Blast-exposed Veterans with Auditory Complaints

描述（由申请人提供）： VA匹兹堡医疗保健系统（VAPHS）的临床听力学家已经观察到退伍军人自我报告的听力问题的数量大幅增加，但当用标准听力测试电池进行测试时，他们表现出正常或接近正常的听力灵敏度。这些退伍军人的主要抱怨是在背景噪音中难以听到语音，初步临床数据表明，在某些中枢听觉处理测试中表现不佳。此外，当配备了轻度增益开放式助听器时，它放大了语音频谱的高频部分，这些患者报告说他们的听力相关问题减少了。几乎所有这些退伍军人都报告了爆炸暴露和脑震荡的历史，而伊拉克自由行动/持久自由行动（OIF/OEF）部署和描述的症状符合脑震荡后综合征。来自其他VA医疗中心和军事设施的临床听力学家已经报道了患有mTBI的退伍军人的类似听觉模式，尽管这组退伍军人的听觉问题尚未得到很好的描述或研究（Fausti等人，2009; Lew等人，2007年）。这项研究是针对这些退伍军人提供的临床投诉而开发的，其目标是通过广泛评估他们的听觉和听力相关特征来更好地了解他们的问题。一组有爆炸暴露史、与mTBI一致的病史和正常听力测定结果但有明显听觉主诉的退伍军人将使用标准听力测定测试组合、健康状况和生活质量问卷、听觉生理测试程序和行为中枢听觉处理测试进行评价。我们还将管理言语感知和心理声学任务，以及口头工作记忆和语言处理测试，以更好地了解他们通过听力听到，记忆和处理语音和语言的能力的各个方面。与听觉语言处理任务并行的阅读测试也将被管理，以确定任何识别的语言处理问题是否仅限于听觉系统。将与听觉和脑损伤阴性的退伍军人对照组以及一组患有创伤后应激障碍（PTSD）但没有爆炸暴露或脑损伤史的退伍军人进行比较。此外，同时存在的创伤后应激障碍 将被审查。其次，将测试为这一退伍军人群体配备放大语音频谱高频部分的温和增益助听器的好处。从这项研究中获得的信息将是阐明这些退伍军人问题的第一步，并将为未来的研究奠定基础，这些研究将侧重于特定的赤字机制。这项研究还应有助于为这一人群制定有效的评估组合和干预措施。

DESCRIPTION (provided by applicant): Clinical audiologists at the VA Pittsburgh Healthcare System (VAPHS) have observed a substantive increase in the number of Veteran's presenting with self-reported hearing problems but who demonstrate normal or near normal hearing sensitivity when tested with a standard audiometric test battery. The primary complaint of these Veterans is difficulty hearing speech in background noise, and preliminary clinical data have suggested poor performance on some tests of central auditory processing. Moreover, when fitted with mild- gain open-fit hearing aids, which amplify the high-frequency part of the speech spectrum, these patients have reported a reduction in their hearing-related problems. Nearly all of these Veterans have reported histories of blast exposure and concussion while Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) deployed and described symptoms consistent with post-concussive syndrome. Similar auditory patterns for Veterans with mTBI have been reported by clinical audiologists from other VA medical centers and military facilities although the auditory problems of this group of Veterans have not been well described or studied (Fausti et al., 2009; Lew et al., 2007). This study was developed in response to the clinical complaints offered by these Veterans, with the goal being to better understand their problems by extensively assessing their auditory and auditory-related characteristics. A group of Veterans with histories of blast exposure, histories consistent with mTBI, and normal audiometric results, but notable auditory complaints will be evaluated with a standard audiometric test battery, health status and quality of life questionnaires, auditory physiological test procedures, and behavioral central auditory processing tests. We also will administer speech perception and psychoacoustic tasks, and verbal working memory and language processing tests to better understand various aspects of their ability to hear, remember, and process speech and language through audition. A reading test that parallels an auditory language-processing task also will be administered to determine if any identified language processing problems are limited to the auditory system. Comparisons will be made to a control group of Veterans who are negative for auditory and brain impairments, as well as to a group of Veterans with Post Traumatic Stress Disorder (PTSD) but without histories of blast exposure or brain injury. In addition, the influences of coexisting PTSD will be examined. Secondarily, the benefit of fitting this population of Veterans with mild-gain hearing aids that amplify the high-frequency part of the speech spectrum will be tested. The information obtained from this study will be a first step in elucidating the problems of these Veterans and will lay the groundwork for future studies that will focus on specific deficit mechanisms. This study also should contribute to the development of an effective assessment battery and interventions for this population.