Modeling Lost to Intervention in Early Hearing Detection and Intervention: A Modified eDelphi Study.

PURPOSE: The purpose of this study was to develop a functional model of the drivers behind why families may decline early intervention services following the identification of a child as D/deaf or hard of hearing. METHOD: This model was developed using a modified eDelphi method. Invited experts (N = 155) were provided proposed models of why families may decline early intervention services in accordance with current literature. In the first phase of feedback, participants (n = 23) provided changes they would make to the model to be more in line with their perceptions of lost to intervention. These changes were implemented, and a second phase of feedback with participants (n = 25) moved to accept the model as presented. RESULTS: Agreement was reached on five main barriers to early intervention access for children who have been identified as D/deaf or hard of hearing (family experience, family culture, perceived vulnerability, perceived benefits, and perceived barriers). Each of these main barriers has associated examples of how they may manifest across different early intervention programs and situations. CONCLUSIONS: This is the first theoretical model of why loss to intervention happens within early hearing detection and intervention. Having a model provides the opportunity for future work to implement novel approaches to support families during the early intervention enrollment process.

Disposable Hearing Aid Battery Management: Survey Assessment of Providers and Qualitative Interviews of Patients.

Purpose The purpose of this study was to better understand the behaviors that hearing aid users engage in to manage batteries. Method Two arms of research, a survey of audiologists (n = 110) and qualitative interviews with adult hearing aid users (n = 13), were conducted. Surveys were distributed and collected both via paper and online methods. Descriptive analyses of survey results were conducted to report on common threads. Qualitative interviews were conducted with video recording for transcription purposes. These transcripts were then coded thematically to identify shared themes across participants. Results Results of this study highlight the variability in behavior between provider-recommended strategies (preemptive battery management) and the reactive/delay strategies that are implemented by users. Patient reports indicate several challenges related to changing their batteries including limited information on hearing aid batteries, physical/sensory challenges to the act, and the social impact of having to change hearing aid batteries. Concurrently, patients express a wide range of strategies to address other challenges including engaging in cost-conscious behaviors when managing batteries (both purchasing and deciding to replace) and maintaining a collection of easily accessible batteries for use. Conclusions Hearing aid batteries are a topic that reflect social and economic factors in a patient's life. While providers may report they cover these topics sufficiently, challenges related to batteries may need specific elucidation by the clinician to ensure adherence to recommendations and functioning devices.

The influence of receiver size on magnitude of acoustic and perceived measures of occlusion.

PURPOSE: The current study examined measured and perceived occlusion for a receiver-in-the-canal (RIC) hearing aid with different-sized receivers. The relationship between these measures and ear canal volume was also investigated. METHOD: Thirty adult participants were fitted with an RIC hearing aid and tested with 5 receiver size conditions. Measured occlusion effect was calculated from aided and unaided real-ear responses obtained while subjects vocalized /i/. Perceived occlusion measures were acquired using an occlusion effect scale. RESULTS: Measured occlusion was greatest for the largest receiver. The most common perceived occlusion ratings were none to mild occlusion for all receiver sizes. Perceived ratings were weakly correlated to acoustic measures. There was little to no correlation between receiver size and estimated ear canal volume. CONCLUSIONS: Measured and perceived occlusion was minor in all receiver conditions. Occlusion was not correlated to ear canal volume, suggesting that RIC hearing aids most often result in negligible amounts of measured and perceived occlusion effect, regardless of ear canal size. Because no significant relationship existed between the occlusion measures, clinicians may need to consider that self-rating of occlusion may not match measured occlusion results.

The impact of sudden hearing loss secondary to heroin overdose on fitting outcomes.

PURPOSE: There are few cases in the literature that report the auditory effects of heroin overdose. Follow-up and rehabilitation in these cases are unreported. In the case reported here, a 29-year-old woman presented with sudden bilateral sensorineural hearing loss subsequent to reported heroin overdose. She was fitted with binaural amplification and monitored over 3 months. METHOD: The Hearing Handicap Inventory for Adults-Screening version (HHIA-S), Expected Consequences of Hearing Aid Ownership (ECHO), and Satisfaction With Amplification in Daily Life (SADL) were administered after hearing aid fitting. These measures assessed the patient's perceptions of handicap as well as her expectations of and satisfaction with amplification. RESULTS: The patient's responses on the HHIA-S were higher than normative values at the time of the incident, indicating perceptions of greater handicap. Her perceptions of handicap decreased after having been fit with hearing aids. Responses on the SADL and ECHO were within normative values. CONCLUSION: This case provides a framework for managing the rehabilitation of this population. Audiologists need to understand their role in the careful monitoring of hearing rehabilitation and how they may help in determining complaints that may be hearing- or device-related versus those associated with the psychological symptoms experienced during the withdrawal period.

The impact of health literacy on patient understanding of counseling and education materials.

Low health literacy is reported to have negative consequences on patient understanding of health-related information; however, there is a dearth of research regarding health literacy in an audiology-specific context. This study examines the grade level of language used in verbal and written communication samples during routine hearing aid orientation appointments. Patient counseling sessions were videotaped and transcribed; hearing aid instruction guides used during counseling sessions were also transcribed. The Flesch-Kincaid grade level formula was used to determine the approximate United States grade level equivalent of the counseling sessions, hearing aid instruction guides, and to predict patient health literacy. The results indicate that patient predicted health literacy likely impacts understanding of both one-on-one counseling and hearing aid instruction guides.

Normative data for the Attitudes towards Loss of Hearing Questionnaire.

Investigations have shown that patient attitudes toward hearing loss and hearing aids impact self-reported handicap and disability, hearing aid benefit, and hearing aid use. The Attitudes towards Loss of Hearing Questionnaire (ALHQ) was developed by Saunders and Cienkowski (1996) to examine some of the psychosocial factors underlying the use and acquisition of hearing aids. Here we report data from a new version of questionnaire (ALHQ v2.1), which examines attitudes towards hearing loss and hearing aids on five scales: Denial of Hearing Loss, Negative Associations, Negative Coping Strategies, Manual Dexterity and Vision, and Hearing-Related Esteem. Reliability values, internal consistency values, and cut points for typical and atypical scores are provided, along with comparison of the scores of women, men, current hearing aid users, non-hearing aid users, and paying versus nonpaying individuals. The ALHQ takes about ten minutes to complete and identifies for the clinician some of the issues that might jeopardize successful hearing aid outcome.

Auditory-visual speech perception in an adult with aphasia.

The evaluation of auditory-visual speech perception is not typically undertaken in the assessment of aphasia; however, treatment approaches utilise bimodal presentations. Research demonstrates that auditory and visual information are integrated for speech perception. The strongest evidence of this cross-modal integration is the McGurk effect. This indirect measure of integration shows that presentation of conflicting tokens may change perception (e.g. auditory /bi/ + visual /gi/ = /di/). The purpose of this study was to investigate the ability of a person with mild aphasia to identify tokens presented in auditory-only, visual-only and auditory-visual conditions. It was hypothesized that performance would be best in the bimodal condition and that presence of the McGurk effect would demonstrate integration of speech information. Findings did not support the hypotheses. It is suspected that successful integration of AV speech information was limited by a perseverative response pattern. This case study suggests the use of bisensory speech information may be impaired in adults with aphasia.

Auditory-visual speech perception and aging.

OBJECTIVE: This experiment was designed to assess the integration of auditory and visual information for speech perception in older adults. The integration of place and voicing information was assessed across modalities using the McGurk effect. The following questions were addressed: 1) Are older adults as successful as younger adults at integrating auditory and visual information for speech perception? 2) Is successful integration of this information related to lipreading performance? DESIGN: The performance of three groups of participants was compared: young adults with normal hearing and vision, older adults with normal to near-normal hearing and vision, and young controls, whose hearing thresholds were shifted with noise to match the older adults. Each participant completed a lipreading test and auditory and auditory-plus-visual identification of syllables with conflicting auditory and visual cues. RESULTS: The results show that on average older adults are as successful as young adults at integrating auditory and visual information for speech perception at the syllable level. The number of fused responses did not differ for the CV tokens across the ages tested. Although there were no significant differences between groups for integration at the syllable level, there were differences in the response alternatives chosen. Young adults with normal peripheral sensitivity often chose an auditory alternative whereas, older adults and control participants leaned toward visual alternatives. In additions, older adults demonstrated poorer lipreading performance than their younger counterparts. This was not related to successful integration of information at the syllable level. CONCLUSIONS: Based on the findings of this study, when auditory and visual integration of speech information fails to occur, producing a nonfused response, participants select an alternative response from the modality with the least ambiguous signal.

A test to measure subjective and objective speech intelligibility.

Measurement of hearing aid outcome is particularly difficult because there are numerous dimensions to consider (e.g., performance, satisfaction, benefit). Often there are discrepancies between scores in these dimensions. It is difficult to reconcile these discrepancies because the materials and formats used to measure each dimension are so very different. We report data obtained with an outcome measure that examines both objective and subjective dimensions with the same test format and materials and gives results in the same unit of measurement (signal-to-noise ratio). Two variables are measured: a "performance" speech reception threshold and a "perceptual" speech reception threshold. The signal-to-noise ratio difference between these is computed to determine the perceptual-performance discrepancy (PPDIS). The results showed that, on average, 48 percent of the variance in subjective ratings of a hearing aid could be explained by a combination of the performance speech reception threshold and the PPDIS. These findings suggest that the measure is potentially a valuable clinical tool.