Introduction: This discussion paper reviews and synthesises the literature on simulated learning environment (SLE) from allied health sciences, medical and nursing in general and audiology specifically. The focus of the paper is on discussing the use of high-fidelity (HF) SLE and describing the challenges for developing a HF SLE for clinical audiology training. Methods: Through the review of the literature, this paper discusses seven questions, (i) What is SLE? (ii) What are the types of SLEs? (iii) How is SLE classified? (iv) What is HF SLE? (v) What types of SLEs are available in audiology and their level of fidelity? (vi) What are the components needed for developing HF SLE? (vii) What are the possible types of HF SLEs that are suitable for audiology training? Publications were identified by structured searches from three major databases PubMed, Web of Knowledge and PsychInfo and from the reference lists of relevant articles. The authors discussed and mapped the levels of fidelity of SLE audiology training modules from the literature and the learning domains involved in the clinical audiology courses. Results: The discussion paper has highlighted that most of the existing SLE audiology training modules consist of either low- or medium-fidelity types of simulators. Those components needed to achieve a HF SLE for audiology training are also highlighted. Conclusion: Overall, this review recommends that the combined approach of different levels and types of SLE could be used to obtain a HF SLE training module in audiology training.
Audiology ; Hearing

Background and Objectives: There is growing interest in the use of the Level-specific (LS) CE-Chirp® stimulus in auditory brainstem response (ABR) due to its ability to produce prominent ABR waves with robust amplitudes. There are no known studies that investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus. The present study aims to investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus and compare its reliability with the ABR to standard click stimulus at multiple intensity levels in normal-hearing adults. Subjects and Methods: Eleven normal-hearing adults participated. The ABR test was repeated twice in the same clinical session and conducted again in another session. The ABR was acquired using both the click and LS CE-Chirp® stimuli at 4 presentation levels (80, 60, 40, and 20 dBnHL). Only the right ear was tested using the ipsilateral electrode montage. The reliability of the ABR findings (amplitudes and latencies) to the click and LS CE-Chirp® stimuli within the same clinical session and between the two clinical sessions was calculated using an intra-class correlation coefficient analysis (ICC). Results: The results showed a significant correlation of the ABR findings (amplitude and latencies) to both stimuli within the same session and between the clinical sessions. The ICC values ranged from moderate to excellent. Conclusions The ABR results from both the LS CE-Chirp® and click stimuli were consistent and reliable over the two clinical sessions suggesting that both stimuli can be used for neurological diagnoses with the same reliability.

To map the evidence from the relevant studies regarding the use of music and sound-based intervention for autism spectrum disorder (ASD) using a scoping review study design. Scoping review was conducted according to the inclusion criteria using Google Scholar, PubMed, CINAHL, MEDLINE, and Scopus. The review was accomplished in five steps: 1) identify the inclusion criteria, 2) search for relevant studies, 3) studies selection, 4) data extraction and charting, and 5) data analysis and presentation. Four major themes emerged from 39 studies that matched the inclusion criteria as follows: 1) forms of sound therapy discussing methods of sound therapy and stimulus used, 2) duration of the intervention explain in terms of listening time and total listening sessions, 3) clinical characteristics of the intervention exploring the main interest of sound therapy study in ASD, and 4) evidence for the intervention effectiveness looking into the positive, negative, and mixed findings of previous studies. Each theme was explored to identify the knowledge gaps in sound-intervention therapy. This review demonstrated the need for further studies to address several issues including identifying the effectiveness of sound-therapy intervention for ASD according to the individual sound types, the minimum duration for ASD sound-therapy intervention and more details on the use of technology, and clinical features of the sound-therapy intervention. These elements are important to further demonstrate the effectiveness of sound therapy intervention for ASD children.

BACKGROUND AND OBJECTIVES: There is a scant evidence on the use of simulations in audiology (especially in Malaysia) for case-history taking, although this technique is widely used for training medical and nursing students. Feedback is one of the important components in simulations training; however, it is unknown if feedback by instructors could influence the simulated patient (SP) training outcome for case-history taking among audiology students. Aim of the present study is to determine whether the SP training with feedback in addition to the standard role-play and seminar training is an effective learning tool for audiology case-history taking. SUBJECTS AND METHODS: Twenty-six second-year undergraduate audiology students participated. A cross-over study design was used. All students initially attended two hours of seminar and role-play sessions. They were then divided into three types of training, 1) SP training (Group A), 2) SP with feedback (Group B), and 3) a non-additional training group (Group C). After two training sessions, the students changed their types of training to, 1) Group A and C: SP training with feedback, and 2) Group B: non-additional training. All the groups were assessed at three points: 1) pre-test, 2) intermediate, and 3) post-test. The normalized median score differences between and within the respective groups were analysed using non-parametric tests at 95% confidence intervals. RESULTS: Groups with additional SP trainings (with and without feedback) showed a significantly higher normalized gain score than no training group (p<0.05). CONCLUSIONS: The SP training (with/ without feedback) is a beneficial learning tool for history taking to students in audiology major.
Audiology ; Cross-Over Studies ; Education, Medical ; Hearing ; Humans ; Islam ; Learning ; Malaysia ; Students, Nursing

BACKGROUND AND OBJECTIVES: Sine a self-reported questionnaire for hearing-impaired listeners is not available by Malay language yet, it is important to develop or translate any available existing questionnaires. The aim of this study was to translate, adapt and validate the Hearing Handicap Inventory for Adult (HHIA) to be used by the audiologist among the hearing-impaired population in Malaysia. SUBJECTS AND METHODS: The HHIAs was translated to Malay language using forward-backward translation techniques by four-panellists (two for each level). The translated HHIA was then reconciled and harmonized for cultural aspects and content of the questionnaire by the researchers and two expert panels before being pilot-tested among 10 hearing-impaired patients. Questionnaire validation was conducted among 80 adults with a hearing loss to calculate for Cronbach’s α (internal reliability), Spearman’s correlation (inter-item correlation) and factor analysis. RESULTS: None of the translated items were removed from the scale. The overall Cronbach’s α was 0.964; 0.927 and 0.934 for both social and emotional subscales, respectively. The factor analysis (force-concept inventory) demonstrated a two-structure with a strong correlation between all items in either component 1 or 2, that resembled the original scale. The Mann-Whitney test revealed significantly higher scores for those adults with a hearing loss than those adults with normal hearing. CONCLUSIONS: The Malay HHIA has been successfully translated and validated for the purpose of determining the psychosocial aspects of adults with hearing loss in the local population.
Adult ; Hearing Loss ; Hearing ; Humans ; Malaysia

Background and Objectives: No known studies have investigated the influence of stimulus polarity on the Auditory Brainstem Response (ABR) elicited from level-specific (LS) chirp. This study is important as it provides a better understanding of the stimulus polarity selection for ABR elicited from LS chirp stimulus. We explored the influence of stimulus polarity on the ABR from LS chirp compared to the ABR from click at 80 dBnHL in normal-hearing adults. Subjects and Methods: Nineteen adults with normal hearing participated. The ABRs were acquired using click and LS chirp stimuli using three stimulus polarities (rarefaction, condensation, and alternating) at 80 dBnHL. The ABRs were tested only on the right ear at a stimulus rate of 33.33 Hz. The ABR test was stopped when the recording reached the residual noise level of 0.04 µV. The ABRs amplitudes, absolute latencies, inter-peak latencies (IPLs), and the recorded number of averages were statistically compared among ABRs at different stimulus polarities and stimuli combinations. Results: Rarefaction polarity had the largest ABR amplitudes and SNRs compared with other stimulus polarities in both stimuli. There were marginal differences in the absolute latencies and IPLs among stimulus polarities. No significant difference in the number of averages required to reach the stopping criteria was found. Conclusions Stimulus polarities have a significant influence on the ABR to LS chirp. Rarefaction polarity is recommended for clinical use because of its larger ABR peak I, III, and V amplitudes than those of the other stimulus polarities.

Background and Objectives: Despite few reports on the influence of ambient acoustic noise on auditory brainstem response (ABR) to click stimuli, its effects on ABR to level-specific (LS) stimuli have not been systematically investigated. This study aimed to investigate the influence of ambient acoustic noise on ABR findings using both LS chirp and click stimuli. Subjects and Methods: Twelve normal-hearing adults participated in this repeated measure design study. The ABRs were acquired at 80, 50, and 30 dBnHL using two stimuli (LS chirp and click) under two conditions (quiet and noise). The ABRs under noise conditions were acquired using babble noise and white noise. The noise level was set at 55 dBA. Two-way repeated measure analysis was used to identify the main effects of the test conditions, stimulus types, and their interactions at a 95% confidence level. Results: No significant influence of ambient acoustic noise on ABR findings was identified at all intensity levels. No significant difference was found in the number of signal averages to reach the 0.04 μV residual noise as stopping criteria among the ABRs recorded with different types of stimuli and test conditions. The ABR waves I and V amplitudes were larger with LS chirp than with click stimulus. Conclusions Ambient acoustic noise has no significant influence on ABR findings and the ABR test time based on the 55 dBA noise level used in this study.

Background and Objectives: Auditory sensory gating deficits are abnormalities in patients with autism spectrum disorder (ASD) that may lead to sensory processing difficulties. It is particularly difficult for children with ASD to distinguish multiple auditory stimuli, which hinders them from focusing on a single auditory stimulus and separating unnecessary sounds. Suppression of otoacoustic emission (OAE) is an approach used to identify sensory gating deficits in the general population, specifically for children with ASD. This study aimed to investigate the suppression effect of various types of sound suppressors to measure their sensory gating capacity in children with ASD. Subjects and Methods: Twenty children including 10 with ASD and 10 normally developing children aged 6-12 years were recruited for this study. One accessible ear was exposed to transient-evoked OAE, whereas the other was exposed to suppressor tones. Contralateral suppressors included white noise, Quranic recitations, environmental noise, and natural sound. The magnitude of OAE suppression was determined from the difference between the OAE amplitude with and without the masker (in dB sound pressure levels) for all sound types. The sound with the highest suppression effect was determined using effect size calculation and repeated-measures analysis of variance at a 95% confidence level. A high suppression effect may suggest a high sensory gating performance, whereas low suppression may indicate low sensory gating performance. Results: Based on the analysis, the sound with the highest suppression effect was that of the waterfall. The suppression results were supported by descriptive analysis findings and effect-size calculations. Conclusions This study provides a better understanding of the alternative sound stimuli, besides the standard white noise tone, for the assessment of sensory gating deficits among children with ASD. Sounds with a high suppression effect have the potential to be used as sound therapy interventions for children with ASD as part of rehabilitation and therapy.

Background and Objectives: Auditory sensory gating deficits are abnormalities in patients with autism spectrum disorder (ASD) that may lead to sensory processing difficulties. It is particularly difficult for children with ASD to distinguish multiple auditory stimuli, which hinders them from focusing on a single auditory stimulus and separating unnecessary sounds. Suppression of otoacoustic emission (OAE) is an approach used to identify sensory gating deficits in the general population, specifically for children with ASD. This study aimed to investigate the suppression effect of various types of sound suppressors to measure their sensory gating capacity in children with ASD. Subjects and Methods: Twenty children including 10 with ASD and 10 normally developing children aged 6-12 years were recruited for this study. One accessible ear was exposed to transient-evoked OAE, whereas the other was exposed to suppressor tones. Contralateral suppressors included white noise, Quranic recitations, environmental noise, and natural sound. The magnitude of OAE suppression was determined from the difference between the OAE amplitude with and without the masker (in dB sound pressure levels) for all sound types. The sound with the highest suppression effect was determined using effect size calculation and repeated-measures analysis of variance at a 95% confidence level. A high suppression effect may suggest a high sensory gating performance, whereas low suppression may indicate low sensory gating performance. Results: Based on the analysis, the sound with the highest suppression effect was that of the waterfall. The suppression results were supported by descriptive analysis findings and effect-size calculations. Conclusions This study provides a better understanding of the alternative sound stimuli, besides the standard white noise tone, for the assessment of sensory gating deficits among children with ASD. Sounds with a high suppression effect have the potential to be used as sound therapy interventions for children with ASD as part of rehabilitation and therapy.