National Center for Rehabilitative Auditory Research

国家反射听觉研究中心（NCRAR）采用的中心模型使用 核心资金提供支持核心调查人员的基础设施，然后核心调查人员利用这一支持， 外部同行审查供资，并支持教育/外联活动。计划在以下领域进行研究 诊断和评估，康复和预防退伍军人的听觉和平衡功能障碍。 教育/外展计划将包括两年一次的会议，每月一次的研讨会系列，NIH资助的T-35 听力学学生的研究培训，以及为期一年的第四年的实习。学生与合作 VA波特兰医疗保健系统（VAPORHCS）听力学服务。技术方面，进一步发展 计划用于NCRAR的OtoID，一种正在申请专利的高频便携式听力计，并升级到 最近获得专利的耳鸣评估系统，这将用于一项研究，以标准化耳鸣评估。 在我们的每个关键研究领域计划的研究的一些例子是： 诊断和评估1）耳鸣和听力亢进评估的标准化; 2）续 开发用于退伍军人听力临床评估的宽带听觉评估工具; 3） 临床评估爆炸暴露、创伤性脑损伤（TBI）和 他们与创伤后应激障碍的相互作用; 4）新的生理和行为方法，以确定 过度噪声暴露导致的“隐性听力损失”; 5）年龄和TBI对动态步态的影响 控制和平衡功能障碍; 6）糖尿病退伍军人听觉功能障碍的纵向研究， 了解糖尿病对听觉系统的长期影响; 7）使用行为方法， 评估不精确的时间处理和降低频率选择性的影响， 感音神经性听力损失，并使用听觉诱发电位来探讨年龄和 听力损失对噪声中言语感知的影响。 康复1）完善渐进式耳鸣管理（PTM）作为一个跨学科的，分步的- 一个结合了声学疗法和认知行为疗法的护理计划。与卫生部合作 服务研究和开发（HSR&D）和研究人员在VAPORHCS，PTM将准备 在整个VA实施; 2）重复经颅磁刺激的多中心临床试验 （rTMS）缓解耳鸣，沿着努力，以确定最佳的磁铁放置方法; 3）继续 研究助听器定位和使用动机访谈来改善助听器效果; 4） 研究听力健康行为，以增加听力保健的吸收和成功的康复; 5） 使用听觉反馈的平衡康复，以及基于确定的 TBI患者的感觉和/或运动缺陷;以及6）使用神经成像方法来确定TBI患者的感觉和/或运动缺陷。 培训对MS退伍军人使用辅助移动设备的影响。 预防1）继续进行一项有关噪音引致听力损失及耳鸣的流行病学研究 耳鸣和听力损失的危害有哪些？ 预防耳鸣和听力损失的发展在服兵役期间的目标; 2）临床 与HSR&D合作实施NCRAR全面VA耳毒性监测计划 VAPORHCS的研究人员; 3）将继续关注以社区为基础的成人听力筛查 利用正在进行的研究的结果和健康行为研究的原则; 4）福尔斯预防使用 MS退伍军人中的流动设备培训和自动福尔斯检测;和5）提示步骤定时的影响 作为平衡假肢的基础。 关键词：听力损失，耳鸣，姿势平衡，诊断，康复，一级预防，感觉 艾滋病，转化研究

The Center model employed by the National Center for Rehabilitative Auditory Research (NCRAR) uses core funding to provide infrastructure that supports core investigators, who then leverage this support to garner external peer-reviewed funding, and to support education/outreach activities. Research is planned in the areas of Diagnosis and Assessment, Rehabilitation, and Prevention of auditory and balance dysfunction in Veterans. Education/outreach programs will include biennial conferences, a monthly seminar series, NIH-funded T-35 audiology student research training, and year-long externships for 4th year Au.D. students in collaboration with the VA Portland Health Care System (VAPORHCS) Audiology Service. Technology-wise, further development is planned for NCRAR's OtoID, a patent-pending high-frequency portable audiometer, and for an upgrade to a recently patented Tinnitus Evaluation System, which will be used in a study to standardize tinnitus evaluation. Some examples of studies planned in each of our key research areas are: Diagnosis and Assessment 1) standardization of assessment for tinnitus and hyperacusis; 2) continued development of wideband auditory assessment tools for the clinical evaluation of hearing in Veterans; 3) clinical assessment of central auditory deficits resulting from blast exposure, traumatic brain injury (TBI), and their interaction with post-traumatic stress disorder; 4) new physiologic and behavioral methods to identify “hidden hearing loss” resulting from excessive noise exposure; 5) effects of aging and TBI on dynamic gait control and balance dysfunction; 6) a longitudinal study of auditory dysfunction in Veterans with diabetes to understand the long-term effects of diabetes on the auditory system; and 7) use of behavioral methods to assess the effects of imprecise temporal processing and reduced frequency selectivity associated with sensorineural hearing loss, and the use of auditory evoked potentials to explore the effects of aging and hearing loss on speech perception in noise. Rehabilitation 1) refinement of Progressive Tinnitus Management (PTM) as an interdisciplinary, stepped- care program that combines acoustic therapy and Cognitive-Behavioral Therapy. In collaboration with Health Services Research and Development (HSR&D) and researchers at the VAPORHCS, PTM will be readied for implementation throughout VA; 2) a multi-center clinical trial of repetitive transcranial magnetic stimulation (rTMS) for the relief of tinnitus, along with efforts to identify best methods for magnet placement; 3) continued research on hearing-aid orientation and use of motivational interviewing to improve hearing aid outcome; 4) studies on hearing health behaviors to increase hearing health care uptake and successful rehabilitation; 5) balance rehabilitation using auditory feedback, and targeted therapy for balance disorders based on identified sensory and/or motor deficits in patients with TBI; and 6) use of neuroimaging methods to determine the impact of training on the use of assistive ambulatory devices in Veterans with MS. Prevention 1) continuation of an epidemiology study on noise induced hearing loss and tinnitus in recently discharged Veterans with the goal of developing algorithms for predicting risk of tinnitus and hearing loss with the goal of preventing the development of tinnitus and hearing loss during military service; 2) clinical implementation of NCRAR's comprehensive VA ototoxicity monitoring program in collaboration with HSR&D researchers at VAPORHCS; 3) continued focus on community-based adult hearing screening will be explored using the results of ongoing studies and the principles of Health-Behaviors research; 4) falls prevention using ambulatory device training and automated falls detection in Veterans with MS; and 5) effect of cued step timing on dynamic balance to serve as the basis for a balance prosthesis. KEYWORDS: hearing loss, tinnitus, postural balance, diagnosis, rehabilitation, primary prevention, sensory aids, translational research