A context-based model to predict the intelligibility of sentences in non-stationary noises.

The context-based Extended Speech Transmission Index (cESTI) (van Schoonhoven et al., 2022, J. Acoust. Soc. Am. 151, 1404-1415) was successfully applied to predict the intelligibility of monosyllabic words with different degrees of context in interrupted noise. The current study aimed to use the same model for the prediction of sentence intelligibility in different types of non-stationary noise. The necessary context factors and transfer functions were based on values found in existing literature. The cESTI performed similar to or better than the original ESTI when noise had speech-like characteristics. We hypothesize that the remaining inaccuracies in model predictions can be attributed to the limits of the modelling approach with regard to mechanisms, such as modulation masking and informational masking.

Exploring Factors That Contribute to the Success of Rehabilitation With Hearing Aids.

OBJECTIVES: Hearing aids are an essential and important part of hearing rehabilitation. The combination of technical data on hearing aids and individual rehabilitation needs can give insight into the factors that contribute to the success of rehabilitation. This study sets out to investigate if different subgroups of (comparable) hearing aids lead to differences in the success of rehabilitation, and whether these differences vary between different domains of auditory functioning. DESIGN: This study explored the advantages of including patient-reported outcome measures (PROMs) in the process of purchasing new hearing aids in a large sample of successful hearing aid users. Subject data were obtained from 64 (commercial) hearing aid dispensers and 10 (noncommercial) audiological centers in the Netherlands. The PROM was a 32-item questionnaire and was used to determine the success of rehabilitation using hearing aids by measuring auditory disability over time. The items were mapped on six domains of auditory functioning: detection, discrimination, localization, speech in quiet, speech in noise, and noise tolerance, encompassing a variety of daily-life listening situations. Hearing aids were grouped by means of cluster analysis, resulting in nine subgroups. In total, 1149 subjects were included in this study. A general linear model was used to model the final PROM results. Model results were analyzed via a multifactor Analysis of Variance. Post hoc analyses provided detailed information on model variables. RESULTS: Results showed a strong statistically significant effect of hearing aids on self-perceived auditory functioning in general. Clinically relevant differences were found for auditory domains including detection, speech in quiet, speech in noise, and localization. There was only a small, but significant, effect of the different subgroups of hearing aids on the final PROM results, where no differences were found between the auditory domains. Minor differences were found between results obtained in commercial and noncommercial settings, or between novice and experienced users. Severity of Hearing loss, age, gender, and hearing aid style (i.e., behind-the-ear versus receiver-in-canal type) did not have a clinically relevant effect on the final PROM results. CONCLUSIONS: The use of hearing aids has a large positive effect on self-perceived auditory functioning. There was however no salient effect of the different subgroups of hearing aids on the final PROM results, indicating that technical properties of hearing aids only play a limited role in this respect. This study challenges the belief that premium devices outperform basic ones, highlighting the need for personalized rehabilitation strategies and the importance of evaluating factors contributing to successful rehabilitation for clinical practice.

Factors associated with change in the need for recovery and subjective listening effort in employees with hearing loss receiving aural rehabilitation.

OBJECTIVE: Compared to normally-hearing employees, those with hearing loss suffer from higher Need For Recovery (NFR) after work. The aims of this study are to assess the NFR of employees with hearing loss before and after aural rehabilitation and to examine to what extent change in the NFR can be explained by changes in subjective listening effort, personal adjustments, communication strategies, auditory work demands, and self-reported hearing ability. METHODS: We included patients who received aural rehabilitation in two audiological centers in the Netherlands because of hearing complaints in their work situation. Outcomes were measured by questionnaires at baseline and 3 month follow-up. The NFR before and after the rehabilitation was compared with a t test. Hierarchical multiple analyses were performed. RESULTS: In total, 60 patients (aged 22-63, working hours ≥8 per week) participated in the study, of which 50 completed the follow-up questionnaires. The NFR was significantly lower after the aural rehabilitation (M = 45.03) compared to before the aural rehabilitation (M = 51.89), t = -3.43, p < 0.01). Change in NFR could best be explained by the change in personal adjustments (R2 = 0.45, B = -1.23, p < 0.01). CONCLUSION: The NFR of employees with hearing loss can be improved by aural rehabilitation, but this study shows that current practices reduce the NFR only in part of the employees. Therefore, improving current practices should be considered and evaluated, for example by applying a different combination of rehabilitation components. Especially, interventions that affect personal adjustments may be promising to further reduce the NFR in employees with hearing loss.

Surgery for chronic otitis media in the elderly.

PURPOSE: To evaluate the effectiveness and safety of surgery for chronic otitis media in elderly patients, compared to younger adults and children. METHODS: Patients with chronic otitis media with and without cholesteatoma formation were assessed. Patients aged 65 years and older were included and compared to adults aged 35-55 and to children. Effectiveness was evaluated by comparing postoperative dry and safe ears in ages groups, safety was assessed by comparing postoperative adverse events. RESULTS: Postoperative success and adverse events did not differ between age groups. Children had more recurrent cholesteatoma than adults. No difference in recurrent cholesteatoma between adults was observed. CONCLUSION: Surgical treatment for chronic otitis media with and without cholesteatoma in elderly patients is safe and effective. Age has no influence on postoperative adverse events and treatment outcomes in chronic otitis media. Cholesteatoma recurrence was not different between adult age groups.

The relationship between hearing status, listening effort, and the need for recovery in employees of a manufacturing company.

OBJECTIVE: Hearing screening can be used to detect hearing loss, but its value for identifying employees with work functioning difficulties is unclear. The objective of this study was to assess the association between the hearing status measured with an occupational hearing-in-noise screening test, Listening Effort (LE), and Need For Recovery (NFR) in employees of a manufacturing company, and to examine whether these associations depend on the perceived noise level at the workplace. METHODS: Employees of coatings and paints manufacturing company were included. Their hearing status was assessed with an occupational hearing-in-noise screening test. An online survey was used to assess their LE, NFR, and the perceived noise level at the workplace. Responses from 143 employees were analyzed (mean age = 53 years) using hierarchical multiple regression analysis with the outcomes LE and NFR. RESULTS: Regression analysis-with adjustments for gender, age, educational level, health status, pace/amount of work, job variety, and work pleasure-revealed that hearing status was significantly associated with LE, but the interaction between hearing status and the perceived noise level was not. Hearing status nor the interaction between hearing status and the perceived noise level was significantly associated with NFR. CONCLUSION: The results confirm that poorer hearing is associated with higher LE, but not with higher NFR. These associations were unrelated to the perceived noise level at the workplace. Therefore, the value of occupational hearing screening appears to be early identification of hearing loss in employees, but not identification of work functioning difficulties.

A context-based approach to predict intelligibility of meaningful and nonsense words in interrupted noise: Model evaluation.

The context-based Extended Speech Transmission Index (cESTI) by Van Schoonhoven et al. (2022) was successfully used to predict the intelligibility of meaningful, monosyllabic words in interrupted noise. However, it is not clear how the model behaves when using different degrees of context. In the current paper, intelligibility of meaningful and nonsense CVC words in stationary and interrupted noise was measured in fourteen normally hearing adults. Intelligibility of nonsense words in interrupted noise at -18 dB SNR was relatively poor, possibly because listeners did not profit from coarticulatory cues as they did in stationary noise. With 75% of the total variance explained, the cESTI model performed better than the original ESTI model (R2 = 27%), especially due to better predictions at low interruption rates. However, predictions for meaningful word scores were relatively poor (R2 = 38%), mainly due to remaining inaccuracies at interruption rates below 4 Hz and a large effect of forward masking. Adjusting parameters of the forward masking function improved the accuracy of the model to a total explained variance of 83%, while the predicted power of previously published cESTI data remained similar.

A context-based approach to predict speech intelligibility in interrupted noise: Model design.

The Extended Speech Transmission Index (ESTI) by van Schoonhoven et al. [(2019). J. Acoust. Soc. Am. 145, 1178-1194] was used successfully to predict intelligibility of sentences in fluctuating background noise. However, prediction accuracy was poor when the modulation frequency of the masker was low (<8 Hz). In the current paper, the ESTI was calculated per phoneme to estimate phoneme intelligibility. In the next step, the ESTI model was combined with one of two context models {Boothroyd and Nittrouer, [(1988). J. Acoust. Soc. Am. 84, 101-114]; Bronkhorst et al., [(1993). J. Acoust. Soc. Am. 93, 499-509} in order to improve model predictions. This approach was validated using interrupted speech data, after which it was used to predict speech intelligibility of words in interrupted noise. Model predictions improved using this new method, especially for maskers with interruption rates below 5 Hz. Calculating the ESTI at phoneme level combined with a context model is therefore a viable option to improve prediction accuracy.

Measuring Auditory Fitness in Locomotive Engineers: Development and Validation of a Signal Detection Test.

OBJECTIVES: To perform their job safely and effectively, locomotive engineers are required to detect auditory warning signals in the noisy work setting of a train cabin. Based on audio recordings of Dutch train cabins, we have developed a task and job-specific test for assessing the engineer's ability to detect the two acoustic warning signals for the Dutch situation. The aim of this study was to evaluate the reliability, agreement, and construct validity of this test. DESIGN: Two experiments were performed. In the first experiment, reliability and agreement of the signal detection test were assessed. Normally hearing individuals (N = 12) completed a signal detection test twice in 12 driving conditions. In the second experiment, construct validity was assessed. We retrospectively identified locomotive engineers, suspected of being hearing impaired, who were referred to the Amsterdam UMC for an auditory fitness for job assessment. All included engineers (N = 83) performed the signal detection test in four driving conditions, underwent tone audiometry and two speech perception in noise tests, and rated the effort and concentration it takes to detect the auditory signals. Seven a priori formulated hypotheses were tested. RESULTS: In the first experiment, sufficient reliability and agreement were found in nine driving conditions (ICC = 0.54-0.81; standard error of measurement = 1.15-1.92), poor reliability in two driving conditions (ICC < 0.50), and poor agreement in one driving condition (standard error of measurement = 2.67 dBA). In the second experiment, the results of the signal detection test correlated moderately with the pure-tone thresholds, speech reception threshold in fluctuating noise, and engineer's subjective rating of effort and concentration, but not with the speech reception threshold in continuous noise. According to the hypotheses, poorer test scores were obtained by hearing aid users compared with nonhearing aid users. CONCLUSIONS: The signal detection test has sufficient reliability and agreement in all but three driving conditions. This study provides evidence supporting the construct validity of the signal detection test in locomotive engineers. The moderate associations with conventional hearing tests show that the conventional hearing tests did not cover the whole construct measured with the signal detection test. The results, therefore, underpin the importance of evaluating the ability to detect auditory warning signals separately from other hearing-critical job tasks.

Uni- and bilateral spectral loudness summation and binaural loudness summation with loudness matching and categorical loudness scaling.

OBJECTIVE: Current hearing aid prescription rules assume that spectral loudness summation decreases with hearing impairment and that binaural loudness summation is independent of hearing loss and signal bandwidth. Previous studies have shown that these assumptions might be incorrect. Spectral loudness summation was measured and compared for loudness scaling and loudness matching. DESIGN: In this study, the effect of bandwidth on binaural summation was investigated by comparing loudness perception of low-pass filtered, high-pass filtered, and broadband pink noise at 35 Categorical Units for both unilateral and bilateral presentation. STUDY SAMPLE: Sixteen hearing-impaired listeners. RESULTS: The results show that loudness differences between the three signals are different for bilateral presentation than for unilateral presentation. In specific, binaural loudness summation is larger for the low-pass filtered pink noise than for the high-pass filtered pink noise. Finally, individual variability in loudness perception near loudness discomfort level was found to be very large. CONCLUSIONS: Loudness matching is offered as a fast and reliable method to measure individual loudness perception. As discomfort with loud sounds is one of the major problems encountered by hearing aid users, measurement of individual loudness perception could improve hearing aid fitting substantially.

Detectability of auditory warning signals in the ambient noise of Dutch train cabins.

Locomotive engineers need to detect auditory warning signals for safe and effective job performance. We measured the levels and spectra of the warning signals and noises present in Dutch train cabins to evaluate the effectiveness of these signals. Audio-recordings were made in six train types during normal operation. Signal detectability was estimated using the Detectsound software and compared against ISO 7731. Signal detectability was also measured in six normally-hearing individuals in a laboratory setting. Signal levels ranged between 68 and 84 dBA. Noise levels ranged between 53 and 77 dBA. The acoustical requirements for signal detectability were not met in multiple driving conditions, especially at higher speed. Sufficient signal-to-noise ratio's were achieved in the laboratory measurements, but difficulties can be expected in unfavourable driving situations or when the engineer suffers from hearing loss. Acoustical, environmental, or work modifications might be required to prevent situations with insufficient audibility in hearing-impaired engineers. Practitioner summary: The audibility of the warning signals in Dutch trains was evaluated by comparing signal and noise spectra. The results showed that sufficient audibility is not always guaranteed. Under laboratory conditions, normally-hearing individuals could compensate for the suboptimal acoustic circumstances, but acoustical, environmental, or work modifications might be required to prevent situations with insufficient audibility in hearing-impaired engineers.

Classification of Hearing Aids Into Feature Profiles Using Hierarchical Latent Class Analysis Applied to a Large Dataset of Hearing Aids.

OBJECTIVES: We developed a framework for objectively comparing hearing aids, independent of brand, type, or product family. This was done using a large dataset of commercially available hearing aids. To achieve this, we investigated which hearing aid features are suitable for comparison, and are also relevant for the rehabilitation of hearing impairment. To compare hearing aids objectively, we distinguished populations of hearing aids based on a set of key hearing aid features. Finally, we describe these hearing aid subpopulations so that these could potentially be used as a supporting tool for the selection of an appropriate hearing aid. DESIGN: In this study, we used technical (meta-)data from 3911 hearing aids (available on the Dutch market in March 2018). The dataset contained about 50 of the most important characteristics of a hearing aid. After cleaning and handling the data via a well-defined knowledge discovery in database procedure, a total 3083 hearing aids were included. Subsequently, a set of well-defined key hearing aid features were used as input for further analysis. The data were split into an in-the-ear style hearing aid subset and a behind-the-ear style subset, for separate analyses. The knowledge discovery in databases procedure was also used as an objective guiding tool for applying an exploratory cluster analysis to expose subpopulations of hearing aids within the dataset. The latter was done using Latent Class Tree Analysis, which is an extension to the better-known Latent Class Analysis clustering method: with the important addition of a hierarchical structure. RESULTS: A total of 10 hearing aid features were identified as relevant for audiological rehabilitation: compression, sound processing, noise reduction (NR), expansion, wind NR, impulse (noise) reduction, active feedback management, directionality, NR environments, and ear-to-ear communication. These features had the greatest impact on results yielded by the Latent Class Tree cluster analysis. At the first level in the hierarchical cluster model, the two subpopulations of hearing aids could be divided into 3 main branches, mainly distinguishable by the overall availability or technology level of hearing aid features. Higher-level results of the cluster analysis yielded a set of mutually exclusive hearing aid populations, called modalities. In total, nine behind-the-ear and seven in-the-ear modalities were found. These modalities were characterized by particular profiles of (complex) interplay between the selected key features. A technical comparison of features (e.g., implementation) is beyond the scope of this research. CONCLUSIONS: Combining a large dataset of hearing aids with a probabilistic hierarchical clustering method enables analysis of hearing aid characteristics which extends beyond product families and manufacturers. Furthermore, this study found that the resulting hearing aid modalities can be thought of as a generic alternative to the manufacturer-dependent proprietary "concepts," and could potentially aid the selection of an appropriate hearing aid for technical rehabilitation. This study is in line with a growing need for justification of hearing aid selection and the increasing demand for evidence-based practice.

Classification of Hearing Aids Into Feature Profiles Using Hierarchical Latent Class Analysis Applied to a Large Dataset of Hearing Aids.

OBJECTIVES: We developed a framework for objectively comparing hearing aids, independent of brand, type, or product family. This was done using a large dataset of commercially available hearing aids. To achieve this, we investigated which hearing aid features are suitable for comparison, and are also relevant for the rehabilitation of hearing impairment. To compare hearing aids objectively, we distinguished populations of hearing aids based on a set of key hearing aid features. Finally, we describe these hearing aid subpopulations so that these could potentially be used as a supporting tool for the selection of an appropriate hearing aid. DESIGN: In this study, we used technical (meta-)data from 3911 hearing aids (available on the Dutch market in March 2018). The dataset contained about 50 of the most important characteristics of a hearing aid. After cleaning and handling the data via a well-defined knowledge discovery in database procedure, a total 3083 hearing aids were included. Subsequently, a set of well-defined key hearing aid features were used as input for further analysis. The data were split into an in-the-ear style hearing aid subset and a behind-the-ear style subset, for separate analyses. The knowledge discovery in databases procedure was also used as an objective guiding tool for applying an exploratory cluster analysis to expose subpopulations of hearing aids within the dataset. The latter was done using Latent Class Tree Analysis, which is an extension to the better-known Latent Class Analysis clustering method: with the important addition of a hierarchical structure. RESULTS: A total of 10 hearing aid features were identified as relevant for audiological rehabilitation: compression, sound processing, noise reduction (NR), expansion, wind NR, impulse (noise) reduction, active feedback management, directionality, NR environments, and ear-to-ear communication. These features had the greatest impact on results yielded by the Latent Class Tree cluster analysis. At the first level in the hierarchical cluster model, the two subpopulations of hearing aids could be divided into 3 main branches, mainly distinguishable by the overall availability or technology level of hearing aid features. Higher-level results of the cluster analysis yielded a set of mutually exclusive hearing aid populations, called modalities. In total, nine behind-the-ear and seven in-the-ear modalities were found. These modalities were characterized by particular profiles of (complex) interplay between the selected key features. A technical comparison of features (e.g., implementation) is beyond the scope of this research. CONCLUSIONS: Combining a large dataset of hearing aids with a probabilistic hierarchical clustering method enables analysis of hearing aid characteristics which extends beyond product families and manufacturers. Furthermore, this study found that the resulting hearing aid modalities can be thought of as a generic alternative to the manufacturer-dependent proprietary "concepts," and could potentially aid the selection of an appropriate hearing aid for technical rehabilitation. This study is in line with a growing need for justification of hearing aid selection and the increasing demand for evidence-based practice.

Correction to: Factors influencing the need for recovery in employees with hearing loss: a cross-sectional study of health administrative data.

The original publication of this article contains typographical error in Table 5, Row 2.

Factors influencing the need for recovery in employees with hearing loss: a cross-sectional study of health administrative data.

OBJECTIVE: Need for recovery is a predictor of work stress and health problems, but its underlying factors are not yet well understood. We aimed to identify hearing-related, work-related, and personal factors influencing need for recovery in hearing-impaired employees. METHODS: We retrospectively identified hearing-impaired employees (N = 294) that were referred to the Amsterdam University Medical Center between 2004 and 2019. Routinely obtained healthcare data were used, including a survey and hearing assessments. A directed acyclic graph was constructed, revealing the hypothesized structure of factors influencing need for recovery as well as the minimal set of factors needed for multiple regression analysis. RESULTS: Four variables were included in the regression analysis. In total, 46.1% of the variance in need for recovery was explained by the factors feeling that something should change at work (B = 19.01, p < 0.001), self-perceived listening effort (B = 1.84, p < 0.001), personal adaptations scale score (B = - 0.34, p < .001), and having a moderate/poor general health condition (B = 20.06, p < 0.001). Although degree of hearing loss was associated with self-perceived listening effort, the direct association between degree of hearing loss and need for recovery was not significant. CONCLUSIONS: The results suggest that the way employees perceive their hearing loss and how they cope with it directly influence need for recovery, rather than their measured degree of hearing loss. Additionally, general health condition was found to be an independent factor for need for recovery. The results should be confirmed by future, longitudinal research.

The Extended Speech Transmission Index: Predicting speech intelligibility in fluctuating noise and reverberant rooms.

The Speech Transmission Index (STI) is used to predict speech intelligibility in noise and reverberant environments. However, measurements and predictions in fluctuating noises lead to inaccuracies. In the current paper, the Extended Speech Transmission Index (ESTI) is presented in order to deal with these shortcomings. Speech intelligibility in normally hearing subjects was measured using stationary and fluctuating maskers. These results served to optimize model parameters. Data from the literature were then used to verify the ESTI-model. Model outcomes were accurate for stationary maskers, maskers with artificial fluctuations, and maskers with real life non-speech modulations. Maskers with speech-like characteristics introduced systematic errors in the model outcomes, probably due to a combination of modulation masking, context effects, and informational masking.

Ocular albinism with infertility and late-onset sensorineural hearing loss.

Ocular albinism type 1 (OA1) is caused by mutations in the GPR143 gene located at Xp22.2. The manifestations, which are due to hypopigmentation, are confined to the eyes and optic pathway. OA1 associated with late-onset sensorineural hearing loss was previously reported in a single family and hypothesized to be caused by a contiguous gene deletion syndrome involving GPR143 and the adjacent gene, TBL1X. Here, we report on a family with OA1, infertility, late-onset sensorineural hearing loss, and a small interstitial Xp microdeletion including the GPR143, TBL1X, and SHROOM2 genes. In addition, we re-examined a patient previously described with OA1, infertility and a similar Xp deletion with audiologic follow-up showing a late-onset sensorineural hearing loss. Our results raise an intriguing question about the possibility for TBL1X (absence) involvement in this type of hearing loss. However, our study cannot claim a causative relationship and more convincing evidence is needed before the hypothesis can be accepted that TBL1X could be involved in late-onset sensorineural hearing loss and that ocular albinism with late-onset sensorineural hearing loss can present itself as a contiguous gene deletion/microdeletion syndrome. The finding of infertility in all affected male patients demonstrates that this deletion, including the SHROOM2 gene, may be a potentially causative X-linked genetic factor of male infertility.

Evidence-Based Occupational Hearing Screening I: Modeling the Effects of Real-World Noise Environments on the Likelihood of Effective Speech Communication.

OBJECTIVES: The objectives of this study were to (1) identify essential hearing-critical job tasks for public safety and law enforcement personnel; (2) determine the locations and real-world noise environments where these tasks are performed; (3) characterize each noise environment in terms of its impact on the likelihood of effective speech communication, considering the effects of different levels of vocal effort, communication distances, and repetition; and (4) use this characterization to define an objective normative reference for evaluating the ability of individuals to perform essential hearing-critical job tasks in noisy real-world environments. DESIGN: Data from five occupational hearing studies performed over a 17-year period for various public safety agencies were analyzed. In each study, job task analyses by job content experts identified essential hearing-critical tasks and the real-world noise environments where these tasks are performed. These environments were visited, and calibrated recordings of each noise environment were made. The extended speech intelligibility index (ESII) was calculated for each 4-sec interval in each recording. These data, together with the estimated ESII value required for effective speech communication by individuals with normal hearing, allowed the likelihood of effective speech communication in each noise environment for different levels of vocal effort and communication distances to be determined. These likelihoods provide an objective norm-referenced and standardized means of characterizing the predicted impact of real-world noise on the ability to perform essential hearing-critical tasks. RESULTS: A total of 16 noise environments for law enforcement personnel and eight noise environments for corrections personnel were analyzed. Effective speech communication was essential to hearing-critical tasks performed in these environments. Average noise levels, ranged from approximately 70 to 87 dBA in law enforcement environments and 64 to 80 dBA in corrections environments. The likelihood of effective speech communication at communication distances of 0.5 and 1 m was often less than 0.50 for normal vocal effort. Likelihood values often increased to 0.80 or more when raised or loud vocal effort was used. Effective speech communication at and beyond 5 m was often unlikely, regardless of vocal effort. CONCLUSIONS: ESII modeling of nonstationary real-world noise environments may prove an objective means of characterizing their impact on the likelihood of effective speech communication. The normative reference provided by these measures predicts the extent to which hearing impairments that increase the ESII value required for effective speech communication also decrease the likelihood of effective speech communication. These predictions may provide an objective evidence-based link between the essential hearing-critical job task requirements of public safety and law enforcement personnel and ESII-based hearing assessment of individuals who seek to perform these jobs.

Accuracy of an internet-based speech-in-noise hearing screening test for high-frequency hearing loss: incorporating automatic conditional rescreening.

PURPOSE: To validate the accuracy of an internet-based speech-in-noise hearing screening test for high-frequency hearing loss (HFHL) 'Occupational Earcheck (OEC)' incorporating an automatic conditional rescreening, in an occupationally noise-exposed population. Secondary objectives were to assess the effects of age on test accuracy measures, and to assess the test accuracy for different degrees of HFHL. METHODS: A study was conducted on cross-sectional data of occupational audiometric examinations, including the index test OEC and reference standard pure-tone air conduction audiometry, of 80 noise-exposed workers. Sensitivity, specificity, and likelihood ratios were calculated for the OEC, after automatic conditional rescreening, for a younger and an older age group, and for two degrees of HFHL (HFHL25: PTA3,4,6 ≥ 25 dB HL, and HFHL35: PTA3,4,6 ≥ 35 dB HL, both for at least one ear). RESULTS: Test specificity for HFHL25 after a single test was 63%, and improved to 93% after the automatic conditional rescreen. Test sensitivity for HFHL25 decreased from 65% to 59%. Test sensitivity and specificity including automatic conditional rescreening for HFHL35 was 94% and 90%, respectively. The positive likelihood ratio for HFHL25 was 8.4, and for HFHL35 9.4. The negative likelihood ratio for HFHL35 was below 0.1. CONCLUSIONS: The OEC is an appropriate screening test, especially for HFHL35. Normal-hearing workers who obtained a positive test result for the first test for one or two ears, benefit from having an automatic rescreen, resulting in an improvement of the test specificity, and hence prevent unnecessary referral.

Evidence-based occupational hearing screening II: validation of a screening methodology using measures of functional hearing ability.

OBJECTIVE: Validate use of the Extended Speech Intelligibility Index (ESII) for prediction of speech intelligibility in non-stationary real-world noise environments. Define a means of using these predictions for objective occupational hearing screening for hearing-critical public safety and law enforcement jobs. DESIGN: Analyses of predicted and measured speech intelligibility in recordings of real-world noise environments were performed in two studies using speech recognition thresholds (SRTs) and intelligibility measures. ESII analyses of the recordings were used to predict intelligibility. Noise recordings were made in prison environments and at US Army facilities for training ground and airborne forces. Speech materials included full bandwidth sentences and bandpass filtered sentences that simulated radio transmissions. STUDY SAMPLE: A total of 22 adults with normal hearing (NH) and 15 with mild-moderate hearing impairment (HI) participated in the two studies. RESULTS: Average intelligibility predictions for individual NH and HI subjects were accurate in both studies (r2 ≥ 0.94). Pooled predictions were slightly less accurate (0.78 ≤ r2 ≤ 0.92). CONCLUSIONS: An individual's SRT and audiogram can accurately predict the likelihood of effective speech communication in noise environments with known ESII characteristics, where essential hearing-critical tasks are performed. These predictions provide an objective means of occupational hearing screening.

In situ Hearing Tests for the Purpose of a Self-Fit Hearing Aid.

This study investigated the potential and limitations of a self-fit hearing aid. This can be used in the "developing" world or in countries with large distances between the hearing-impaired subjects and the professional. It contains an on-board tone generator for in situ user-controlled, automated audiometry, and other tests for hearing aid fitting. Twenty subjects with mild hearing losses were involved. In situ audiometry showed a test-retest reliability (SD <3.7 dB) that compared well with the precision of diagnostic audiometry using headphones. There was good correspondence (SD <5.2 dB) with traditional pure-tone audiometry. In situ loudness scaling yielded important information about suprathreshold perception, which will have an added value for the selection of compression and the selection of maximum power output to be allowed in hearing aids.