The Otology Questionnaire Amsterdam: a generic patient reported outcome measure about the severity and impact of ear complaints. A cross-sectional study on the development of this questionnaire.

OBJECTIVE: Development of the 'Otology Questionnaire Amsterdam' (OQUA), a patient reported outcome measure (PROM), measuring the severity and impact of ear complaints of patients visiting an ENT surgeon. DESIGN: Multicenter, cross-sectional study. Phase 1: qualitative research. In-depth interviews (N = 16) to identify relevant types of ear complaints and to formulate items. Pilot study of the first and second draft of the OQUA (N = 32, N = 39). Phase 2: quantitative research. Field-testing of the OQUA (N = 352). Item reduction based on inter-item correlation, factor analysis and expert opinion. SETTING: Two secondary and two tertiary ENT clinics. PARTICIPANTS: Patients over the age of sixteen visiting an ENT surgeon with an ear complaint. MAIN OUTCOME MEASURES: Phase 1: meaning units and frequency of selected descriptions. Phase 2: inter-item correlation, factor loading and Cronbach's Alpha (α). RESULTS: Phase 1: eight relevant types of ear complaints were identified: earache, pressure in ear, hearing loss, tinnitus, otorrhoea, itch, dizziness and loss of taste. Phase 2: factor analysis generated a factor 'impact' (α = 0.913). The current version of the OQUA consists of 34 items, covers eight types of ear complaints and consists of two constructs: complaints and impact. CONCLUSION: The OQUA is a generic, otologic PROM designed to evaluate the severity of ear complaints and their impact on patients lives.

Psychosocial health of cochlear implant users compared to that of adults with and without hearing aids: Results of a nationwide cohort study.

OBJECTIVES: This study aimed to examine the psychosocial health status of adult cochlear implant (CI) users, compared to that of hearing aid (HA) users, hearing-impaired adults without hearing aids and normally hearing adults. DESIGN: Cross-sectional observational study, using both self-reported survey data and a speech-in-noise test. SETTING: Data as collected within the Netherlands Longitudinal Study on Hearing (NL-SH) between September 2011 and June 2016 were used. PARTICIPANTS: Data from 1254 Dutch adults (aged 23-74), selected in a convenience sample design, were included for analyses. MEAN OUTCOME MEASURES: Psychosocial health measures included emotional and social loneliness, anxiety, depression, distress and somatisation. Psychosocial health, hearing status, use of hearing technology and covariates were measured by self-report; hearing ability was assessed through an online digit triplet speech-in-noise test. RESULTS: After adjusting for the degree of hearing impairment, HA users (N = 418) and hearing-impaired adults (N = 247) had significantly worse scores on emotional loneliness than CI users (N = 37). HA users had significantly higher anxiety scores than CI users in some analyses. Non-significant differences were found between normally hearing (N = 552) and CI users for all psychosocial outcomes. CONCLUSIONS: Psychosocial health of CI users is not worse than that of hearing-impaired adults with or without hearing aids. CI users' level of emotional loneliness is even lower than that of their hearing-impaired peers using hearing aids. A possible explanation is that CI patients receive more professional and family support, and guidance along their patient journey than adults who are fitted with hearing aids.

The relationship between hearing status and the participation in different categories of work: demographics.

OBJECTIVE: To investigate the association between hearing status, socioeconomic status and work status. PARTICIPANTS: Cross-sectional data of 18-64 year old participants (N=1888) from the National Longitudinal Study on Hearing (NL-SH) were used. Both normal hearing and hearing impaired subjects participated. METHODS: Hearing ability in noise was measured with the National Hearing test, an online speech-in-noise test. Educational level, monthly income, being primary income earner and working status (i.e. paid employment, unemployed and looking for work, unfit for work, voluntary work, household work, being a student, or taking early retirement, and the type of work contract) were assessed with a questionnaire. Logistic regression analyses were applied. RESULTS: Participants with poorer hearing ability were less likely to be found in the upper categories of educational level and income, having paid work > 12 hours per week, being a student, or taking early retirement. On the other hand they were more likely to look for work or to be unfit for work. No associations were found with voluntary work and household work. DISCUSSION: Hearing ability seems to be related to both socioeconomic status and being employed. Our findings underline the importance of rehabilitation programs in audiology, aimed at supporting people with hearing impairment to help them to successfully enter or re-enter the workforce.

Adult hearing screening: follow-up and outcomes1.

PURPOSE: To screen hearing and evaluate outcomes in community-dwelling older adults. METHOD: Three thousand and twenty-five adults responded to an invitation to be screened by questionnaire, otoscopy, and pure-tone audiometry. Pure-tone average (PTA) >35 dB HL in the worse ear, unilateral hearing loss, or otoscopic findings were the criteria for referral for services. A questionnaire related to compliance with referral recommendations was completed by telephone interview for 160 randomly selected participants after 1-2 years from referral. RESULTS: The referral rate for audiologic/hearing aid evaluation was 46%, and referral for cerumen removal/medical evaluation was 17%. Of the people referred for audiologic/hearing aid evaluation, 18% tried a hearing aid; 2 years later, 11% were using a hearing aid. Screening recommendations affected participants' decision to seek help. Study participants stated that the screening was helpful, it should be offered to everybody, and they would participate in future screenings. CONCLUSION: Although adult hearing screening offered timely identification of hearing loss for adults seeking help, follow-up with hearing aid treatment was low.

A proposal for a model to calculate hearing disability.

The present paper presents an alternative method to calculate hearing disability. As opposed to existing models to calculate hearing disability, the present method is not just based on the pure-tone audiogram. Hearing activities playing an important role in daily listening are taken into account: detection of sounds, distinction of sounds, intelligibility in quiet and in noise, auditory localization. Psycho-acoustical tests to measure each of these activities are described. Test scores are used to calculate overall hearing disability. A comparison is made between the present model and the method of the American Medical Association (AMA). Calculations are based on theoretical cases only. Further study has to be undertaken to verify the calculations by examining the scores of real cases to improve the validity and internal consistency of the present model.

Guidelines for choosing a self-report outcome measure.

A table of available self-report inventories used throughout the world is provided with references for obtaining necessary psychometric data for research or clinical applications. Considerations for choosing an inventory (reliability, validity, and content appropriateness) are discussed and issues related to group versus single-subject applications examined. It is preferable that translation and revalidation of existing outcome measures be considered above developing new ones for international application.

The self-reported handicapping effect of hearing disabilities.

This study investigates the extent to which individuals see themselves as being handicapped by a hearing disability. Self-reports were obtained with the Amsterdam Inventory for Auditory Disability and Handicap which distinguishes five basic disabilities: intelligibility in noise, intelligibility in quiet, localization of sounds, distinction of sounds and detection of sounds. Responses of 239 hearing-impaired people with varying types of hearing loss have been examined. The occurrence of the five disabilities in the population as well as the self-reported limiting and annoying effect per disability has been examined. This study shows that the handicapping effects of the disabilities do not have equal weights. Handicap resulting from the inability to understand speech in noise is most strongly felt. This paper argues that the type of disability jointly determines the severity of a person's handicap.

Assessing aspects of auditory handicap by means of pupil dilatation.

The demand on extra effort and concentration during listening are notorious handicapping effects of hearing impairment as is shown by self-assessment studies. In an attempt to explore new ways of assessing hearing handicap, the present study focuses on an objective measure of mental effort during listening. Pupil dilatation is used as the index of mental effort. Results for 14 hearing-impaired and 14 normal hearing listeners show a relation between pupil dilatation and difficulty in speech reception in noise, as manipulated by the speech-to-noise ratio. In addition the study shows that, with regard to effort and concentration, hearing-impaired subjects benefit less than normals from easier listening situations (e.g. at 5 dB above the individual speech-reception threshold). The results show a significant correlation between self-rated handicap and pupil dilatation.

The relationships between self-reported hearing disability and measures of auditory disability.

Although required for many practical purposes, adequate measures of hearing disability are not yet available. In an attempt to identify a set of performance tests for predicting hearing disability in daily life the relationship between self-reported disability scores and measures of auditory disability was examined. The Amsterdam Inventory was completed by 51 respondents aged 30 to 70 years who also performed on various tests. Earlier factor analysis of the inventory scores resulted in the distinction of five aspects of auditory disability. Stepwise multiple regression analysis in the present study shows that the tests describe and differentiate quite well between these five aspects. Multiple correlation coefficients range from R = 0.60 to R = 0.74.

Factors in subjective hearing disability.

This report describes an approach to identify different factors in hearing disability. On the basis of interviews and case studies, the Amsterdam Inventory for Auditory Disability and Handicap was developed. It consists of 30 questions, dealing with a variety of everyday listening situations. Reports of 274 hearing-impaired subjects are presented. Item and factor analysis on the questions resulted in five factors, interpreted as five basic auditory disabilities: distinction of sounds, intelligibility in noise, auditory localization, intelligibility in quiet and detection of sounds. Investigation of one excluded item showed that 'intolerance of noise' may be a sixth aspect.