Theses and Dissertations from UMD

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New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a give thesis/dissertation in DRUM

More information is available at Theses and Dissertations at University of Maryland Libraries.

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    Values in American Hearing Healthcare
    (2024) Menon, Katherine Noel; Hoover, Eric C; Hearing and Speech Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The long-term objective of this research is to create a more inclusive, patient-centered hearing healthcare system that aligns with all stakeholders’ diverse values and needs. This dissertation explores the values shaping hearing healthcare through three complementary studies. Chapter 2 analyzes the introduction of over-the-counter (OTC) hearing aids, revealing a values shift from traditional audiology’s focus on accuracy, safety, and subjective benefit to prioritizing access and affordability. Implementing an OTC service delivery model for hearing healthcare promoted values different from those of traditional audiology. Still, the creation of OTC offers affordances that enable us to create more patient-centered hearing healthcare systems to reflect stakeholders’ values. Chapter 3 validates a comprehensive list of values in audiology through a national survey of audiologists, confirming alignment with best-practice guidelines. Previous work developed a codebook of values based on textual documents representing best practices in traditional audiology, and it was essential to validate these findings by directly engaging with audiologists. Chapter 4 develops a codebook based on the values of individuals with hearing difficulties, categorizing their concerns into Material, Social, and Healthcare domains. Results from this study highlight the importance of considering the values of individuals with hearing loss, which encompasses not only the use of hearing aids and affordable hearing healthcare but also concerns regarding the effectiveness, usefulness, and social implications of hearing aids. Together, these studies underscore the balance between efforts to improve accessibility and the need to maintain patient-centered outcomes, suggesting that future research should focus on understanding how values intersect with the daily lives and decision-making processes of all people with difficulty hearing.
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    FAMILY CHARACTERISTICS, STATE PROGRAM EFFECTIVENESS, AND REPORT OF INADEQUATE CARE AMONG FAMILIES OF YOUNG CHILDREN WITH HEARING LOSS
    (2016) Determan, Ada Henry; Hofferth, Sandra L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Approximately 1.6 per 1,000 newborns in the U.S. are born with hearing loss. Congenital hearing loss poses a risk to their speech, language, cognitive, and social-emotional development. Early detection and intervention can improve outcomes. Every state has an Early Hearing Detection and Intervention program (EHDI) to promote and track screening, audiological assessments and linkage to early intervention. However, a large percentage of children are “lost to system (LTS),” meaning that they did not receive recommended care or that it was not reported. This study used data from the 2009-2010 National Survey of Children with Special Health Care Needs and data from the 2011 EHDI Hearing Screening and Follow-Up Survey to examine how 1) family characteristics; 2) EHDI program effectiveness, as determined by LTS percentages; and 3) the family conditions of education and poverty are related to parental report of inadequate care. The sample comprised 684 children between the ages of 0 and 5 years with hearing loss. The results indicated that living in states with less effective EHDI programs was associated with an increased likelihood of not receiving early intervention services (EIS) and of reporting poor family-centered communication. Sibling classification was associated with both receipt of EIS and report of unmet need. Single mothers were less likely to report increased difficulties accessing care. Poor and less educated families, assessed separately, who lived in states with less effective EHDI programs, were more likely to report non-receipt of EIS and less likely to report unmet need as compared to similar families living in states with more effective programs. Poor families living in states with less effective programs were more likely to report less coordinated care than were poor families living in states with more effective programs. This study supports the conclusion that both family characteristics and the effectiveness of state programs affect quality of care outcomes. It appears that less effective state programs affect disadvantaged families’ service receipt report more than that of advantaged families. These findings are important because they may provide insights into the development of targeted efforts to improve the system of care for children with hearing loss.
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    Characterizing the Auditory Phenotype of Niemann-Pick, Type C Disease: A Comparative Examination of Humans and Mice
    (2011) King, Kelly Anne; Gordon-Salant, Sandra; Brewer, Carmen; Hearing and Speech Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Niemann-Pick, type C disease (NPC) is a rare (1:120,000-150,000) autosomal recessive lysosomal lipidosis resulting in a progressive and fatal neurological deterioration. There is much about the pathogenesis and natural history of this complex, heterogeneous disorder that remains unknown. Limited literature suggests auditory dysfunction is part of the phenotype, but an aspect of the disease process that is poorly understood and, indeed, has likely been underreported. Experiment one includes auditory data from 55 patients with NPC seen at the National Institutes of Health between 8/14/2006 and 12/27/2010. These data confirm a prevalent high frequency hearing loss that progressively worsens in at least some individuals. Retrocochlear involvement is common, with abnormalities that suggest a profile of auditory neuropathy spectrum disorder in some patients. Analysis of late-onset cases suggests hearing loss is a premonitory symptom in this disease subcategory. The investigation was expanded to include the mouse model for NPC (BALB/cNctr-Npc1m1N/J), in which symptomatology is clinically, biochemically, and morphologically comparable with affected humans. There have been no previous reports of auditory function in NPC mice, although brainstem histopathology has been localized to the auditory pathway. Experiment two includes auditory brainstem response (ABR) and otoacoustic emission (OAE) data revealing a high frequency hearing loss in mutant NPC mice as early as postnatal day (p) 20, which becomes progressively poorer across the experimental lifespan. With support for both a cochlear and retrocochlear site of lesion, OAE level and ABR latency data provide surprising evidence for a disruption in maturational development of the auditory system in diseased animals, which may add a unique perspective on the role of NPC pathogenesis. This comparative, translational study has, for the first time, addressed comprehensively the existence of, and implications for, auditory dysfunction in NPC. Similar auditory phenotypes between affected humans and mutant mice should aid future efforts in refining site of lesion. In combination, these data support the auditory system as a useful marker for disease status and provide valuable prognostic and quality of life information for patients and their families.
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    The Impact of Rheumatoid Arthritis on Middle Ear Function
    (2007-08-03) Roberts, Caroline Marie; Fitzgerald, Tracy; Hearing and Speech Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation and swelling of the joints. Middle ear joints may be subject to rheumatic involvement similar to other joints in the body. Results from previous studies examining audiological characteristics in individuals with RA have varied with respect to incidence and type of hearing loss, as well as incidence and type of middle ear involvement (increased or decreased stiffness). The purpose of this study was to compare audiometric, immittance, distortion-product otoacoustic emission (DPOAE), and energy reflectance (ER) results between participants with RA and normal control (NC) participants to further examine the effects of RA on middle ear function. Twenty-one participants with RA (38 ears) were matched 1:1 based on age and gender to 21 individuals (38 ears) without RA. The following measures were completed for all participants: pure-tone air- and bone-conduction thresholds, 226-, 678- and 1000-Hz tympanograms, acoustic reflex thresholds, acoustic reflex decay, and middle ear resonant frequency. ER and DPOAEs were measured for a subset of 16 RA (28 ears) and 16 NC (28 ears) matched participants. No significant difference in prevalence of hearing loss was found between groups. Individuals with hearing loss in both groups presented with sensorineural-type hearing loss, which was typically a mild to moderate high-frequency hearing loss. No significant differences were found between groups for air- and bone-conduction thresholds. A significantly greater number of ears from the RA group had thresholds poorer than the 95th percentile for their age range and gender across the audiometric test frequencies. Generally, younger individuals with RA had poorer thresholds at 1000 and 2000 Hz compared to normative data for age and gender. No differences were found between groups for static admittance, the number of notched versus single-peaked 678- and 1000-Hz tympanograms, acoustic reflex thresholds, ER, and DPOAE measurements. The RA group had a significantly lower mean resonant frequency, consistent with an increase in the laxity or an increase in the mass dominance of the middle ear system. These significant findings revealed the importance of considering audiological assessment of individuals with RA.