human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction : A nonbehavioral method for monitoring ototoxicity in patients treated with cisplatin  is needed because patients enduring chemotherapy  may not be well or cooperative enough to undergo repeated hearing tests . Distortion-product otoacoustic emissions ( DPOAEs ) provide a nonbehavioral measure of auditory function that is sensitive to cisplatin exposure . However , interpreting DPOAE findings in the context of ototoxicity monitoring requires that their accuracy be determined in relation to a clinical ly accepted gold st and ard test . Objectives : Among patients receiving cisplatin for the treatment of cancer , we sought to ( 1 ) identify the combination of DPOAE metrics and ototoxicity risk factors that best classified ears with and without ototoxic-induced hearing changes ; and ( 2 ) evaluate the test performance achieved by the composite measure as well as by DPOAEs alone . Design : Odds of experiencing hearing changes at a given patient visit were determined using data collected prospect ively from 24 Veterans receiving cisplatin .  Pure-tone thresholds were examined within an octave of each subject 's high-frequency hearing limit . DPOAE were collected as a set of four response growth ( input/output ) functions near the highest f2 frequency that yielded a robust response at L2 = L1 = 65 dB SPL . Logistic regression modeled the risk of hearing change using several DPOAE metrics , drug treatment factors , and other patient factors as independent variables . An optimal discriminant function was derived by reducing the model so that only statistically significant variables were included . Receiver operating characteristic curve analyses were used to evaluate test performance . Results : At higher cisplatin doses , ears with better hearing at baseline were more likely to exhibit ototoxic hearing changes than those with poorer hearing . Measures of pre-exposure hearing , cumulative drug dose , and DPOAEs generated a highly accurate discriminant function with a cross-vali date d area under the receiver operating characteristic curve of 0.9 . DPOAEs alone also provided an indication of ototoxic hearing change when measured at the highest DPOAE test frequency that yielded a robust response . Conclusions : DPOAEs alone and especially in combination with pre-exposure hearing and cisplatin dose provide an indication of whether or not hearing has changed as a result of cisplatin administration . These promising results need to be vali date d in a separate sample OBJECTIVES To develop a new method of screening audiometry that reduces the adverse effects of low frequency background noise by using active noise reduction ( ANR ) headphone technology . DESIGN Prospect i ve testing within an anechoic chamber evaluated the physical properties of ANR headphones . A prospect i ve clinical crossover study compared st and ard audiometry with ANR headphone audiometry . METHODS Bose Aviation X circum-aural ANR headphones were tested for both active and passive attenuation properties in a hemi-anechoic chamber using a head and torso simulator . Thirty-seven otology clinic patients then underwent st and ard audiometry and ANR audiometry , which was performed in a 30- and /or 40-dB sound field . RESULTS Objective  ANR headphone attenuation levels of up to 12 dB were achieved at frequencies below 2,000 Hz . In st and ard audiometric testing , 40 dB of narrow-b and background noise decreased patient pure tone thresholds by 24 dB at 250 Hz . The use of ANR technology provided 12 dB of additional attenuation . This result ed in a significant improvement in test results despite the 40 dB of background noise ( P = < 0.001 ) . In a 30-dB sound field , st and ard audiometric thresholds were shifted down by an average of 12 dB. The use of ANR technology completely attenuated this effect and result ed in a significant improvement in results ( P = < 0.01 ) . These results were identical to those obtained in a quiet sound booth . CONCLUSIONS Despite a 30-dB sound field , ANR audiometry can produce an audiogram identical to that obtained in a double-walled sound booth . ANR headphone audiometry improves the sensitivity of audiometric screening for mild low-frequency hearing loss . This technology may have important applications for screening in schools , industry , and community practice Background Access to hearing health care is limited in many parts of the world , creating a lack of prompt diagnosis , which further complicates treatment . The use of portable audiometry for hearing loss testing can improve access to diagnostics in marginalized population s. Our study objectives were twofold : ( 1 ) to determine the prevalence of hearing loss in children aged 4 to 11 years in Iqaluit , Nunavut , and ( 2 ) to test and demonstrate the use of our tablet audiometer as a portable hearing-testing device in a remote location . Study Design Prospect i ve cross-sectional observational . Setting Remote elementary schools in 3 Canadian Northern communities . Subjects and Methods Tablet audiometers were used to test hearing in 218 children . Air conduction pure tones thresholds were obtained at 500 , 1000 , 2000 , and 4000 Hz . Children with hearing loss ≥30 dB in either ear were referred for audiology services . Results Tablet audiometry screening testing revealed abnormal results in 14.8 % of the study participants . No significant difference in the rate of hearing loss was seen by sex ; however , the rate of hearing loss decreased significantly with increasing age . The median duration of the hearing test was 5 minutes 30 seconds . Conclusions Of the study population , 14.8 % tested positive for hearing loss based on our interactive tablet audiometer . In this setting , the tablet audiometer was both time efficient and largely language independent . This type of testing is valuable for providing much-needed hearing health care for high-risk population s in rural and remote areas where audiology services are often unavailable BACKGROUND An estimated 36 million US citizens have impaired hearing , but nearly half of them have never had a hearing test . As noted by a recent National Institutes of Health/National Institute on Deafness and Other Communication Disorders ( NIH/NIDCD ) Working Group , " In the United States ( in contrast to many other nations ) there are no readily accessible low cost hearing screening programs … " ( Donahue et al , 2010 , p. 2 ) . Since 2004 , telephone administered screening tests utilizing three-digit sequences presented in noise have been developed , vali date d , and implemented in seven countries . Each of these tests has been based on a test protocol conceived by Smits and colleagues in The Netherl and s. PURPOSE Investigators from Communication Disorders Technology , Inc. , Indiana University , and VU University Medical Center of Amsterdam agreed to collaborate in the development and validation of a screening test for hearing impairment suitable for delivery over the telephone , for use in the United States . This test , utilizing spoken three-digit sequences ( triplets ) , was to be based on the design of Smits and his colleagues . RESEARCH DESIGN A version of the digits-in-noise test was developed utilizing digit triplets spoken in Middle American dialect . The stimuli were individually adjusted to speech-to-noise ratio ( SNR ) values yielding 50 % correct identification , on the basis of data collected from a group of 10 young adult listeners with normal hearing . A final set of 64 homogeneous stimuli were selected from an original 160 recorded triplets . Each test consisted of a series of 40 triplets drawn at r and om , presented in a noise background . The SNR threshold for 50 % correct identification of the triplets was determined by a one-down , one-up adaptive procedure . The test was implemented by telephone , and administered to listeners with varying levels of hearing impairment . The listeners were then evaluated with pure-tone tests and other audiometric measures as clinical ly appropriate . STUDY SAMPLE Ninety participants included 72 who were volunteers from the regular client population at the Indiana University Hearing Clinic , and 18 who were recruited with a newspaper ad offering a free hearing test . Of the 90 participants , 49 were later determined to have mean pure-tone thresholds greater than 20 dB hearing level ( HL ) . DATA COLLECTION AND ANALYSIS The primary data analyses were correlations between telephone test thresholds and other measures , including pure-tone thresholds and speech recognition tests , collected for the same participants . RESULTS The correlation between the telephone test and pure-tone thresholds ( r = 0.74 ) was within the range of correlations observed with successful telephone screening tests in use in other countries . Thresholds based on the average of only 21 trials ( trials five through 25 of the 40-trial tracking history ) yielded sensitivity and specificity values of 0.80 and 0.83 , respectively , using pure-tone average((0.5 , 1.0 , 2.0 kHz ) ) > 20 dB HL as the criterion measure . CONCLUSIONS This US version of the digits-in-noise telephone screening test is sufficiently valid to be implemented for use by the general public . Its properties are quite similar to those telephone screening tests currently in use in most European countries . Telephone tests provide efficient , easy to use , and valid screening for functional hearing impairment . The results of this test are a reasonable basis for advising those who fail to seek a comprehensive hearing evaluation by an audiologist BACKGROUND AND PURPOSE To report on the incidence and relative risk of tinnitus onset from a variety of drug therapies known to be ototoxic . Two main questions were asked : ( 1 ) What is the prevalence and incidence of tinnitus among patients treated with cisplatin , carboplatin , or ototoxic antibiotic therapies  ? ( 2 ) Do commonly reported treatment or subject factors confound or modify the incidence of tinnitus onset ? DATA COLLECTION AND ANALYSIS A prospect i ve observational study design was used to evaluate occurrence of significant otologic changes in 488 veterans ( 962 ears ) receiving chemotherapeutic agents ( cisplatin , carboplatin ) , ototoxic antibiotics ( primarily aminoglycoside ) , or nonototoxic drugs ( control medications ) . A subset of 260 veterans lacking tinnitus prior to drug exposure was used to compare rates of tinnitus onset . Subjects were tested prior to , during , and following their treatment . Planned comparisons using logistic regression , analysis of variance ( ANOVA ) , and chi(2 ) statistics were made among groups by the type of medication taken , age , presence of preexisting hearing loss , days on drug , and cumulative dose of drug . RESULTS Baseline tinnitus rates were high ( nearly 47 % ) relative to the general population of a similar age . Subjects with exposure to ototoxic medications had significantly increased risk for developing tinnitus . Those on chemotherapeutic agents were found to have the greatest risk .  Cisplatin elevated the risk by 5.53 times while carboplatin increased the risk by 3.75 over nonototoxic control medications . Ototoxic antibiotics result ed in borderline risk ( 2.81 ) for new tinnitus . Contrary to other reports , we did not find that subject factors ( increased age or pre-existing hearing loss ) or treatment factors ( days on drug or cumulative dose ) contributed to rates of tinnitus onset during treatment . CONCLUSIONS This large prospect i ve study confirms that new tinnitus during treatment is associated with chemotherapy and with certain ototoxic antibiotic treatment . Cisplatin and carboplatin were found to be the most potent ototoxic agents causing tinnitus at much greater numbers than the other drugs studied . Implication s for counseling and audiological re source allocation are discussed OBJECTIVE To determine the hearing levels of participants of a r and omized group using a  smartphone hearing application  and to compare these results with the results from a pure-tone audiogram . MATERIAL S AND METHODS A heterogenous group consisting of both normal-hearing and hearing-impaired participants were included in this study . Pure-tone audiogram thresholds were measured from 250 Hz to 8000 Hz , while smartphone measurements were obtained with a Samsung Galaxy GT-19500 S4 with a bundled headphone running the Hearing Test ™ software ( e-audiologia.pl ) , which was downloaded from the Google Play Store as a free application . We compared these results with those obtained from pure-tone audiograms performed by an audiologist as a reference . RESULTS Validity analysis indicated that the results for each ear and each frequency were excellent ( > 0.75 ) . We assessed the mean difference between the pure-tone audiogram and the smartphone hearing test results and found the absolute difference to be less than 8.8 dB. CONCLUSION Smartphone hearing test applications are providing alternative tests that present low-cost solutions . Using the hearing application test may decrease the dem and for audiological services in underserved areas . The study suggests that smartphone hearing test results are comparable to pure-tone audiometry results Objective The aim of this study is to determine the feasibility of an Apple iOS-based automated hearing testing application and to compare its accuracy with conventional audiometry . Study Design Prospect i ve diagnostic study . Setting Academic medical center . Subjects and Methods An iOS-based software application was developed to perform automated pure-tone hearing testing on the iPhone , iPod touch , and iPad . To assess for device variations and compatibility , preliminary work was performed to compare the st and ardized sound output ( dB ) of various Apple device and headset combinations . Forty-two subjects underwent automated iOS-based hearing testing in a sound booth ,  automated iOS-based hearing testing  in a quiet room ,  and conventional manual audiometry . Results The maximum difference in sound intensity between various Apple device and headset combinations was 4 dB. On average , 96 % ( 95 % confidence interval [ CI ] , 91%-100 % ) of the threshold values obtained using the automated test in a sound booth were within 10 dB of the corresponding threshold values obtained using conventional audiometry . When the automated test was performed in a quiet room , 94 % ( 95 % CI , 87%-100 % ) of the threshold values were within 10 dB of the threshold values obtained using conventional audiometry . Under 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction : A nonbehavioral method for monitoring ototoxicity in patients treated with cisplatin  is needed because patients enduring chemotherapy  may not be well or cooperative enough to undergo repeated hearing tests . Distortion-product otoacoustic emissions ( DPOAEs ) provide a nonbehavioral measure of auditory function that is sensitive to cisplatin exposure . However , interpreting DPOAE findings in the context of ototoxicity monitoring requires that their accuracy be determined in relation to a clinical ly accepted gold st and ard test . Objectives : Among patients receiving cisplatin for the treatment of cancer , we sought to ( 1 ) identify the combination of DPOAE metrics and ototoxicity risk factors that best classified ears with and without ototoxic-induced hearing changes ; and ( 2 ) evaluate the test performance achieved by the composite measure as well as by DPOAEs alone . Design : Odds of experiencing hearing changes at a given patient visit were determined using data collected prospect ively from 24 Veterans receiving cisplatin .  Pure-tone thresholds were examined within an octave of each subject 's high-frequency hearing limit . DPOAE were collected as a set of four response growth ( input/output ) functions near the highest f2 frequency that yielded a robust response at L2 = L1 = 65 dB SPL . Logistic regression modeled the risk of hearing change using several DPOAE metrics , drug treatment factors , and other patient factors as independent variables . An optimal discriminant function was derived by reducing the model so that only statistically significant variables were included . Receiver operating characteristic curve analyses were used to evaluate test performance . Results : At higher cisplatin doses , ears with better hearing at baseline were more likely to exhibit ototoxic hearing changes than those with poorer hearing . Measures of pre-exposure hearing , cumulative drug dose , and DPOAEs generated a highly accurate discriminant function with a cross-vali date d area under the receiver operating characteristic curve of 0.9 . DPOAEs alone also provided an indication of ototoxic hearing change when measured at the highest DPOAE test frequency that yielded a robust response . Conclusions : DPOAEs alone and especially in combination with pre-exposure hearing and cisplatin dose provide an indication of whether or not hearing has changed as a result of cisplatin administration . These promising results need to be vali date d in a separate sample OBJECTIVES To develop a new method of screening audiometry that reduces the adverse effects of low frequency background noise by using active noise reduction ( ANR ) headphone technology . DESIGN Prospect i ve testing within an anechoic chamber evaluated the physical properties of ANR headphones . A prospect i ve clinical crossover study compared st and ard audiometry with ANR headphone audiometry . METHODS Bose Aviation X circum-aural ANR headphones were tested for both active and passive attenuation properties in a hemi-anechoic chamber using a head and torso simulator . Thirty-seven otology clinic patients then underwent st and ard audiometry and ANR audiometry , which was performed in a 30- and /or 40-dB sound field . RESULTS Objective  ANR headphone attenuation levels of up to 12 dB were achieved at frequencies below 2,000 Hz . In st and ard audiometric testing , 40 dB of narrow-b and background noise decreased patient pure tone thresholds by 24 dB at 250 Hz . The use of ANR technology provided 12 dB of additional attenuation . This result ed in a significant improvement in test results despite the 40 dB of background noise ( P = < 0.001 ) . In a 30-dB sound field , st and ard audiometric thresholds were shifted down by an average of 12 dB. The use of ANR technology completely attenuated this effect and result ed in a significant improvement in results ( P = < 0.01 ) . These results were identical to those obtained in a quiet sound booth . CONCLUSIONS Despite a 30-dB sound field , ANR audiometry can produce an audiogram identical to that obtained in a double-walled sound booth . ANR headphone audiometry improves the sensitivity of audiometric screening for mild low-frequency hearing loss . This technology may have important applications for screening in schools , industry , and community practice Background Access to hearing health care is limited in many parts of the world , creating a lack of prompt diagnosis , which further complicates treatment . The use of portable audiometry for hearing loss testing can improve access to diagnostics in marginalized population s. Our study objectives were twofold : ( 1 ) to determine the prevalence of hearing loss in children aged 4 to 11 years in Iqaluit , Nunavut , and ( 2 ) to test and demonstrate the use of our tablet audiometer as a portable hearing-testing device in a remote location . Study Design Prospect i ve cross-sectional observational . Setting Remote elementary schools in 3 Canadian Northern communities . Subjects and Methods Tablet audiometers were used to test hearing in 218 children . Air conduction pure tones thresholds were obtained at 500 , 1000 , 2000 , and 4000 Hz . Children with hearing loss ≥30 dB in either ear were referred for audiology services . Results Tablet audiometry screening testing revealed abnormal results in 14.8 % of the study participants . No significant difference in the rate of hearing loss was seen by sex ; however , the rate of hearing loss decreased significantly with increasing age . The median duration of the hearing test was 5 minutes 30 seconds . Conclusions Of the study population , 14.8 % tested positive for hearing loss based on our interactive tablet audiometer . In this setting , the tablet audiometer was both time efficient and largely language independent . This type of testing is valuable for providing much-needed hearing health care for high-risk population s in rural and remote areas where audiology services are often unavailable BACKGROUND An estimated 36 million US citizens have impaired hearing , but nearly half of them have never had a hearing test . As noted by a recent National Institutes of Health/National Institute on Deafness and Other Communication Disorders ( NIH/NIDCD ) Working Group , " In the United States ( in contrast to many other nations ) there are no readily accessible low cost hearing screening programs … " ( Donahue et al , 2010 , p. 2 ) . Since 2004 , telephone administered screening tests utilizing three-digit sequences presented in noise have been developed , vali date d , and implemented in seven countries . Each of these tests has been based on a test protocol conceived by Smits and colleagues in The Netherl and s. PURPOSE Investigators from Communication Disorders Technology , Inc. , Indiana University , and VU University Medical Center of Amsterdam agreed to collaborate in the development and validation of a screening test for hearing impairment suitable for delivery over the telephone , for use in the United States . This test , utilizing spoken three-digit sequences ( triplets ) , was to be based on the design of Smits and his colleagues . RESEARCH DESIGN A version of the digits-in-noise test was developed utilizing digit triplets spoken in Middle American dialect . The stimuli were individually adjusted to speech-to-noise ratio ( SNR ) values yielding 50 % correct identification , on the basis of data collected from a group of 10 young adult listeners with normal hearing . A final set of 64 homogeneous stimuli were selected from an original 160 recorded triplets . Each test consisted of a series of 40 triplets drawn at r and om , presented in a noise background . The SNR threshold for 50 % correct identification of the triplets was determined by a one-down , one-up adaptive procedure . The test was implemented by telephone , and administered to listeners with varying levels of hearing impairment . The listeners were then evaluated with pure-tone tests and other audiometric measures as clinical ly appropriate . STUDY SAMPLE Ninety participants included 72 who were volunteers from the regular client population at the Indiana University Hearing Clinic , and 18 who were recruited with a newspaper ad offering a free hearing test . Of the 90 participants , 49 were later determined to have mean pure-tone thresholds greater than 20 dB hearing level ( HL ) . DATA COLLECTION AND ANALYSIS The primary data analyses were correlations between telephone test thresholds and other measures , including pure-tone thresholds and speech recognition tests , collected for the same participants . RESULTS The correlation between the telephone test and pure-tone thresholds ( r = 0.74 ) was within the range of correlations observed with successful telephone screening tests in use in other countries . Thresholds based on the average of only 21 trials ( trials five through 25 of the 40-trial tracking history ) yielded sensitivity and specificity values of 0.80 and 0.83 , respectively , using pure-tone average((0.5 , 1.0 , 2.0 kHz ) ) > 20 dB HL as the criterion measure . CONCLUSIONS This US version of the digits-in-noise telephone screening test is sufficiently valid to be implemented for use by the general public . Its properties are quite similar to those telephone screening tests currently in use in most European countries . Telephone tests provide efficient , easy to use , and valid screening for functional hearing impairment . The results of this test are a reasonable basis for advising those who fail to seek a comprehensive hearing evaluation by an audiologist BACKGROUND AND PURPOSE To report on the incidence and relative risk of tinnitus onset from a variety of drug therapies known to be ototoxic . Two main questions were asked : ( 1 ) What is the prevalence and incidence of tinnitus among patients treated with cisplatin , carboplatin , or ototoxic antibiotic therapies  ? ( 2 ) Do commonly reported treatment or subject factors confound or modify the incidence of tinnitus onset ? DATA COLLECTION AND ANALYSIS A prospect i ve observational study design was used to evaluate occurrence of significant otologic changes in 488 veterans ( 962 ears ) receiving chemotherapeutic agents ( cisplatin , carboplatin ) , ototoxic antibiotics ( primarily aminoglycoside ) , or nonototoxic drugs ( control medications ) . A subset of 260 veterans lacking tinnitus prior to drug exposure was used to compare rates of tinnitus onset . Subjects were tested prior to , during , and following their treatment . Planned comparisons using logistic regression , analysis of variance ( ANOVA ) , and chi(2 ) statistics were made among groups by the type of medication taken , age , presence of preexisting hearing loss , days on drug , and cumulative dose of drug . RESULTS Baseline tinnitus rates were high ( nearly 47 % ) relative to the general population of a similar age . Subjects with exposure to ototoxic medications had significantly increased risk for developing tinnitus . Those on chemotherapeutic agents were found to have the greatest risk .  Cisplatin elevated the risk by 5.53 times while carboplatin increased the risk by 3.75 over nonototoxic control medications . Ototoxic antibiotics result ed in borderline risk ( 2.81 ) for new tinnitus . Contrary to other reports , we did not find that subject factors ( increased age or pre-existing hearing loss ) or treatment factors ( days on drug or cumulative dose ) contributed to rates of tinnitus onset during treatment . CONCLUSIONS This large prospect i ve study confirms that new tinnitus during treatment is associated with chemotherapy and with certain ototoxic antibiotic treatment . Cisplatin and carboplatin were found to be the most potent ototoxic agents causing tinnitus at much greater numbers than the other drugs studied . Implication s for counseling and audiological re source allocation are discussed OBJECTIVE To determine the hearing levels of participants of a r and omized group using a  smartphone hearing application  and to compare these results with the results from a pure-tone audiogram . MATERIAL S AND METHODS A heterogenous group consisting of both normal-hearing and hearing-impaired participants were included in this study . Pure-tone audiogram thresholds were measured from 250 Hz to 8000 Hz , while smartphone measurements were obtained with a Samsung Galaxy GT-19500 S4 with a bundled headphone running the Hearing Test ™ software ( e-audiologia.pl ) , which was downloaded from the Google Play Store as a free application . We compared these results with those obtained from pure-tone audiograms performed by an audiologist as a reference . RESULTS Validity analysis indicated that the results for each ear and each frequency were excellent ( > 0.75 ) . We assessed the mean difference between the pure-tone audiogram and the smartphone hearing test results and found the absolute difference to be less than 8.8 dB. CONCLUSION Smartphone hearing test applications are providing alternative tests that present low-cost solutions . Using the hearing application test may decrease the dem and for audiological services in underserved areas . The study suggests that smartphone hearing test results are comparable to pure-tone audiometry results Objective The aim of this study is to determine the feasibility of an Apple iOS-based automated hearing testing application and to compare its accuracy with conventional audiometry . Study Design Prospect i ve diagnostic study . Setting Academic medical center . Subjects and Methods An iOS-based software application was developed to perform automated pure-tone hearing testing on the iPhone , iPod touch , and iPad . To assess for device variations and compatibility , preliminary work was performed to compare the st and ardized sound output ( dB ) of various Apple device and headset combinations . Forty-two subjects underwent automated iOS-based hearing testing in a sound booth ,  automated iOS-based hearing testing  in a quiet room ,  and conventional manual audiometry . Results The maximum difference in sound intensity between various Apple device and headset combinations was 4 dB. On average , 96 % ( 95 % confidence interval [ CI ] , 91%-100 % ) of the threshold values obtained using the automated test in a sound booth were within 10 dB of the corresponding threshold values obtained using conventional audiometry . When the automated test was performed in a quiet room , 94 % ( 95 % CI , 87%-100 % ) of the threshold values were within 10 dB of the threshold values obtained using conventional audiometry . Under 
    Output:
    