Psychometric Evaluation of a Patient Experience Questionnaire (PEQ) for Outpatient Appointments: Analysis Using Data from a U.K. National Health Service Audiology Department.

BACKGROUND: The Audiology Department at the Royal Surrey NHS Foundation Trust (RSFT), United Kingdom, developed a patient experience questionnaire (PEQ) to assess and compare patients' experiences of attending a wide range of appointments (e.g., hearing assessment, hearing aid fitting, hearing aid review, tinnitus therapy, balance assessment, and balance rehabilitation). PURPOSE: The aim of this study was to assess the psychometric properties of the PEQ. The PEQ is a unidimensional instrument with four items that assess a patient's experience of an outpatient appointment. RESEARCH DESIGN: Retrospective cross-sectional study. STUDY SAMPLE: Patients attending appointments for audiology services at RSFT between January and March 2020. DATA COLLECTION AND ANALYSIS: All patients (n = 656) attending appointments for audiology services at RSFT during randomly selected days between January and March 2020 were given the questionnaire to complete themselves (PEQ-self) or to complete on their child's behalf (PEQ-parent). The factor structures for the PEQ-self and PEQ-parent were assessed separately, using confirmatory factor analysis. A multiple-causes, multiple-indicators (MIMIC) model was fitted to explore potential bias due to gender and age. Internal consistency was assessed using Cronbach's α. The bivariate correlations between PEQ scores and other variables were evaluated using the nonparametric Spearman correlation coefficient. Floor and ceiling effects were assessed using the distribution of total scores. RESULTS: Confirmatory factor analysis revealed that a one-factor model gave a close fit to the data for both the self and parent versions. Cronbach's α for the total score was 0.77 for the PEQ-self and 0.86 for the PEQ-parent. The MIMIC model showed no significant direct effects of age or gender for either version. CONCLUSIONS: Both the PEQ-self and PEQ-parent questionnaire can be reliably used to measure patients' experiences of outpatient audiology appointments. Future studies should aim to assess the psychometric properties of the PEQ-self and PEQ-parent for a range of outpatient appointments other than audiology.

Adult hearing-aid users with cochlear dead regions restricted to high frequencies: Implications for amplification.

OBJECTIVES: Cochlear dead regions (DR) are common in adult hearing-aid users, but are usually restricted to high frequencies. The aim was to determine the benefit of high-frequency amplification for ears with and without high-frequency DRs. DESIGN: Participants were fitted with the study hearing aid and tested under four conditions: unfiltered (NAL-NL2 prescription), and low-pass filtered at 1.5, 2, and 3 kHz. VCV stimuli were presented at 65 dB (A) in quiet and in 20-talker babble at a signal-to-babble ratio of 0 dB. STUDY SAMPLE: Experienced adult hearing-aid users: one group of 18 with a DR edge frequency above 1.5 kHz, and a group of 18 matched controls. RESULTS: Overall performance was best in the unfiltered condition. There was no significant difference in mean performance between the two groups when tested in quiet. However, the DR group obtained less benefit from high-frequency amplification when tested in babble: the mean difference between the unfiltered and 3-kHz filtered condition was 6% and 13% for the DR group and controls, respectively. CONCLUSIONS: In adults with a moderate hearing loss and a restricted DR, speech recognition was always best in the unfiltered condition, although mean performance in babble was lower for the DR group.

Repeatability, agreement, and feasibility of using the threshold equalizing noise test and fast psychophysical tuning curves in a clinical setting.

OBJECTIVE: To investigate repeatability, agreement, and clinical feasibility of the threshold equalizing noise (TEN) test and fast psychophysical tuning curve (PTC) measurements to detect off-frequency listening, an indicator of cochlear dead regions (DRs). DESIGN: The TEN-test was carried out from 0.5 to 4 kHz and fast PTCs were carried out at ≥ 2 frequencies. STUDY SAMPLE: The TEN-test was completed on 70 ears; fast PTCs were measured on 20 ears. RESULTS: TEN-test findings were repeatable in terms of meeting the criteria for a DR (97%) and identifying the same edge frequency (fe) (87%). In all cases, fast PTCs were repeatable in terms of meeting the criteria for DRs. There was 87% agreement between the two procedures in terms of the presence of off-frequency listening, and there was 73% agreement in terms of fe. Fast PTCs had a 10% lower 'conclusive finding' rate than the TEN-test and the test duration was typically 40 minutes longer. CONCLUSIONS: Both the TEN-test and fast PTCs have high test-retest repeatability. The TEN-test is more clinically feasible due to its shorter test duration and higher interpretation rate, but it may underestimate the extent of a DR because of its inability to precisely identify fe.

Prevalence of cochlear dead regions in new referrals and existing adult hearing aid users.

OBJECTIVES: The primary aim of this study was to identify the prevalence of dead regions (DRs) in new adult hearing aid referrals and existing adult hearing aid users. Secondary aims included determining the effect of hearing threshold levels and slope, age, and sex on the presence of DRs. DESIGN: Three hundred and seventy-six adults were recruited from a U.K. National Health Service audiology clinic. Three hundred and forty-three participants (674 ears) with a sensorineural hearing impairment were assessed for the presence of a DR at audiometric frequencies from 0.5 to 4 kHz using the Threshold Equalizing Noise test. RESULTS: The overall prevalence of DRs was 36% (95% confidence interval 31-41). The prevalence in new referrals, and in new and existing hearing aid users was 31% (25-37), 33% (26-40), and 43% (35-51), respectively. The overall prevalence of extensive DRs, defined as spanning ≥3 consecutive frequencies, was 3% (1-5). CONCLUSIONS: On the basis of the findings from the Threshold Equalizing Noise test, prevalence of DRs was relatively high in adult hearing aid users with a sensorineural hearing impairment. However, in most cases, the DR was limited to a small frequency region. This suggests that, in most cases, the presence of a DR may not be clinically significant. The difference in DR prevalence between new referrals and existing hearing aid users was not statistically significant. Hearing threshold levels, slope of hearing impairment, age, and sex could not be used to reliably identify DRs.