The impact of face coverings on audio-visual contributions to communication with conversational speech.

The use of face coverings can make communication more difficult by removing access to visual cues as well as affecting the physical transmission of speech sounds. This study aimed to assess the independent and combined contributions of visual and auditory cues to impaired communication when using face coverings. In an online task, 150 participants rated videos of natural conversation along three dimensions: (1) how much they could follow, (2) how much effort was required, and (3) the clarity of the speech. Visual and audio variables were independently manipulated in each video, so that the same video could be presented with or without a superimposed surgical-style mask, accompanied by one of four audio conditions (either unfiltered audio, or audio-filtered to simulate the attenuation associated with a surgical mask, an FFP3 mask, or a visor). Hypotheses and analyses were pre-registered. Both the audio and visual variables had a statistically significant negative impact across all three dimensions. Whether or not talkers' faces were visible made the largest contribution to participants' ratings. The study identifies a degree of attenuation whose negative effects can be overcome by the restoration of visual cues. The significant effects observed in this nominally low-demand task (speech in quiet) highlight the importance of the visual and audio cues in everyday life and that their consideration should be included in future face mask designs.

Speech intelligibility enhancement using hearing-aid array processing.

Microphone arrays can improve speech recognition in the noise for hearing-impaired listeners by suppressing interference coming from other than desired signal direction. In a previous paper [J. M. Kates and M. R. Weiss, J. Acoust. Soc. Am. 99, 3138-3148 (1996)], several array-processing techniques were evaluated in two rooms using the AI-weighted array gain as the performance metric. The array consisted of five omnidirectional microphones having uniform 2.5-cm spacing, oriented in the endfire direction. In this paper, the speech intelligibility for two of the array processing techniques, delay-and-sum beamforming and superdirective processing, is evaluated for a group of hearing-impaired subjects. Speech intelligibility was measured using the speech reception threshold (SRT) for spondees and speech intelligibility rating (SIR) for sentence materials. The array performance is compared with that for a single omnidirectional microphone and a single directional microphone having a cardioid response pattern. The SRT and SIR results show that the superdirective array processing was the most effective, followed by the cardioid microphone, the array using delay-and-sum beamforming, and the single omnidirectional microphone. The relative processing ratings do not appear to be strongly affected by the size of the room, and the SRT values determined using isolated spondees are similar to the SIR values produced from continuous discourse.

Acclimatization to hearing aids.

OBJECTIVE: To investigate acclimatization to hearing aids. DESIGN: Forty-eight subjects took part in a study in which hearing aid benefit was measured four times over the initial 3 mos of participation. At the start, 24 subjects were experienced hearing aid users and 24 had never worn a hearing aid before. Subjects wore one of three models of hearing aid with one of six different configurations (combination of frequency response and method of output limiting). Hearing aid benefit was measured with CID W-1 spondees and the Hearing in Noise Test (HINT) test. Testing took place on Days 0 (day of fitting), 30, 60, and 90. Analyses of variance were used to determine whether hearing aid benefit changed over time as a function of hearing aid user status, hearing aid configuration, and hearing aid volume setting. RESULTS: There were small, nonsignificant changes in hearing aid benefit over the test sessions with both sets of test materials. There were no interactions between hearing aid benefit over time and hearing aid user status or hearing aid volume setting. There was an interaction between benefit over time and hearing aid configuration on one test measure only. CONCLUSIONS: The data showed little evidence of acclimatization over the 3 mo of hearing aid use. The test materials used here were low- to mid-frequency sensitive, and, therefore, it is concluded that if acclimatization did occur, it did so primarily at high frequencies. Because the HINT test has good face validity to everyday listening situations, it is suggested that the clinical ramifications of acclimatization are probably small.

Refinement and psychometric evaluation of the Attitudes Toward Loss of Hearing Questionnaire.

OBJECTIVE: To refine and statistically validate the Attitudes Toward Loss of Hearing Questionnaire (ALHQ) so that it will be appropriate for clinical application and to understand some of the personality attributes underlying attitudes toward hearing loss. DESIGN: An American-English version of an ALHQ, originally designed by Brooks (1989), was completed by 226 men; a subset of 80 also completed personality questionnaires. All subjects underwent pure-tone testing and speech audiometry. Factor analysis was used to extract scales from the ALHQ. Reliability analyses using Cronbach's alpha were carried out on each scale. Test-retest reliability was evaluated from questionnaires completed 6 to 18 mo after initial administration. Multiple regression analysis was used to examine the audiometric and personality determinants of attitudes. RESULTS: Five reliable scales were extracted from a 24-question version of the ALHQ: 1) Social and Emotional Impact of Hearing Loss, 2) Acceptance/ Adjustment to Hearing Loss, 3) Perceived Support from Significant Others, 4) Hearing Aid Stigma, and 5) Awareness of Hearing Loss. Audiometric data explained little of the variance in attitude scores; age and other demographic factors did not correlate with attitudes either. The personality traits of extroversion, self-esteem, and anxiety/neuroticism played a larger role in determining attitude. CONCLUSIONS: The ALHQ is psychometrically acceptable and is a potentially useful clinical tool. It is quick and easy to complete and to score and could be used as a basis for counseling and for following attitude change in patients over time.

The influence of personality-related factors upon consultation for two different "marginal" organic pathologies with and without reports of auditory symptomatology.

Obscure Auditory Dysfunction (OAD) is explained by a combination of hearing-related deficits and personality factors Saunders & Haggard (1992). In this study, we determine which factors are associated specifically with OAD and which are associated with the seeking of medical attention in general. We achieved this by obtaining a second patient group with a parallel syndrome to OAD, called "chronic pelvic pain without obvious organic pathology" (CPPWOOP). CPPWOOP patients complain of lower abdominal pain that is not explainable by conventional medical tests. Fifteen CPPWOOPs underwent the OAD test battery. For the analyses they were retrospectively matched to 15 of the original OADs and their matched controls. The three groups were compared by analysis of variance and Kruskall-Wallis analyses. The CPPWOOPs and controls performed significantly better than OADs on hearing-related variables, but did not differ from each other, whereas the OADs and CPPWOOPs were significantly more anxious than the controls, but did not differ from each other. We conclude that anxiety-related traits are associated with the seeking of medical attention in general, whereas the hearing-related deficits we measured are associated specifically with OAD. Anxiety-related traits should, therefore, be considered when dealing with marginal pathologies, but in depth investigation may also reveal an organic basis; therefore, patients should not be dismissed as simply neurotic.

The clinical assessment of "Obscure Auditory Dysfunction" (OAD) 2. Case control analysis of determining factors.

Obscure Auditory Dysfunction (OAD) is defined as a clinical referral for self-reported auditory disability with no audiometric abnormality by stringent criteria. In stage 2 of a case control study of OAD, we have confirmed the general finding of stage 1 that OAD is multifactorial; compared with controls, patients as a group have a genuine performance deficit for understanding speech in noise, accompanied by personality-related factors. Paired logistic regression analysis optimally differentiated the 50 patients from their 50 matched controls on the basis of variables from three different domains: masked thresholds (psychoacoustic domain), dichotic listening ability (central/cognitive domain), and underestimation of own hearing ability (personality domain). A further and influential contributing variable was understanding of speech in noise supplementing the variables in both the psychoacoustic and the cognitive domains. With this model, 82.7% of the total group deviance was explained (i.e., the binary variable of case/control). A corresponding discriminant function analysis correctly classified 80% of patients and 90% of controls. When factors underlying the performance and personality-related variables were investigated with multiple linear regression within the two groups separately, relatively little of the within-group variance among OADs was explained. This is consistent with the multifactorial nature of OAD, in that the combinations of factors leading to OAD status differ between individuals. The research findings have been used to design a clinical test package to provide diagnostic information on the basis of OAD in individuals.

Lack of association between otoacoustic emissions and hearing difficulty in subjects with normal hearing thresholds.

Evoked otoacoustic emissions (EOAE) are a sensitive indicator of subtle cochlear damage and hence might explain why some people complain of excessive difficulty understanding speech in a background of noise, despite having normal hearing thresholds. This phenomenon has been termed "Obscure Auditory Dysfunction" (OAD). Recorded EOAE waveforms from a group of 50 OAD patients were compared with those from a group of 50 matched controls. No significant difference could be found between the two groups across a range of objective and subjective descriptors of the EOAEs. Any cochlear component of OAD does not appear to affect the function of the outer hair cells sufficiently to modify EOAEs materially.

A clinical test battery for obscure auditory dysfunction (OAD): development, selection and use of tests.

Obscure auditory dysfunction (OAD) is defined as convincing self-report of auditory disability accompanied by normal pure-tone thresholds. This has been increasingly recognized as a clinical problem, but until now there has not been a standard clinical procedure for dealing with such patients. This paper summarizes a demographic and clinical characterization of a sample of 50 OAD patients, reports new norms on the tests in the version issued, and describes a test package developed from a case-control research study that can be routinely used with OAD patients. The package enables clinicians: (i) to confirm, or otherwise, OAD as the appropriate classification for individuals presenting with OAD-like symptoms; (ii) to elucidate the underlying basis of OAD in such individuals and hence in most cases to provide explanations that are justified by test findings; and (iii) to counsel cases in a fashion appropriate for each individual. The package consists of four performance tests, a specialized clinical interview and a brief questionnaire to determine the severity of OAD. The assessment takes approximately 37 min and can be run using a two-channel audiometer and a cassette recorder.

The clinical assessment of obscure auditory dysfunction--1. Auditory and psychological factors.

We define obscure auditory dysfunction (OAD) as the clinical presentation of reported difficulty understanding speech in the presence of noise accompanied by clinically "normal" hearing thresholds, and no other obvious cause. The term deliberately avoids particular pathophysiological connotations. A detailed characterization of such patients was undertaken as the basis for future diagnosis and management of OAD by clinicians. Twenty patients were compared with 20 pairs of controls (matched for age, sex, educational level, and noise exposure) on tests of auditory, linguistic, and psychological function. Patients showed a genuine performance deficit on a speech-in-noise task, due in part to minor auditory dysfunction and poor linguistic ability. Their high level of self-rated disability and handicap cannot, however, be entirely explained by this genuine deficit. An anxious personality and a history of otological symptoms typified the patient group; either or both have presumably contributed to patients' seeking of medical or audiological advice. OAD is thus a multifactorial syndrome with contributions from auditory, psychological, and linguistic factors. The variance in (and correlation between) performance levels on two sentence-in-noise tests, present only within the patient group, indicates that these patients are not a homogenous group.

Total and free salicylate concentrations in juvenile rheumatoid arthritis.

Salicylates are known to be highly protein bound, primarily to albumin. Patients with juvenile rheumatoid arthritis (JRA) are known to have decreased albumin concentrations. Total and free salicylate concentrations were determined for 19 patients with JRA. Although many of these patients were below the normal therapeutic range, the percent of salicylate bound was essentially constant and did not differ significantly regardless of albumin concentrations or total salicylate concentrations. Elevated liver enzymes did not correlate with total or free salicylate concentrations. We conclude that total salicylate concentrations should be used for monitoring aspirin therapy in JRA. Free salicylate concentrations do not appear to be more reliable or feasible.

Interlaboratory salicylate variability.

Nineteen patients with juvenile rheumatoid arthritis had salicylate concentration determination by 2 different methods in 2 laboratories. Differences in the results from these laboratories prompted testing at 4 laboratories with known samples of salicylates. Significant variation was shown between spectrofluorometric and Trinder methods. We feel that it is imperative that physicians and clinical pharmacists determine the reliability of salicylate determinations performed in their laboratories prior to making recommendations for changes in patients' drug regimens.