Acceptance of internet-based hearing healthcare among adults who fail a hearing screening.

OBJECTIVE: This study measured help-seeking readiness and acceptance of existing internet-based hearing healthcare (IHHC) websites among a group of older adults who failed a hearing screening (Phase 1). It also explored the effects of brief training on participants' acceptance of IHHC (Phase 2). STUDY SAMPLE: Twenty-seven adults (age 55+) who failed a hearing screening participated. DESIGN: During Phase 1 participants were administered the University of Rhode Island Change Assessment (URICA) and patient technology acceptance model (PTAM) Questionnaire. During Phase 2 participants were randomly assigned to a training or control group. Training group participants attended an instructional class on existing IHHC websites. The control group received no training. The PTAM questionnaire was re-administered to both groups 4-6 weeks following the initial assessment. RESULTS: The majority of participants were either considering or preparing to do something about their hearing loss, and were generally accepting of IHHC websites (Phase 1). The participants who underwent brief IHHC training reported increases in hearing healthcare knowledge and slight improvements in computer self-efficacy (Phase 2). CONCLUSIONS: Older adults who fail hearing screenings may be good candidates for IHHC. The incorporation of a simple user-interface and short-term training may optimize the usability of future IHHC programs for this population.

Self-monitoring of listening abilities in normal-hearing children, normal-hearing adults, and children with cochlear implants.

BACKGROUND: Self-monitoring has been shown to be an essential skill for various aspects of our lives, including our health, education, and interpersonal relationships. Likewise, the ability to monitor one's speech reception in noisy environments may be a fundamental skill for communication, particularly for those who are often confronted with challenging listening environments, such as students and children with hearing loss. PURPOSE: The purpose of this project was to determine if normal-hearing children, normal-hearing adults, and children with cochlear implants can monitor their listening ability in noise and recognize when they are not able to perceive spoken messages. RESEARCH DESIGN: Participants were administered an Objective-Subjective listening task in which their subjective judgments of their ability to understand sentences from the Coordinate Response Measure corpus presented in speech spectrum noise were compared to their objective performance on the same task. STUDY SAMPLE: Participants included 41 normal-hearing children, 35 normal-hearing adults, and 10 children with cochlear implants. DATA COLLECTION AND ANALYSIS: On the Objective-Subjective listening task, the level of the masker noise remained constant at 63 dB SPL, while the level of the target sentences varied over a 12 dB range in a block of trials. Psychometric functions, relating proportion correct (Objective condition) and proportion perceived as intelligible (Subjective condition) to target/masker ratio (T/M), were estimated for each participant. Thresholds were defined as the T/M required to produce 51% correct (Objective condition) and 51% perceived as intelligible (Subjective condition). Discrepancy scores between listeners' threshold estimates in the Objective and Subjective conditions served as an index of self-monitoring ability. In addition, the normal-hearing children were administered tests of cognitive skills and academic achievement, and results from these measures were compared to findings on the Objective-Subjective listening task. RESULTS: Nearly half of the children with normal hearing significantly overestimated their listening in noise ability on the Objective-Subjective listening task, compared to less than 9% of the adults. There was a significant correlation between age and results on the Objective-Subjective task, indicating that the younger children in the sample (age 7-12 yr) tended to overestimate their listening ability more than the adolescents and adults. Among the children with cochlear implants, eight of the 10 participants significantly overestimated their listening ability (as compared to 13 of the 24 normal-hearing children in the same age range). We did not find a significant relationship between results on the Objective-Subjective listening task and performance on the given measures of academic achievement or intelligence. CONCLUSIONS: Findings from this study suggest that many children with normal hearing and children with cochlear implants often fail to recognize when they encounter conditions in which their listening ability is compromised. These results may have practical implications for classroom learning, particularly for children with hearing loss in mainstream settings.

Longitudinal infant speech perception in young cochlear implant users.

PURPOSE: This paper presents longitudinal case studies of children who received (cochlear implants) CIs and a controlled sample of children with normal hearing (NH). Phoneme discrimination (i.e., /sa-ma/, /a-i/, /a-u/, /u-i/, /ta-da/, /pa-ka/) was assessed prior to receiving CIs and monthly for 3 mo following CI activation. RESEARCH DESIGN: Case studies. STUDY SAMPLE: Three cochlear implant recipients and seven NH control participants were recruited through the University of Colorado Hospital and the University of Colorado, Boulder. DATA COLLECTION AND ANALYSIS: The study utilized the visual reinforcement audiometry and interactive play assessment of speech pattern contrasts (VRASPAC) algorithm. A comparison of scoring was conducted using Cohen's kappa to determine interrater reliability. RESULTS: Findings from this study revealed that CI recipients could discriminate at least three out of five phoneme contrasts at mastery level (≥90%) by 2 mo of device use. None of the CI recipients reached mastery prior to implantation. Following 3 mo of CI use there was no difference in contrast discrimination performance between the CI users and their NH age-matched peers (with the exception of /pa-ka/ for one CI user. CONCLUSIONS: The CI users in this case study, who were implanted between 12 and 16 mo of age, were able to master the phoneme contrasts regardless of bilateral or unilateral CI, socioeconomic status, or language spoken at home.

The Development of an Internet-Based Decision Coaching Guide to Encourage Audiology Care: The Results of a Participatory Design Approach.

Purpose The purpose of the research described here is to create a theoretically based, interactive online program to motivate adults with untreated hearing loss to seek audiology care. We describe the results of the participatory design (PD) approach used to increase uptake and adherence to the Internet-based program. Method Using information gathered from field experts (n = 7), a program outline was generated by the study team. In keeping with PD principles, multiple focus groups and panels consisting of persons with hearing loss (n = 26), frequent communication partners (n = 6), audiologists (n = 9), and other area experts (n = 16) revised and expanded both content and design of the program in an iterative fashion. Results The proposed program was modified multiple times based on the input of stakeholders throughout the PD process. In particular, the scope of the program shifted from focusing on self-management strategies to decision coaching regarding the choice to visit an audiologist. Other specific program content and activities were modified based on stakeholder input. Conclusions The program evolved dramatically through the influence and input of multiple stakeholders as a result of the implementation of PD principles.

Visual attention and hearing loss: past and current perspectives.

BACKGROUND: It is reasonable to expect that deaf individuals require the use of vision for purposes other than those needed by hearing persons. For example, without the use of hearing, one would need to scan the environment visually to determine if someone was approaching rather than listening for footsteps or a name being called. Furthermore, these experiential differences could alter the development of neural organization of sensory systems of deaf persons. PURPOSE: To review the evidence-based literature in the area of visual attention and deafness with an emphasis on a series of visual attention studies utilizing several paradigms including the Continuous Performance Task, the Letter Cancellation Task, the Flanker Task, and a self-designed task of target identification in the periphery under distracter and nondistracter conditions conducted at Vanderbilt University. RESEARCH DESIGN: Systematic review. RESULTS: Collectively, the Vanderbilt studies pointed to a compensatory role that the visual system plays for deaf individuals. Specifically, the visual system appears to play an important role in directing a deaf individual's attention to the near visual periphery. CONCLUSIONS: Studies of visual attention in deaf individuals have been mixed in their conclusions about whether altered neural organization results in better or worse visual attention abilities by those who are deaf relative to those with normal hearing. The notion of across-the-board deficits or enhancements in the visual function of deaf individuals is not supported by the literature, nor is there support for the idea that fundamental visual sensory abilities such as acuity or light detection differ between deaf and hearing persons.

Design Considerations for Internet-Delivered Self-Management Programs for Adults With Hearing Impairment.

PURPOSE: Hearing impairment (HI) is a chronic condition; thus, even with treatment, residual participation restrictions and activity limitations typically remain. Individuals must learn to self-manage their HI. The purpose of this research note is to review components of successful Internet-based self-management programs and to evaluate group auditory rehabilitation (AR) programs with varying content, in order to make recommendations for the design of future Internet-based self-management programs. METHOD: Effect sizes for changes in HI-specific quality of life following group AR activities from 4 published studies were calculated to determine if effect size varied systematically as a function of group activities. These findings are described using a self-management framework. RESULTS: Successful group AR activities include (a) psychosocial activities to promote role management, emotional management, and social support; (b) informational lectures and group discussion to promote education; (c) communication strategy exercises to promote self-efficacy and self-management skills; and (d) the inclusion of a frequent communication partner to promote social support and self-tailoring. CONCLUSIONS: It is recommended that future Internet-based self-management programs focus on the mechanisms of social support and education to promote learning and self-management skills. Future research will determine if these AR activities may be implemented effectively via the Internet.

The Effect of Chronological Age on the Acceptance of Internet-Based Hearing Health Care.

PURPOSE: The purpose of this article is to offer design considerations in developing Internet-based hearing health care for older adults by analyzing and discussing the relationship between chronological age, computer skills, and the acceptance of Internet-based hearing health care. METHOD: This article reports baseline data from a training study measuring the acceptance of Internet-based hearing health care. Participants (n = 26; 20 men, 6 women) were aged 55­95 years. All passed a cognitive screen and failed a hearing screen. Participants completed the Patient- Technology Acceptance questionnaire (Or, 2008). Computer literacy was measured using the Northstar Digital Literacy Assessment (Cytron-Hysom, Hadley, Vanek, Graif, & Asp, 2012). RESULTS: Computer literacy was negatively correlated with increasing age. Additional negative relationships were seen between computer literacy and computer anxiety and between computer literacy and computer self-efficacy. Finally, there was a negative relationship between computer self-efficacy and computer anxiety. CONCLUSION: These results suggest computer literacy is lower in adults of advanced age than in those who are a few years younger. Indirect relationships were observed between age and computer self-efficacy and between age and computer anxiety. Consideration should be given to addressing discrepancies in self-efficacy and computer literacy in older adults to increase the likelihood of acceptance of Internet-based hearing health care.

Visual attention in children with normal hearing, children with hearing aids, and children with cochlear implants.

Previous studies have reported both positive and negative effects of deafness on visual attention. The purpose of this study was to replicate and expand findings of previous studies by examining visual attention abilities in children with deafness and children with normal hearing. Twenty-eight children, ages 8-14 years, were evaluated. There were two groups of children with prelingual deafness and one group with normal hearing. The children with deafness were divided further into two groups: those with cochlear implants and those with conventional hearing aids. Unlike previous studies, the current study found no substantial differences in performance among these three groups of children on a continuous-performance visual attention task or on a letter cancellation task. Children in all three groups performed very well on the visual attention tasks. Furthermore, there was little association between performance on the visual attention tasks and parent or teacher ratings of behavior and attention. Age and nonverbal intelligence were significantly correlated with performance on visual attention tasks. The theoretical implications of these findings are discussed, along with directions for future research.

Responses to targets in the visual periphery in deaf and normal-hearing adults.

The purpose of this study was to compare the response times of deaf and normal-hearing individuals to the onset of target events in the visual periphery in distracting and nondistracting conditions. Visual reaction times to peripheral targets placed at 3 eccentricities to the left and right of a center fixation point were measured in prelingually deafened adults and normal-hearing adults. Deaf participants responded more slowly than normal-hearing participants to targets in the near periphery in the nondistracting condition and to targets in the near and distant periphery when distracting stimuli were present. One interpretation of these findings is that deaf individuals may be more deliberate than normal-hearing individuals in responding to near peripheral events and to peripheral events that occur in the presence of distracting stimuli.

The effect of asymmetrical signal degradation on binaural speech recognition in children and adults.

To determine the effect of asymmetrical signal degradation on binaural speech recognition, 28 children and 14 adults were administered a sentence recognition task amidst multitalker babble. There were 3 listening conditions: (a) monaural, with mild degradation in 1 ear; (b) binaural, with mild degradation in both ears (symmetric degradation); and (c) binaural, with mild degradation in one ear and severe degradation in the other ear (asymmetric degradation). Sentences and babble were degraded digitally to simulate mild and severe cochlear hearing loss. All participants demonstrated significant binaural advantage (average of 7 dB) when listening to symmetrically degraded signals as compared to when listening monaurally. In contrast, adults and children achieved little or no binaural benefit, on average, when listening to asymmetrically degraded signals. Moreover, overall performance of the adults was significantly worse when listening to binaural asymmetrically degraded signals than when listening to monaural signals, thus demonstrating evidence of binaural interference. In contrast to our original speculations, however, children did not show an overall demonstration of binaural interference. Relative performance in the binaural-asymmetric and the monaural conditions was not influenced by which ear (right or left) received the more degraded signal.

Informational masking and spatial hearing in listeners with and without unilateral hearing loss.

PURPOSE: This study assessed selective listening for speech in individuals with and without unilateral hearing loss (UHL) and the potential relationship between spatial release from informational masking and localization ability in listeners with UHL. METHOD: Twelve adults with UHL and 12 normal-hearing controls completed a series of monaural and binaural speech tasks that were designed to measure informational masking. They also completed a horizontal localization task. RESULTS: Monaural performance by participants with UHL was comparable to that of normal-hearing participants. Unlike the normal-hearing participants, the participants with UHL did not exhibit a true spatial release from informational masking. Rather, their performance could be predicted by head shadow effects. Performance among participants with UHL in the localization task was quite variable, with some showing near-normal abilities and others demonstrating no localization ability. CONCLUSION: Individuals with UHL did not show deficits in all listening situations but were at a significant disadvantage when listening to speech in environments where normal-hearing listeners benefit from spatial separation between target and masker. This inability to capitalize on spatial cues for selective listening does not appear to be related to localization ability.