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[Practical hearing compensation and an assessment of hearing effect in patients with profound hearing loss using hearing aids].

This investigation was carried out to study practical hearing compensation with hearing aids and the correlation between subjective evaluation (questionnaire survey) and objective evaluation (speech perception test) as an assessment of hearing aid effect in patients with profound hearing loss. 1. Forty-nine patients with hearing levels of 90dB or more (23 men and 26 women) were examined. Their mean and median hearing levels were 105.9dB (standard deviation: 10.4dB) and 106.3dB, respectively. The patients ranged in age from 18 to 74, with a mean age of 47.4. 2. Subjective evaluation was carried out by a questionnaire survey in which the patients chose one of 4 or 5 graded categories in 10 different hearing conditions, and three items of "satisfactory", "uneasiness" and "effectiveness". Speech sound discrimination ability for vowels and monosyllables, and speech intelligibility of words and sentences, were evaluated in audition only (A), vision only (V) and a combination of both (A + V), totaling 12 conditions with hearing aids as the objective evaluation using video tapes materials. 3. The subjective evaluation revealed that 60% of patients with hearing loss of 90-110dB understood "one to one conversation in a quiet place". Speech perception was poorer in "conversation in a noisy place" than in "conversation in a quiet place". Speech perception became poorer in the order of "one to one", "to a few people", and "to many people". For subjective feeling, 56.4% answered "satisfactory", and for hearing aid effectiveness, 78.7% answered "effective". 4. In the objective evaluation, the rates of correct answers were 19.6% in A and 46.3% in A + V for monosyllables, 19.8% in A and 43.4% in A + V for words, and 29.5% in A and 60.0% in A+V for sentences. 5. There were significant correlations (p < 0.001) between subjective evaluation of "in a quiet place and one to one conversation" (among other conditions) and objective evaluations of monosyllables, and word and sentence recognition, mostly in A and A + V. These results suggest that hearing compensation by hearing aids can be evaluated objectively in patients with profound hearing loss when word and sentence recognition tests are performed in addition to the monosyllable recognition test, and it is more practical if vision is examined in addition to hearing for speech perception in patients with profound hearing loss.

Adolescent↗

The New York State universal newborn hearing screening demonstration project: ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention.

OBJECTIVE: To determine the ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention through a multi-center, state-wide universal newborn hearing screening project. DESIGN: Universal newborn hearing screening was conducted at eight hospitals across New York State. All infants who did not bilaterally pass hearing screening before discharge were recalled for outpatient retesting. Inpatient screening and outpatient rescreening were done with transient evoked otoacoustic emissions and/or auditory brain stem response testing. Diagnostic testing was performed with age appropriate tests, auditory brain stem response and/or visual reinforcement audiometry. Infants diagnosed with permanent hearing loss were considered for hearing aids and early intervention. Ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention were investigated regarding nursery type, risk status, unilateral versus bilateral hearing loss, loss type, loss severity, and state regions. RESULTS: The prevalence of infants diagnosed with permanent hearing loss was 2.0/1000 (85 of 43,311). Of the 85 infants with hearing loss, 61% were from neonatal intensive care units (NICUs) and 67% were at risk for hearing loss. Of the 36 infants fitted with hearing aids, 58% were from NICUs and 78% were at risk for hearing loss. The median age at identification and enrollment in early intervention was 3 mo. Median age at hearing aid fitting was 7.5 mo. Median ages at identification were less for infants from the well-baby nurseries (WBNs) than for the NICU infants and for infants with severe/profound than for infants with mild/moderate hearing loss, but were similar for not-at-risk and at-risk infants. Median ages at hearing aid fitting were less for well babies than for NICU infants, for not-at-risk infants than for at-risk infants, and for infants with severe/ profound hearing loss than for infants with mild/ moderate hearing loss. However, median ages at early intervention enrollment were similar for nursery types, risk status, and severity of hearing loss. CONCLUSIONS: Early ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention can be achieved for infants from NICUs and WBNs and for infants at risk and not at risk for hearing loss in a large multi-center universal newborn hearing screening program.

Age Factors↗

Low prevalence of hearing aid use among older adults with hearing loss: the Epidemiology of Hearing Loss Study.

OBJECTIVES: To measure the prevalence of hearing aid use among older adults with hearing loss and to identify factors associated with those currently using hearing aids. DESIGN: Population-based cohort study. SETTING: The south-central Wisconsin community of Beaver Dam. PARTICIPANTS: A total of 1629 adults, aged 48 to 92 years, who have hearing loss and are participating in the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study. MEASUREMENTS: A hearing-related risk factor and medical history questionnaire, the Hearing Handicap Inventory for the Elderly (screening version), screening tympanometry, pure-tone air- and bone-conduction audiometry, and word recognition tests were administered by trained examiners using standard protocols. RESULTS: The prevalence of current hearing aid use among those with a hearing loss (pure-tone average > 25 decibels hearing level over 500, 1000, 2000, and 4000 Hertz, worse ear) was 14.6%. The prevalence was 55% in a subset of the most severely affected participants. In univariate analyses, current hearing aid use was associated with age, severity of loss, word recognition scores, self-reported hearing loss, self-perceived hearing handicap, and history of noise exposure. Factors associated with current hearing aid use in multivariate logistic regression models were age, severity of loss, education, word recognition scores, Hearing Handicap Inventory for the Elderly (screening version) score, and self-report of a hearing loss. CONCLUSIONS: Few older adults with hearing loss are currently utilizing hearing aids. Improved screening and intervention programs to identify older adults who would benefit from amplification are needed to improve hearing-related quality of life for this large segment of the population.

Age Factors↗

Hearing loss- and hearing aid-related stigma: perceptions of women with age-normal hearing.

Impaired hearing and the use of hearing aids are often perceived negatively. Many adults deny hearing loss and reject amplification, in part due to such stigma. Women and men differ in how they age and adjust to impaired hearing, yet little is known specifically about women's perceptions of stigma related to hearing loss and hearing aid use. The purpose of this study was to examine the degree of stigma associated with hearing loss and hearing aid use among women in three age groups (35-45 years, 55-65 years, and 75-85 years). Participants were 191 women with hearing within normal limits based on age-related norms. Using pairs of descriptors (i.e., semantic differentials), participants completed statements related to hearing loss and hearing aid use. Results suggest that negative perceptions associated with hearing loss and hearing aid use are affected by age. Younger women perceive greater stigma than older women. Less stigma is associated with hearing aid use than hearing loss, suggesting a positive effect of hearing loss management. Implications for clinical practice and marketing of hearing instruments are discussed.

Adult↗

[Rehabilitation of patients with hearing disorders using hearing aids and tactical hearing measures].

After a brief summary of the problems of rehabilitation of hearing-impaired subjects, the optimal conditions for rehabilitation with hearing aids are presented: a) The right timing is crucial. b) Optimal provision of hearing aids must be carried out in close co-operation between the patient, the hearing aid technician and the otolaryngologist. c) Easy handling of the hearing aid and the use of attachments must be guaranteed. d) The hearing-impaired person must be fully informed as to the extent and type of hearing loss. He/she must accept the affliction and know about the possibilities of rehabilitation. The patient's motivation is a pre-requisite for all further steps. e) The patients must learn tactical measures to make optimal use of their hearing ability in relation to their environment. Hearing tactics consist of hearing training and a change in the attitude of the hearing-impaired patients themselves and their attitude towards their surroundings.

Auditory Perception↗

A cross-sectional study of speech- and language-abilities of children with normal hearing, mild fluctuating conductive hearing loss, or moderate to profound sensoneurinal hearing loss.

A total of 1528 pre-school children (mean age 4 years and 9 months), being identified as speech or language delayed, were evaluated with respect to micro-otoscopy, nose and throat pathology, hearing function, and speech-language abilities. Subjects were classified into groups of (I) constant normal hearing, (II) fluctuating conductive hearing loss and (III) bilateral moderate to profound sensorineural hearing loss requiring hearing aids. In groups II and III, severe speech and language pathologies were found more frequently than in group I. Additionally, auditory perception skills were less in group II, even if peripheral hearing function was normalized. Group III was affected more than group II, but not significantly. The results indicate that in children having speech or language delay for severals reasons, mild fluctuating hearing loss can additionally alter language acquisition, but less than in cases of moderate or profound sensoneurinal hearing loss. The need of early detection of sensoneurinal hearing loss appears widely accepted; this study demonstrates also the necessity of early diagnosis of mild fluctuating hearing loss, especially in children with speech-language delay.

Acoustic Impedance Tests↗

[Hearing aid prescription in ENT practice. II. Forms of hearing aid construction and prescription of bilateral hearing aids].

The fundamental constructional types of hearing aids are box or pocket hearing aids, behind-the-ear devices and in-the-ear devices. Other special forms include hearing aid spectacles. The indications for prescription of the various constructional types are described with consideration of their advantages and disadvantages, supplemented by a comment on the legal aspects of prescription of in-the-ear aids. In binaural deafness, provision of hearing aids for both ears is to be regarded as the normal approach with careful observation of the limits of the indications. The advantages of hearing in both ears compared with monaural hearing, and the contra-indications to binaural provision of hearing aids are described in detail. The legal basis of binaural hearing aid provision is explained.

Auditory Threshold↗

[Directional hearing of unilaterally hearing impaired--especially sense of sound direction in monaural hearing impairment and monaural deafness].

I. OBJECTIVE. The present study was undertaken in order to determine the onset of monaural deafness, especially whether it is congenital or acquired, making an investigation into the sense of sound direction in monaural hearing impairment and monaural deafness and comparing them between hearing-impaired patients and normal hearers. II. SUBJECTS. This study was carried out on 26 patients with monaural hearing impairment, 22 patients with monaural deafness and 10 normal hearers. III. METHODS. A circle with a radius of 1.3m was drawn around a fixed patient's position in a sound proof room, and the circle was divided into 16 directions at an equal angle of 22.5 degrees. A blindfolded hearer was instructed to listen to a speaker for white noise of 60dB (A) for one second and verbally answer in which direction he heard the noise. The normal hearers were tested in 4-, 8-, and 16-directions, and the hearing-impaired patients were tested in only 8-directions. IV. RESULTS. 1. Normal Hearers The rate of correct answers decreased with increasing directions of sound. The incorrect answers in 4-direction testing were only confusion between forward and backward directions, and similar incorrect answers were made in 8- and 16-direction testing. All other incorrect answers were errors of less than 45 degrees. 2. Monaurally Hearing-impaired Patients The rate of correct answers on the whole was low. There was such a relationship between the rate of correct answers and the mean hearing level of patients that the total rate of correct answers decreased with increasing hearing impairment. This correlation was statistically significant, and there was a still more significant correlation between the degree of hearing impairment and the rate of correct answers as to the right and left directions. Incorrect answers were errors of 90 degrees or less on the healthy side, while errors were made for all directions on the affected side. 3. Monaurally Deaf Patients The rate of correct answers was by far lower on the affected side. Whereas many errors were within 45 degrees on the healthy side, errors were made for all directions on the affected side. Judging from the onset of hearing loss, the monaurally deaf patients were divided into a group of 8 patients who obviously had sudden acquired deafness and a group of 9 patients who were presumed to have congenital monaural deafness. The mean rate of correct answers of the former group was superior to the latter group's, particularly on the effected side.

Adolescent↗

Perception of hearing loss and hearing handicap on hearing aid use by nursing home residents.

The purpose of this study was to examine the perception of hearing loss and self-assessed hearing handicap on hearing aid use by nursing home residents. Sixty elderly individuals who had a hearing loss and wore hearing aids were given the Nursing Home Hearing Handicap Index and were asked specific questions related to hearing aid use. The overall results indicated that there was a moderate correlation among all three variables. It was determined that nursing home residents consistently use their hearing aids. However, amplification does not address all the communication needs of the nursing home resident. Assistive listening devices and environmental modification would improve communication ability and the quality of life of the nursing home resident.

Aged↗

Hearing performance in noise of cochlear implant patients versus severely-profoundly hearing-impaired patients with hearing aids.

It is possible for most post-lingually deaf patients to attain significant open speech recognition following cochlear implantation. In contrast, many severely-profoundly sensorineural hearing-impaired patients receive no benefit from their hearing aids, especially in situations with background noise. The aim of the study was to evaluate the speech recognition ability in quiet and in noise of post-lingually deaf adults implanted with Combi 40/40+ cochlear implants versus severely-profoundly sensorineural hearing-impaired patients fitted with hearing aids. For this purpose, we tested two groups of patients: one that had received cochlear implants (n=22) and a group of subjects with severe-profound sensorineural hearing impairment, fitted with hearing aids (n = 15). All of the patients were tested using the Hochmaier, Schultz, and Moser Discrimination Test in quiet and noise. The results of the study demonstrate that most of our cochlear implant patients received a substantial benefit from their implant, achieving scores of 70 to 100 per cent (mean, 90 per cent) for the numbers test and 10 to 72 per cent (mean, 43 per cent) for the monosyllable test 1 year after implantation. Even in situations with background noise, scores of 1 to 99 per cent (mean, 45.65 per cent) for a signal to noise ratio (SNR) of +15 dB 1 year following the implantation improved to 7 to 95 per cent (mean, 50.7 per cent) at 2 years and 8 to 99 per cent (mean, 60 per cent) at 3 years after implantation. These results are significantly (p<0.04) superior to the hearing aid patients' scores of 1 to 64.2 per cent (mean, 26.7 per cent) for a SNR of 15 dB. The results of the present study may have clinical implications in regard to selection of candidates for cochlear implantation.

Adult↗

Speech understanding and directional hearing for hearing-impaired subjects with in-the-ear and behind-the-ear hearing aids.

With respect to acoustical properties, in-the-ear (ITE) aids should give better understanding and directional hearing than behind-the-ear (BTE) aids. Also hearing-impaired subjects often prefer ITEs. A study was performed to assess objectively the improvement in speech understanding and directional hearing afforded by ITE aids versus BTEs. In 28 hearing-impaired subjects, who visited our Centre for a check-up of their ITEs, the following parameters were measured: (a) thresholds for third-octave bandpass noises between 0.25 and 4 kHz, (b) speech reception thresholds for short Dutch sentences in quiet and with background noise, (c) directional hearing. All three experiments were done binaurally with the subjects wearing their ITEs, BTEs, and no hearing aid. With the 2-cc coupler, the gain used by the subject was measured. The SRT values for the ITE were significantly lower than those for BTE. More gain at 2 and 4 kHz in the ITE proved to be a responsible factor for this improvement. Directional hearing was not improved by wearing an ITE. Large interindividual differences were found between functional gain and the 2-cc coupler measurements. The mean functional gain at 4 kHz for an ITE is higher than the gain measured in a 2-cc coupler. For a BTE, the functional gain at 2 and 4 kHz is lower than the 2-cc coupler gain.

Adult↗

Hearing impairment, coping and perceived hearing handicap in middle-aged subjects with acquired hearing loss.

Coping strategies are presumed to be modifying factors between a hearing impairment and the perceived handicap. The focus of this investigation was to explore audiological and psychological factors affecting the perceived handicap in hearing-impaired middle-aged subjects. The Hearing Measurement Scale, supplemented by a subjective estimation of the perceived handicap, was used as the dependent variable in a study of 62 subjects, heterogeneous as to type and severity of hearing loss and to hearing aid use. In a stepwise regression analysis, maladaptive communication strategies as well as active and constructive coping behaviours were found to increase the self-perception of hearing handicap. Other significant variables were severity of hearing loss and years of education. Tinnitus symptoms did not contribute to the explained variance in the perceived handicap, which was an unexpected finding. A conclusion that may be drawn from the present study is that active coping strategies tend to focus attention on disability and thereby increase perceived handicap.

Adaptation, Psychological↗

Hearing disability and hearing aid benefit related to type of hearing impairment.

This study was designed to investigate whether patients with a conductive hearing impairment derive more benefit from the provision of a hearing aid than comparable individuals with a sensorineural hearing impairment. A secondary aim was to assess the relative hearing disability of those with each type of impairment. Twenty-eight patients with a bilateral, symmetrical conductive impairment were selected. They were matched for age, sex and speech frequency average to individuals with a bilateral, symmetrical sensorineural hearing impairment. Each patient performed free-field audio and audio-visual tests in noise, both with and without a hearing aid, during which the non-test ear was acoustically occluded. When unaided, individuals with a conductive impairment were more disabled than those with a sensorineural impairment. On the other hand, those with a conductive impairment derived more benefit from an aid than those with a sensorineural impairment.

Adult↗

Acquisition of spoken and signed English by hearing-impaired children of hearing-impaired or hearing parents.

This study examines the degree to which hearing-impaired children of hearing-impaired parents (HIP) demonstrate an advantage in their acquisition of signed and spoken English over hearing-impaired children of hearing parents (HP). A subset from the normative sample of the Grammatical Analysis of Elicited Language, 50 HIP children and 50 HP children, were matched in terms of their educational program, hearing level, and age. Results indicate that both groups had comparably poor expressive English language ability at 5 and 6 years of age. However, at age 7 and 8 HIP children demonstrated a significant linguistic advantage in both their spoken and signed English over HP children. Because the production of English by HIP children closely resembled that of orally educated hearing-impaired children of hearing parents, consistent language stimulation throughout the child's early years may be a critical factor in the development of English, regardless of the language or mode of expression.

Age Factors↗

Psychometric evaluation of the Gothenburg Profile for measurement of experienced hearing disability and handicap: applications with new hearing aid candidates and experienced hearing aid users.

The Gothenburg Profile (GP) for measurement of experienced hearing disability and handicap was developed with content partly taken from the shortened Hearing Measurement Scale (HMS25). The GP consists of 20 items divided into two subscales. The first subscale measures Experienced Disability as to hearing speech (items 1-5) and sound localization (items 6-10). The second subscale targets the Experienced Handicap in social settings (items 11-15) and the personal reactions to the experienced handicap (items 16-20). In this study, data are presented for new hearing aid candidates (NewHA) (n=441) and for experienced hearing aid users (ExpHA) (n=476). Principal components factor analyses were conducted and a three-factor solution was obtained, supporting the two factors of the Experienced Disability subscale, but just confirming one factor in the Experienced Handicap subscale. The internal consistency reliability (coefficient alpha) was good (0.85 to 0.95) for the subscales as was the test-retest reliability. The ExpHA group expressed significantly greater disability (first subscale) as well as experienced handicap (second subscale). However, when controlling for hearing level the differences disappeared. The clinical use of the GP for assessment of rehabilitation needs is recommended.

Adolescent↗

[Studies on screening for hard-of-hearing children by questionnaire. 2. Comparison of response rates to individual questions in 1-year-6-month-old children with normal hearing and hearing loss using a health screening questionnaire].

We report the results of studies on responses to questions on hearing impairment, comparing 165 school children whose hearing was diagnosed as normal at the time of admission to primary school and 37 children with hearing loss attending facilities for children with this disability. These children had been covered by similar surveys as part of the health screening for 1-year-6-month-old infants conducted by municipal authorities. Significant differences between the two groups were noted in the response rates to all questions on hearing. Similar differences were noted in the responses to questions on family history of hearing impairment. There were no significant differences in the incidences of asphyxia and jaundice at birth. The most striking differences were noted in the response rates to questions 6, 7, 8, 10, 11, 16, and 18. Most useful and universally valid in this survey were questions 8, 10 and 18 in addition to the question on whether or not parents suspected infantile hearing loss.

Child, Preschool↗

Psychological and somatic distress in relation to perceived hearing disability, hearing handicap, and hearing measurements.

Acquired hearing loss has frequently been reported to cause strains in everyday life, but few attempts have been reported where the affliction is related to the concept of stress. In this within-subjects investigation of 48 middle-aged to elderly hearing impaired patients, the relationships between hearing measurements, experienced disability and handicap (HMS), and psychological and somatic distress symptoms (SCL-90(R)) were analyzed. The variations in experienced hearing disability was found to correlate to the occurrence of a few, but more severe distress symptoms, and by loss of hearing for high frequencies. The experienced handicap, defined as emotional responses and personal opinions, was found to correlate to a general level of distress. In particular those distress items expressing insecurity were related to handicap experience. It was suggested that insecurity in social settings, and diminished hearing for contextual sounds, could cause a perceived loss of control, which could induce stress reactions.

Adaptation, Psychological↗