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

Public Health Relevance

Research conducted at the National Center for Rehabilitative Auditory Research (NCRAR) involves the assessment and diagnosis, rehabilitation and prevention of auditory and balance dysfunction. It is highly relevant to Veterans' health care because tinnitus and hearing loss are the number one and number two most prevalent service-connected disabilities, respectively, among new Veteran compensation recipients and among all Veteran compensation recipients according to the Veterans Benefits Administration. Moreover, balance dysfunction is associated with blast exposure and traumatic brain injury often seen in Veterans of recent conflicts. Additionally, since it is expected that those over 65 will continue to be the largest portion of Veterans (VA Strategic Plan 2014-2020), NCRAR research will remain relevant to the health of the majority of Veterans because it focuses on the assessment and diagnosis, rehabilitation, and prevention of tinnitus, hearing loss and balance dysfunction, which are all disorders prevalent in aging Veterans.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (I50)
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Centers, Research Enhancement Award Program and Consortiums (RRDC)
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Portland VA Medical Center
United States
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Papesh, Melissa A; Billings, Curtis J; Baltzell, Lucas S (2015) Background noise can enhance cortical auditory evoked potentials under certain conditions. Clin Neurophysiol 126:1319-30