Frequency importance functions in simulated bimodal cochlear-implant users with spectral holes.

Frequency importance functions (FIFs) for simulated bimodal hearing were derived using sentence perception scores measured in quiet and noise. Acoustic hearing was simulated using low-pass filtering. Electric hearing was simulated using a six-channel vocoder with three input frequency ranges, resulting in overlap, meet, and gap maps, relative to the acoustic cutoff frequency. Spectral holes present in the speech spectra were created within electric stimulation by setting amplitude(s) of channels to zero. FIFs were significantly different between frequency maps. In quiet, the three FIFs were similar with gradually increasing weights with channels 5 and 6 compared to the first three channels. However, the most and least weighted channels slightly varied depending on the maps. In noise, the patterns of the three FIFs were similar to those in quiet, with steeper increasing weights with channels 5 and 6 compared to the first four channels. Thus, channels 5 and 6 contributed to speech perception the most, while channels 1 and 2 contributed the least, regardless of frequency maps. Results suggest that the contribution of cochlear implant frequency bands for bimodal speech perception depends on the degree of frequency overlap between acoustic and electric stimulation and if noise is absent or present.

Enhancing social-emotional functioning in adolescents with developmental language disorder or deaf or hard of hearing through a Theory of Mind intervention.

BACKGROUND: This study examines the effect of a Theory of Mind (ToM) intervention on ToM abilities and social-emotional functioning in adolescents with developmental language disorder (DLD) or who are deaf/hard of hearing (D/HH). It emphasizes the importance of self-reflection and measurement for personal growth. The research design incorporates both subjective and objective measures to evaluate the intervention's efficacy. AIMS: To investigate the impact of the ToM intervention on ToM abilities and social-emotional functioning in adolescents with DLD or who are D/HH. It hypothesizes that participants in the intervention groups will show improved ToM and social-emotional functioning compared with those in the control groups. METHODS & PROCEDURES: Adolescents with DLD or who are D/HH were recruited through collaboration with educational institutions. The study utilized a pre-/post-test design, assigning participants to either the intervention or the control group. The ToM intervention involved targeted activities to enhance ToM abilities. ToM abilities and social-emotional functioning were assessed using standardized tests and self-report questionnaires. Statistical analyses compared outcomes between the intervention and no intervention groups. OUTCOMES & RESULTS: The findings reveal subjective improvements in social-emotional functioning among the D/HH intervention group. However, no significant effects on objective ToM measures were observed. These results highlight the need for further investigation and refinement of interventions in these areas. Future research should focus on improving intervention strategies and exploring additional objective measures to gain a comprehensive understanding of the intervention's impact on ToM and social-emotional functioning in this population. CONCLUSIONS & IMPLICATIONS: The ToM intervention shows subjective benefits in improving social-emotional functioning among D/HH adolescents. However, it does not yield significant effects on objective ToM measures. These findings emphasize the ongoing need to refine interventions targeting ToM abilities and social-emotional functioning in this population. Future studies should explore alternative strategies and incorporate additional objective measures to enhance understanding and outcomes. WHAT THIS PAPER ADDS: What is already known on this subject Before this study, it was known that ToM interventions have the potential to enhance ToM abilities. However, the specific effects of such interventions on subjective and objective measures for ToM and social-emotional functioning in adolescents with DLD or who are D/HH remained unclear, necessitating further research. What this paper adds to the existing knowledge This study adds to the existing knowledge by demonstrating subjective improvements in social-emotional functioning among adolescents who are D/HH and underwent a ToM intervention. However, no significant effects on objective ToM measures were observed. These findings highlight the need for refining interventions and exploring additional measures to better understand the intervention's impact. What are the potential or actual clinical implications of this work? The subjective improvements in social-emotional functioning observed in this study have important clinical implications. They suggest that ToM interventions can positively impact the social well-being of adolescents who are D/HH. However, the lack of significant effects on objective ToM measures emphasizes the need for further research and intervention refinement to address specific areas of improvement in this population.

[Improving Social Participation through Cochlear Implants for Hearing Impaired Persons? On the Ambivalence of Human-Machine-Interaction and the Importance of Psycho-Social Support]. / Mehr soziale Teilhabe für Hörgeschädigte durch Cochlea-Implantate? Zur Ambivalenz der Mensch-Maschine-Interaktion und zum Stellenwert psycho-sozialer Begleitung.

AIM OF THE STUDY: Cochlea implants help persons that suffer from deafness over time to regain hearing capacity. However, persons with CI implants experience year-long processes of adapting to technology-assisted hearing. The study highlights how people experience those processes and how they deal with changing expectations. METHODS: Within this qualitative study, 50 cochlear implant recipients were interviewed about their personal experiences with the supplying clinics. 30 persons were recruited through self-help groups; another 20 persons were recruited through a learning center for hearing-impaired persons. They were asked about their experiences in social, cultural and professional participation as well as hearing barriers they still face in everyday life after their CI fitting. Participants had been wearing CI devices for a maximum of three years. This is a timeframe when most subsequent therapies have ended. Also, the initial phase of learning to handle the CI is supposed to be over. RESULTS: The study shows that even with a cochlear implant communication barriers remain. People's expectations are not met when complete comprehension of listening during conversations is not achieved. Difficulties in dealing with a high-tech hearing prosthesis and experiencing a "foreign body" are obstacles that lower acceptance of CI. CONCLUSION: Counselling and support preparing the use of cochlea implants should be guided by realistic goals and expectations. Guided training and communication courses can help, including local care such as certified hearing aid acousticians. Those elements can increase quality and reduce uncertainty.

[Improving Social Participation through Cochlear Implants for Hearing Impaired Persons? On the Ambivalence of Human-Machine-Interaction and the Importance of Psycho-Social Support]. / Mehr soziale Teilhabe für Hörgeschädigte durch Cochlea-Implantate? Zur Ambivalenz der Mensch-Maschine-Interaktion und zum Stellenwert psycho-sozialer Begleitung.

AIM OF THE STUDY: Cochlea implants help persons that suffer from deafness over time to regain hearing capacity. However, persons with CI implants experience year-long processes of adapting to technology-assisted hearing. The study highlights how people experience those processes and how they deal with changing expectations. METHODS: Within this qualitative study, 50 cochlear implant recipients were interviewed about their personal experiences with the supplying clinics. 30 persons were recruited through self-help groups; another 20 persons were recruited through a learning center for hearing-impaired persons. They were asked about their experiences in social, cultural and professional participation as well as hearing barriers they still face in everyday life after their CI fitting. Participants had been wearing CI devices for a maximum of three years. This is a timeframe when most subsequent therapies have ended. Also, the initial phase of learning to handle the CI is supposed to be over. RESULTS: The study shows that even with a cochlear implant communication barriers remain. People's expectations are not met when complete comprehension of listening during conversations is not achieved. Difficulties in dealing with a high-tech hearing prosthesis and experiencing a "foreign body" are obstacles that lower acceptance of CI. CONCLUSION: Counselling and support preparing the use of cochlea implants should be guided by realistic goals and expectations. Guided training and communication courses can help, including local care such as certified hearing aid acousticians. Those elements can increase quality and reduce uncertainty.

An Integrative Review of Current Practice Models and/or Process of Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing.

Over the past few decades, there has been an increasing shift toward emphasizing the importance of the child's family taking an active role in the habilitation process through family-centered early intervention (FCEI) programs. Accordingly, the Health Professions Council of South Africa recommends that early intervention services following confirmation of hearing loss must be family-centered within a community-based model of service delivery that is culturally congruent. The aim of this study was to explore and document current evidence reflecting trends in FCEI for children who are deaf or hard of hearing (DHH) by identifying and describing current practice models and/or processes of FCEI for these children. This study describes our first steps in formulating a framework for FCEI for children who are DHH in South Africa. An integrative literature review was conducted. Sage, Science Direct, PubMed, and Google Scholar databases were searched for studies published in English between January 2009 and January 2019 reporting on FCEI programs for children who are DHH. Studies that focused on the following were excluded from the study: speech and language outcomes of children, youth, and adults who are DHH; education for children who are DHH; universal newborn hearing screening; professionals' roles in early hearing detection and intervention; diagnosis of hearing loss; and sign language. Kappa statistics were performed to determine agreement between reviewers. Twenty-two studies were included in the review. Cohen's kappa revealed a substantial agreement (κ = 0.8) between reviewers for data extraction and synthesis in terms of the articles that met the criteria for inclusion in the review. Findings were discussed under 5 themes: caregiver involvement; caregiver coaching/information sharing; caregiver satisfaction; challenges with FCEI; and telehealth. Generally, there is sufficient evidence for FCEI, with caregivers indicating the need for full involvement in their children's care. Methods of caregiver involvement involving caregiver coaching/information sharing need to be culturally and linguistically appropriate, with sensitivities around time and manner. This increases caregiver satisfaction with intervention programs and improves outcomes for children who are DHH. Challenges identified by the studies raise implications for early hearing detection and intervention programs, as well as Departments of Health and Social Welfare. These included logistical challenges, professional-related challenges, and caregiver-related challenges. Various aspects of FCEI have been reported in the review. Findings of these studies have significant implications for the formulation of quality FCEI programs to ensure contextually relevant and contextually responsive care of children who are DHH.

Deaf Residents With Intellectual Disabilities During the First Covid-19 Associated Lockdown.

Two indicators for stress (mood and aggressive behavior) were evaluated in order to investigate the effect of the restrictions taken against the spread of the coronavirus on people who are deaf and hard of hearing (DHH) and have intellectual disabilities (ID). In three therapeutic living communities, specifically designed for the visual communication needs of people who are DHH and have ID, the mood of the residents is routinely assessed by staff members and every aggressive incident is recorded with the Staff Observation of Aggressions Scale-Revised (SOAS-R). For the 38 residents who were present 8 weeks before the first lockdown (t1) and the following 8 weeks (t2), mood ratings and ratings of aggressive behavior were compared between the two time periods. In contrast to our hypothesis the mood ratings of the residents had a slight significant improvement, whereas the incidents and severity of aggressive behavior did not change significantly. These results suggest that with proper communicative support, individuals who are DHH and have ID can cope effectively with significant restrictions imposed by a pandemic-caused lockdown.

Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss, as Measured by the PedsQL and Health Utility Index Mark 3.

OBJECTIVES: To examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children. METHODS: Data were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots. RESULTS: Children with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement. CONCLUSIONS: Children with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss.

How Bilingualism Contributes to Healthy Development in Deaf Children: A Public Health Perspective.

The aim of this article is to increase awareness of language practices in the deaf community that affect communication needs and health outcomes, focusing particularly on the prevalence of bilingualism among deaf adults. Language deprivation and poor health outcomes in the deaf population are risks that cannot be addressed solely by hearing intervention. We propose that bilingualism acts as a protective measure to minimize the health risks faced by deaf individuals. Provision of culturally and linguistically appropriate services to deaf stakeholders, and particularly hearing families of deaf children, requires familiarity with the developmental and social ramifications of bilingualism.

Early Intervention Protocols: Proposing a Default Bimodal Bilingual Approach for Deaf Children.

Despite advances in hearing technology, a growing body of research, as well as early intervention protocols, deaf children largely fail to meet age-based language milestones. This gap in language acquisition points to the inconsistencies that exist between research and practice. Current research suggests that bimodal bilingual early interventions at deaf identification provide children language foundations that can lead to more effective outcomes. Recommendations that support implementing bimodal bilingualism at deaf identification include early intervention protocols, language foundations, and the development of appropriate bimodal bilingual environments. All recommendations serve as multifaceted tools in a deaf child's repertoire as language and modality preferences develop and solidify. This versatile approach allows for children to determine their own language and communication preferences.

American Sign Language Interpreters in Public Schools: An Illusion of Inclusion that Perpetuates Language Deprivation.

PURPOSE: Many deaf children have limited access to language, spoken or signed, during early childhood - which has damaging effects on many aspects of development. There has been a recent shift to consider deafness and language deprivation as separate but related conditions. As such, educational plans should differentiate between services related to deafness and services related to language deprivation. DESCRIPTION: Many deaf children attend mainstream public schools, and the primary service offered to students who use American Sign Language (ASL) is generally a sign language interpreter. ASSESSMENT: We argue that while sign language interpreters can be an effective accommodation for deafness (i.e., students who are deaf and not language-deprived), there is no reason to believe they are an effective accommodation for language deprivation (i.e., students who are deaf and language-deprived). CONCLUSION: Using interpreters instead of appropriate educational supports may exacerbate symptoms of language deprivation by prolonging the period of time a child goes with limited access to language.

Development of the Hong Kong Sign Language Sentence Repetition Test.

This paper presents the design and development of the Hong Kong Sign Language-Sentence Repetition Test (HKSL-SRT). It will be argued that the test offers evidence of discriminability, reliability, as well as practicality and can serve as an effective global measurement of individuals' proficiency in HKSL. The full version of the test consists of 40 signed sentences of increasing length and complexity. Specifically, we will evaluate the manual and non-manual components of these sentences to find out whether and to what extent they can differentiate three groups of deaf signers, namely, native signers, early learners and late learners. Statistical analyses show that the test scores based on a correct repetition of the manual signs of each sentence bear a significant negative correlation with signers' age of acquisition. Including the correct repetition of non-manuals in the scoring scheme can result in higher reliability and separation index of the test in the Rasch model. This paper will also discuss how psychometric measures of Rasch analysis, including the concept of fit and the rankings of items/persons in the Wright map, have been applied to the original list of the 40 sentence items for the development of a shortened test.

Lived Experience: Deaf Professionals' Stories of Resilience and Risks.

Navigating a phonocentric and audistic society can be challenging for Deaf people, yet some of them adapt and exhibit resilience. Although there is a plethora of resilience studies, Deaf people's narratives are largely unexplored. This phenomenological study explored from a Deaf cultural-linguistic lens 10 Deaf professionals who use American Sign Language in the United States and their observation of other Deaf people's lived experience. The study focused particularly on their experiences in overcoming significant barriers in their lives and the factors that strengthen Deaf people's resilience. Based on qualitative data gathered from narrative interviews, three main themes emerged from this study: (a) Barriers to Incidental Learning: The Dinner Table Syndrome; (b) Importance of Family Involvement; and (c) Protective Role of the Deaf Community as a Second Family. The stories in this study highlight how Deaf professionals and other Deaf people navigate barriers and manifest resilience.

The Audibility of Low Vision Devices with Speech Output Used by Older Adults with Dual Sensory Impairment.

SIGNIFICANCE: The successful uptake, integration, and use of vision rehabilitation devices with speech output depend to a large part on their audibility. However, individuals with combined vision and hearing impairments are at a disadvantage when using devices that do not consider multiple impairments. PURPOSE: Sensory rehabilitation for individuals with combined vision and hearing impairment often relies on the use of assistive technology devices that use speech outputs (e.g., talking clock), but in individuals with dual impairment, their use is likely compromised by a concurrent hearing loss. The goal of this study was to evaluate the audibility of these devices in a population of individuals with acquired dual sensory impairment. METHODS: We measured the ability to correctly repeat speech output presented by three assistive technology devices (talking watch, calculator, scanner) and confidence levels in response accuracy in 24 participants with visual impairment only and in 22 individuals with dual sensory loss. Stimuli were presented at three volumes that were repeated one or four times. Participants were placed at a fixed distance of 74 cm from the sound source. RESULTS: The pattern of results was similar across the different devices, whereby an interaction of volume and repetition indicated that participants' accuracy to repeat a phrase and their confidence in their response improved with increasing volume, but more so at higher numbers of repetition (P < .05; ω, from 0.005 to 0.298). Participants with dual sensory loss generally had lower accuracy and confidence. CONCLUSIONS: Scores and confidence levels being very low across devices and users suggest that even participants with normal hearing for their age experienced a certain level of difficulty understanding speech output, confirming the need for better assistive technology device design.

Binaural hearing is impaired in children with hearing loss who use bilateral hearing aids.

This paper asked whether children fitted with bilateral hearing aids (BHA) develop normal perception of binaural cues which are the basis of spatial hearing. Data from children with BHA (n = 26, age = 12.6 ± 2.84 years) were compared to data from a control group (n = 12, age = 12.36 ± 2.83 years). Stimuli were 250 Hz click-trains of 36 ms and a 40 ms consonant-vowel /da/ at 1 Hz presented through ER3A insert-earphones unilaterally or bilaterally. Bilateral stimuli were presented at different interaural level difference (ILD) and interaural timing difference (ITD) conditions. Participants indicated whether the sound came from the left or right side (lateralization) or whether one sound or two could be heard (binaural fusion). BHA children lateralized ILDs similarly to the control group but had impaired lateralization of ITDs. Longer response times relative to controls suggest that lateralization of ITDs was challenging for children with BHA. Most, but not all, of the BHA group were able to fuse click and speech sounds similarly to controls. Those unable to fuse showed particularly poor ITD lateralization. Results suggest that ITD perception is abnormal in children using BHAs, suggesting persistent effects of hearing loss that are not remediated by present clinical rehabilitation protocols.

What do hearing healthcare professionals do to promote hearing aid use and benefit among adults? A systematic review.

OBJECTIVE: To conduct a systematic review of the evidence in relation to what hearing healthcare professionals do during hearing aid consultations and identifying which behaviours promote hearing aid use and benefit among adult patients. DESIGN: Searches were performed in electronic databases MEDLINE, EMBASE, CINAHL, PsycInfo, Web of Science, PubMed and Google Scholar. The Crowe Critical Appraisal Tool and Melnyk Levels of Evidence were used to assess quality and level of evidence of eligible studies. Behaviours of hearing healthcare professionals were summarised descriptively. STUDY SAMPLE: 17 studies met the inclusion criteria. RESULTS: Twelve studies described behaviours of audiologists and five studies were intervention studies. Audiologists were typically task- or technically-oriented and/or dominated the interaction during hearing aid consultations. Two intervention studies suggested that use of motivational interviewing techniques by audiologists may increase hearing aid use in patients. CONCLUSIONS: Most studies of clinicians' behaviours were descriptive, with very little research linking clinician behaviour to patient outcomes. The present review sets the research agenda for better-controlled intervention studies to identify which clinician behaviours better promote patient hearing aid outcomes and develop an evidence base for best clinical practice.

Individualised active communication education (I-ACE): another clinical option for adults with hearing impairment with a focus on problem solving and self-management.

Objective: This clinical note describes the Individualised - Active Communication Education (I-ACE) programme designed to improve problem solving and self-management in adults with hearing impairment. Design: The I-ACE was offered to adult clients seeking help for the first time and effects were measured for participants using self-report questionnaires: the Client Oriented Scale of Improvement (goal attainment), the Hearing Handicap Questionnaire (hearing disability), and the International Outcome Inventory - Alternative Interventions (outcomes) immediately after programme completion and 3 months later. Participants also provided qualitative feedback about I-ACE. Study sample: Twenty-three participants completed I-ACE, with 22 completing all self-report questionnaires and 23 participants providing qualitative feedback. Results: The participants reported positive outcomes and goal attainment, but no change in hearing disability post-programme. The effects were maintained 3 months later. Qualitative feedback indicated that I-ACE supported participants in recognising and increasing awareness of their hearing difficulties and in developing potential solutions to these difficulties. Participants also enjoyed the opportunity to involve communication partners. Conclusion: I-ACE is an appropriate option for adults with hearing impairment who wish to become more aware of their hearing difficulties and how to solve them.

Long-term subjective loneliness in adults after hearing loss treatment.

Objective: While hearing loss is associated with loneliness, the long term impact of hearing loss interventions remains unknown. We investigated levels of loneliness in adults at baseline, 6-months, 1-year and 5-years after receiving a hearing aid (HA) or cochlear implant (CI). Design: In this 5-year follow-up to the Studying Multiple Outcomes after Aural Rehabilitative Treatment study, participants completed the University of California, Los Angeles (UCLA) Loneliness Scale at baseline, 6-months, 1-year, and 5-year time points. Generalized estimating equations modeled the population average UCLA score over time. Study Sample: Analytic cohort of 115 participants (74% of original 156) 50 years or older who received a HA or CI at baseline and completed at least one follow up visit. Results: Loneliness scores were not different at 5 years versus baseline for HA users. CI users showed significantly reduced loneliness at 6-months and 1-year from baseline and with no significant difference at 5 years. Conclusion: Over 5 years, we observed no increase in loneliness from baseline in a cohort of adults receiving HAs and CIs. Short-term reduction in loneliness in CI users was demonstrated. Future randomized trials are needed to definitively assess the impact of treated versus untreated hearing loss on loneliness.

A systematic narrative synthesis of acute amplification-induced improvements in cognitive ability in hearing-impaired adults.

Objective: This systematic review investigated if hearing aid use was associated with acute improvements in cognitive function in hearing-impaired adults. Design: The review question and inclusion/exclusion criteria were designed using the Population, Intervention, Control, Outcomes, and Study design (PICOS) mnemonic. The review was pre-registered in the International Prospective Register of Systematic Review (PROSPERO) and performed in accordance with the statement on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Study sample: Thirteen articles, of various designs, published between 1990 and 2018, were identified via a search of five electronic databases. Results: Most studies reported 1-2 cognitive outcome measures. Nine studies reported a significant improvement in outcome and four studies reported no significant change. None of the 13 studies received a high score on a quality assessment checklist. Due to concerns over risk of bias and indirectness, the overall quality of evidence was graded as low. Conclusions: Only a few studies were identified, some of which report a small improvement in cognitive outcome; however, the overall quality of evidence was low. Further research is very likely to have an important impact on our confidence in answering the review question.

Beyond motivation: identifying targets for intervention to increase hearing aid use in adults.

OBJECTIVE: The present study investigated: (a) how motivated patients are to use their hearing aid, and (b) whether post-motivational variables (e.g. action planning, coping planning) have anything to offer in terms of developing interventions to boost hearing aid use. DESIGN: participants completed a questionnaire designed to tap Health Action Process Approach constructs prior to their hearing aid prescription and fitting. STUDY SAMPLE: Sixty-seven patients attending NHS audiology clinics. RESULTS: Participants reported very strong intentions to use hearing aids (Median = 7.00 Q1 and Q3 = 6.67, 7.00, on a +1 to +7 scale) and high self-efficacy (Median = 7.00, Q1 and Q3 = 6.00, on a +1 to +7 scale) leaving little room for improvement. In contrast, participants reported moderate levels of post-motivational variables (action planning Median = 4.25, Q1 and Q3 = 1.13, 7.00 and coping planning Median = 2.75, Q1 and Q3 = 1.00, both measured on +1 to +7 scales) thereby showing significant scope for change. CONCLUSIONS: Future interventions to increase hearing aid use should focus on ensuring that patients' motivation is translated into action, rather than further trying to boost motivation.

Reported benefits of peer support group involvement by adults with hearing loss.

OBJECTIVE: The purpose of this study was to better understand the benefits of self-help group involvement by adults with hearing loss. DESIGN: A secondary content analysis of interview transcripts of participants from a previous study on the impact of stigma on help-seeking was carried out. STUDY SAMPLE: Ten members (aged 55-76 years) of self-help groups for persons with hearing loss in the United States of America and Canada participated in the interviews. RESULTS: Three themes describing the benefits of self-help group participation emerged: (1) Practical and accessible information about hearing loss; (2) Social belonging leading to personal transformation; and (3) A new and mutually beneficial direction. CONCLUSIONS: The findings are discussed in relation to the "helper therapy principle", as well as group audiological rehabilitation.