsky Sep 2021

Acoustic Changes Following Clear Speech Intervention, Polina Shuminsky

Dissertations, Theses, and Capstone Projects

Studies have shown that the speech perception of individuals with hearing loss and other perceptual difficulties improves when talkers deliberately use clear speech. Several investigations have reported increased recognition scores of 11 to 34 percentage points for various listener groups in response to naturally produced clear speech. Studies show that clear speech production is highly variable across talkers. Therefore, a consistent method of eliciting clear speech that leads to more unified and consistent production outcomes is needed. Limited evidence suggests that a training program on how to speak clearly may yield greater listener benefit than clear speech produced naturally. The …


Efficiency Of The Acoustic Change Complex For Various Stimulus Presentation Strategies In Infants, Lisa Goldin Sep 2021

Efficiency Of The Acoustic Change Complex For Various Stimulus Presentation Strategies In Infants, Lisa Goldin

Dissertations, Theses, and Capstone Projects

The acoustic-change-complex (ACC) is an objective measure that can be used to study whether sounds are encoded at the level of the cortex. The goals of this study were: 1) To determine if the ACC can be elicited in infants, and 2) To establish whether eliminating the silent interval between stimuli and using a continuously alternating stimulus is more efficient in infants than the traditional interrupted stimulus presentation method. If the continuously alternating stimulus is more efficient, then 3) To determine why the continuously alternating stimulus is more efficient.

Twenty-one infants aged 2 months to 13 months old served as …


Cross-Linguistic Morphosyntactic Influence In Bilingual Speakers Of Jamaican Creole And Jamaican English, Taryn R. Malcolm Sep 2021

Cross-Linguistic Morphosyntactic Influence In Bilingual Speakers Of Jamaican Creole And Jamaican English, Taryn R. Malcolm

Dissertations, Theses, and Capstone Projects

Bilingualism in Jamaica is of considerable consequence, as most individuals are early bilinguals, speaking both a variety of Jamaican Creole (JC) from birth and having standardized English (sE) as the language of instruction in education. Immigrants from Jamaica to the United States are an ideal population to examine how cross-linguistic influence (CLI) impacts morphosyntax as JC and sE differ in morphosyntactic constructions, including verb tense- marking, subject-verb agreement, and copula use. While much of the work in the field of CLI has examined spoken language pairs with varying degrees of similarity (or difference) between the languages, examining CLI in a …


Liam Briggs 2021 Usri - Audio Testing Device, Liam Briggs Aug 2021

Liam Briggs 2021 Usri - Audio Testing Device, Liam Briggs

Undergraduate Student Research Internships Conference

Portable and cost-effective hearing testing device with a UI that can be accessed on a remote web server.


Typical And Atypical Development Of Compensation To Altered Auditory Feedback, Caitlin E. Coughler Aug 2021

Typical And Atypical Development Of Compensation To Altered Auditory Feedback, Caitlin E. Coughler

Electronic Thesis and Dissertation Repository

Auditory feedback, how we hear ourselves speak, plays an important role in the acquisition and maintenance of fluent speech. Although there is wide acceptance of the importance of auditory feedback control throughout development, little is known about how this develops or how the reliance on auditory feedback control may shift compared to other elements of speech motor control. This dissertation aimed to improve our understanding of the development of auditory feedback control and speech motor control in typically developing children and pediatric clinical populations through the exploration of responses to altered auditory feedback. In altered auditory feedback paradigms, small, often …


The Similarities And Differences Between Distortion-Product Otoacoustic Emission Testing Instruments And Accuracy Settings, Maximilian Tran-Luong Aug 2021

The Similarities And Differences Between Distortion-Product Otoacoustic Emission Testing Instruments And Accuracy Settings, Maximilian Tran-Luong

Electronic Thesis and Dissertation Repository

Advanced measures of the auditory system like otoacoustic emission (OAE) testing are essential for highlighting the subtle expressions of hearing loss if clinical care is to remain up to date with current scientific knowledge. The purpose of this study was to compare distortion product OAE (DPOAE) testing across three different measurement systems (Interacoustic Titan, Bio-logic Scout and Vivosonic Integrity) to determine if there are differences in DPOAE testing. Secondly, the study will look to evaluate the effect if varying accuracy settings on DPOAE testing within the Integrity system. DPOAE tests evaluating levels, noise floor levels, probe fit check time and …


Measuring Language Development In Children With Down Syndrome Who Use Aac, Ji Sun Park Jul 2021

Measuring Language Development In Children With Down Syndrome Who Use Aac, Ji Sun Park

Speech and Hearing Sciences ETDs

Purpose: This study examined the inter-observer agreement (IOA) and within-observer agreement as well as the clinical potential of newly proposed measures that are designed to monitor language progress of children with Down syndrome who use AAC. Measures were explored based on the Graphic Symbol Utterance and Sentence Development Framework.

Method: Participants included 8 preschoolers with Down syndrome. Four graduate student observers coded 13 measures across 57 intervention sessions. Each session was coded by two observers for IOA, and all sessions were recoded for within-observer agreement. Statistical analyses were completed on utterance level and session level.

Results: Across all observers and …


Main Concept, Sequencing, And Story Grammar (Mssg) Analyses Of The Cinderella Story In Latent Aphasia, Janet B. Adams Jul 2021

Main Concept, Sequencing, And Story Grammar (Mssg) Analyses Of The Cinderella Story In Latent Aphasia, Janet B. Adams

Speech and Hearing Sciences ETDs

Commonly used standardized tests, like the Western Aphasia Battery-Revised (WAB-R), are not sensitive to higher level discourse deficits, leading to certain individuals not meeting diagnostic criteria for aphasia. Consequently, individuals with aphasia are excluded from receiving potentially beneficial services and/or from being included in research. In a large sample of persons with stroke-induced aphasia, this study analyzed discourse samples using Main Concept, Sequencing, and Story Grammar (MSSG) Analyses to examine macrostructural discourse characteristics of persons with latent aphasia (PWLAs) compared to persons with no underlying brain injury (PNBIs) and persons classified as having anomic aphasia (PWAAs) by the WAB-R. A …


Ancillary Data For Refining Computer Adaptive Algorithms For The Assessment Of Anomia, Emily Kathryn Tudorache Jul 2021

Ancillary Data For Refining Computer Adaptive Algorithms For The Assessment Of Anomia, Emily Kathryn Tudorache

Dissertations and Theses

Computer adaptive testing formats, based in item response theory (IRT), are becoming an increasingly popular approach to testing in healthcare because they offer numerous psychometric and practical advantages to assessment when compared to static tests that rely on classical test theory. Fergadiotis and colleagues (2015) have developed computer adaptive versions of the Philadelphia Naming Test (PNT) short-forms, which have demonstrated acceptable precision and standard error of measurement when compared to the static short-forms and original full-length assessment. This study sought to use synthetic data simulations using the catIrt R package (Nydik, 2014) to investigate possible advantages of the use of …


Objective Measurement Optimization In Early Hearing Detection And Intervention, Matthew J. B. Urichuk Jul 2021

Objective Measurement Optimization In Early Hearing Detection And Intervention, Matthew J. B. Urichuk

Electronic Thesis and Dissertation Repository

Following the fitting of amplification devices, outcomes need to be evaluated to determine benefit of intervention. Objective measurements, which generally require rapid acoustic or electrophysiological measurement without active participation of the individual, are one subset of evaluation methods.

This thesis aimed to improve the reliability, accuracy, and efficiency of a subset of objective outcome measurements: the speech-evoked Envelope Following Response (EFR), and the wideband real-ear-to-coupler-difference (wRECD), which are used in hearing aid validation and verification respectively.

The speech-evoked EFR, a neural response reflecting phase-locked activity to the envelope of a speech stimulus, can be detected using a variety of statistical …


New Mexican Parents’ Perspectives Regarding Public Schools’ Communication And Language Services For Their Elementary-Aged Children With Autism Spectrum Disorder During Covid-19, Susanna E. Cole Jul 2021

New Mexican Parents’ Perspectives Regarding Public Schools’ Communication And Language Services For Their Elementary-Aged Children With Autism Spectrum Disorder During Covid-19, Susanna E. Cole

Speech and Hearing Sciences ETDs

This study explored five New Mexican parents’ perceptions of changes to the public school-based communication and language services for their children with autism spectrum disorder (ASD) during the Covid-19 pandemic and the subsequent advantages and disadvantages of these changes. The parents participated in semi-structured interviews between October 2020 and February 2021. All of the parents reported their children’s services had eventually gone completely remote, but one had secured some in-person instruction time for her child by the time of her interview. Three parents reported reduction in school-based communication and language services for which they sought to compensate through other means. …


Perceptions Of Speech-Language Pathologists On Childhood Bilingualism, Sherlie V. Paz Jul 2021

Perceptions Of Speech-Language Pathologists On Childhood Bilingualism, Sherlie V. Paz

FIU Electronic Theses and Dissertations

A total of 320 Speech-Language Pathologists (SLPs) completed a survey stating their perceptions on childhood bilingualism for typically developing children and children with disabilities. Based on the number of significant responses, 292 participants were analyzed utilizing a binary logistic regression to identify whether SLPs thought childhood bilingualism was advantageous or neutral, while incorporating the predictors of bilingual status and bilingual education received. Additionally, a content analysis was conducted on 173 participants who chose to respond to an open-ended question stating their additional perceptions on childhood bilingualism. Results revealed that bilingual status did not predict the probability of an advantageous perception …


Successful Aging In Adults Who Stutter: Exploring Predictors Of Physical And Mental Health-Related Quality Of Life, Amanda Kelly Jun 2021

Successful Aging In Adults Who Stutter: Exploring Predictors Of Physical And Mental Health-Related Quality Of Life, Amanda Kelly

USF Tampa Graduate Theses and Dissertations

This study was conducted to investigate predictors of physical and mental health quality of life in aging adults who stutter (AWS). Our goal was to identify factors contributing to successful aging in this talker group. The aging population is expected to increase exponentially over the next twenty years. Factors influencing self-perceived health-related quality of life have yet to be investigated in aging AWS.

An online survey was completed by a total of 40 AWS, age 50 years and older, recruited from the Greater Tampa Bay region and nationally. The survey comprised multiple measures that probed for information regarding self-perceived health …


The Effects Of Acidic Foods On Vocal Quality Of Vocally Healthy Individuals, Melissa Barbieri Jun 2021

The Effects Of Acidic Foods On Vocal Quality Of Vocally Healthy Individuals, Melissa Barbieri

FIU Electronic Theses and Dissertations

The purpose of the current study was to examine the relationship between the consumption of acidic liquids on the vocal quality of vocally healthy individuals. Acidic foods and liquids are known to be possible causes of common voice disorders because of their putative effect on systemic hydration of the vocal folds impacting their viscoelastic properties and eventually affecting vocal quality, as they are found in over 50% of dysphonic patients (Karkos et al., 2007). This study investigated the effects of acidic foods on vocal quality in comparison to the effects of non-acidic/alkaline beverages in vocally healthy individuals.

One hundred participants …


A New Age Of Telehealth: Pediatric Speech-Language Pathology Services During The Covid-19 Pandemic And Beyond, Deborah R. Campbell Jun 2021

A New Age Of Telehealth: Pediatric Speech-Language Pathology Services During The Covid-19 Pandemic And Beyond, Deborah R. Campbell

USF Tampa Graduate Theses and Dissertations

The COVID-19 pandemic potentially changed the landscape of how speech-language pathologists provide services. Prior to March 2020, pediatric speech-language therapy provided via telehealth was limited; however, the COVID-19 pandemic caused a worldwide conversion from in-person care to a remote service delivery model. This conversion brought to the fore possible benefits and utility of telehealth use. Yet, clinicians potentially experienced barriers to its use, including the lack of validity and reliability evidence for remote administration of several pediatric assessments. For the viability of remotely delivered speech-language services to continue and evolve in a post-pandemic world, further research is needed to identify …


Modelling Loudness: Acoustic And Perceptual Correlates In The Context Of Hypophonia In Parkinson’S Disease, Daryn Amory Cushnie-Sparrow Jun 2021

Modelling Loudness: Acoustic And Perceptual Correlates In The Context Of Hypophonia In Parkinson’S Disease, Daryn Amory Cushnie-Sparrow

Electronic Thesis and Dissertation Repository

Hypophonia (quiet speech) is a common speech symptom associated with Parkinson’s disease (PD), and is associated with reduced intelligibility, communicative effectiveness, and communicative participation. Studies of hypophonia commonly employ average speech intensity as the primary dependent measure, which may not entirely capture loudness deficits. Loudness may also be affected by the frequency components of speech (i.e. spectral balance) and speech level variability. The present investigation examined relationships between perceived loudness and intelligibility with acoustic measures of loudness, speech intensity, and spectral distribution in individuals with hypophonia secondary to Parkinson’s disease (IWPDs) and neurologically healthy older adults (HOAs).

Samples of sentence …


The Perceptions Of Speech-Language Pathologists Toward Augmentative And Alternative Communication In Thailand, Wansiya Kamonsitichai Jun 2021

The Perceptions Of Speech-Language Pathologists Toward Augmentative And Alternative Communication In Thailand, Wansiya Kamonsitichai

USF Tampa Graduate Theses and Dissertations

Although Augmentative and Alternative Communication (AAC) systems have gained increasing acceptance in the US, they are not well-known and broadly used in Thailand. To begin introducing AAC systems and interventions to children with complex communication needs (CCNs) in Thailand, understanding Speech-Language Pathologists’ (SLP) perceptions toward various AAC systems is considered an important first step. This study assessed SLPs’ perceptions toward three AAC modalities: gestural communication, communication boards, and speech-generating devices. All SLPs in Thailand (n ~ 200) were invited to participate. A total of 78 SLPs watched three video vignettes with a Thai child illustrating each AAC mode. They then …


Happy 😊, Sad 😥Or Pizza 🍕: A Review Of Emoji Effects On Reading Times And Their Relation To Mood, Fetheya Alattar Jun 2021

Happy 😊, Sad 😥Or Pizza 🍕: A Review Of Emoji Effects On Reading Times And Their Relation To Mood, Fetheya Alattar

University Honors Theses

With recent advancements in technology, emoji are continuously changing the way that people communicate and process language. Their use continues to evolve as a mechanism to counter the loss of the rich nonverbal cues of face-to-face communication. Subsequently, the need for research examining how emoji are processed and how they affect language and communication has become more important. This research specifically examines the scholarship on emoji effects on sentence reading times (RT) and how this relates to mood. Results on the effects of emoji on sentence RT are mixed. In some instances, emoji slowed RT and in others, they sped …


Optimizing Communication In Palliative And Hospice Care: A Toolkit For Audiologists, Sherry E. Queen Jun 2021

Optimizing Communication In Palliative And Hospice Care: A Toolkit For Audiologists, Sherry E. Queen

Dissertations, Theses, and Capstone Projects

The prevalence of hearing loss increases with age, with age-related hearing loss (ARHL) being one of the most prevalent forms of sensory decline in older adults. Hearing loss is often overlooked in medical settings including palliative and hospice care. Screening for hearing loss in these settings is rare as is formal staff training on assessing and managing hearing loss in palliative and hospice care. An evidence-based toolkit for integrating audiologists into end-of-life care protocols is presented. This toolkit was developed to optimize communication in palliative and hospice care for patients, caregivers, audiologists, physicians, and other palliative care staff. Effective communication …


The Power Of A Sound Mind: Exploring Meditation And Sound Therapies For Treating The Emotional Impact Of Tinnitus, Sabeena A. Ramnanan Jun 2021

The Power Of A Sound Mind: Exploring Meditation And Sound Therapies For Treating The Emotional Impact Of Tinnitus, Sabeena A. Ramnanan

Dissertations, Theses, and Capstone Projects

Tinnitus is described as a sound perceived by an individual that has no external source. Some individuals with tinnitus can habituate to this phantom sound, while others become emotionally disturbed by it. There are several theories which attempt to rationalize the cause of tinnitus, and various treatments which aim to eliminate, mask, or facilitate habituation to one’s tinnitus. Current common treatments include sound therapies and cognitive-behavioral therapy (CBT), either in isolation or in combination with one another. However, not all these treatments aim to address the emotional impact of tinnitus. Novel treatments are emerging, with some attempting to reduce the …


Alcohol And Its Long-Term Effects On Hearing Loss: A Systematic Review, Talia Sowalsky Jun 2021

Alcohol And Its Long-Term Effects On Hearing Loss: A Systematic Review, Talia Sowalsky

Dissertations, Theses, and Capstone Projects

Objective: To review the literature on potential permanent effects of long-term alcohol consumption on hearing status in adults 40 years of age and older.

Study Design: Systematic review of prospective and retrospective studies; meta-analysis of case-controlled studies.

Methods: One researcher independently reviewed MEDLINE (January 1, 2000-May 1, 2019), CINAHL (January 1, 2000-May 1, 2019), PubMed (January 1, 2000-May 1, 2019), and Web of Science (January 1, 2000-May 1, 2019). A manual reference search was additionally conducted. Randomized controlled trials, prospective cohort studies, consecutive/non-consecutive case series, and retrospective reviews in which a clear definition of hearing loss was stated were included …