Challenges and opportunities for telehealth assessment during COVID-19: iT-RES, adapting a remote version of the test for rating emotions in speech.

OBJECTIVE: COVID-19 social isolation restrictions have accelerated the need to adapt clinical assessment tools to telemedicine. Remote adaptations are of special importance for populations at risk, e.g. older adults and individuals with chronic medical comorbidities. In response to this urgent clinical and scientific need, we describe a remote adaptation of the T-RES (Oron et al. 2020; IJA), designed to assess the complex processing of spoken emotions, based on identification and integration of the semantics and prosody of spoken sentences. DESIGN: We present iT-RES, an online version of the speech-perception assessment tool, detailing the challenges considered and solution chosen when designing the telehealth tool. We show a preliminary validation of performance against the original lab-based T-RES. STUDY SAMPLE: A between-participants design, within two groups of 78 young adults (T-RES, n = 39; iT-RES, n = 39). RESULTS: i-TRES performance closely followed that of T-RES, with no group differences found in the main trends, identification of emotions, selective attention, and integration. CONCLUSIONS: The design of iT-RES mapped the main challenges for remote auditory assessments, and solutions taken to address them. We hope that this will encourage further efforts for telehealth adaptations of clinical services, to meet the needs of special populations and avoid halting scientific research.

The French Cochlear Implant Registry (EPIIC): Cochlear implant candidacy assessment of off-label indications.

OBJECTIVE: Evaluate in France the outcomes of cochlear implantation outside the selection criteria, off-label. MATERIAL AND METHODS: This is a prospective cohort study including adults and children having received a cochlear implant (CI) in an off-label indication, that is outside the criteria established by the "Haute Autorité de santé (HAS)" in 2012. The data was collected from the "EPIIC" registry on recipients who received CIs in France between 2011 and 2014. Speech audiometry was performed at 60dB preimplantation and after one year of CI use, as well as an evaluation of the scores of the quality of life with the APHAB questionnaire, the scores for CAP and the professional/academic status in pre- and post-implantation conditions. Major and minor complications at surgery have been recorded. RESULTS: In total, 590 patients (447 adults and 143 children) with an off-label indication for CIs were included in this study from the EPIIC registry (11.7% of the whole cohort of EPIIC). For adults, the median percentage of comprehension using monosyllabic word lists was 41% in preimplantation condition versus 53% after one year of CI use (P<0.001) and 60% versus 71% in dissyllabic word lists (P<0.001). The CAP scores were 5 versus 6 in pre- and post-implantation conditions respectively (P<0.001) and the APHAB scores were statistically lower after implantation (P<0.001). In the children cohort, the median percentage of comprehension using monosyllabic word lists was 51% in preimplantation condition and 65% after CI (P<0.001), and 48% versus 82% (P<0.001) for dissyllabic word lists. The CAP scores were 5 versus 7 respectively in pre- and post-CI conditions (P<0.001). Thirty-two minor complications (5.4%) and 17 major complications (2.8%) were reported in our panel of off-label indication patients. CONCLUSION: These results suggest that a revision of the cochlear implantation candidacy criteria is necessary to allow more patients with severe or asymmetric hearing loss to benefit from a CI when there is an impact on quality of life despite the use of an optimal hearing aid.

Assessment of Hidden Hearing Loss in Normal Hearing Individuals with and Without Tinnitus.

OBJECTIVES: To evaluate the functions of cochlear structures and the distal part of auditory nerve as well as dead regions within the cochlea in individuals with normal hearing with or without tinnitus by using electrophysiological tests. MATERIALS AND METHODS: Nine individuals (ages: 21-59 years) with normal hearing with tinnitus were included in the study group. Thirteen individuals (ages: 25-60 years) with normal hearing without tinnitus were included in the control group. Immitancemetric examination, pure-tone audiometry (125Hz-16kHz), speech audiometry in quiet and noise environments, transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), threshold equalizing noise (TEN test (500Hz-4kHz), and ECochG tests, Beck Depression Questionnaire, Tinnitus Handicap Questionnaire, and Visual Analog Scale were performed. RESULTS: In the study group, three patients were found to have a minimal depression and six were found to have a mild depression. In pure-tone audiometry, the threshold (6-16 kHz) in the study group was significantly higher than that of the control group at all frequencies. In the study group, lower performance scores were obtained in speech discrimination in noise in both ears. In the control group, no dead region was detected in the TEN test whereas 75% of subjects in the study group had dead regions. DPOAE and TEOAE responses between study and control group subjects were not different. In the ECochG test, subjects in the study group showed an increase in the summating potential/action potential (SP/AP) ratio in both ears. CONCLUSION: Determination of the SP/AP ratio in patients with tinnitus may be useful in diagnosing hidden hearing loss. Detection of dead regions in 75% of patients in the TEN test may indicate that inner hair cells may be responsible for tinnitus.

Systematic Audiological Assessment of Auditory Functioning in Patients With Parkinson's Disease.

Purpose Alterations in primary auditory functioning have been reported in patients with Parkinson's disease (PD). Despite the current findings, the pathophysiological mechanisms underlying these alterations remain unclear, and the effect of dopaminergic medication on auditory functioning in PD has been explored insufficiently. Therefore, this study aimed to systematically investigate primary auditory functioning in patients with PD by using both subjective and objective audiological measurements. Method In this case-control study, 25 patients with PD and 25 age-, gender-, and education-matched healthy controls underwent an audiological test battery consisting of tonal audiometry, short increment sensitivity index, otoacoustic emissions (OAEs), and speech audiometry. Patients with PD were tested in the on- and off-medication states. Results Increased OAE amplitudes were found when patients with PD were tested without dopaminergic medication. In addition, speech audiometry in silence and multitalker babble noise demonstrated higher phoneme scores for patients with PD in the off-medication condition. The results showed no differences in auditory functioning between patients with PD in the on-medication condition and healthy controls. No effect of disease stage or motor score was evident. Conclusions This study provides evidence for a top-down involvement in auditory processing in PD at both central and peripheral levels. Most important, the increase in OAE amplitude in the off-medication condition in PD is hypothesized to be linked to a dysfunction of the olivocochlear efferent system, which is known to have an inhibitory effect on outer hair cell functioning. Future studies may clarify whether OAEs may facilitate an early diagnosis of PD.

Assessment of speech recognition abilities in quiet and in noise: a comparison between self-administered home testing and testing in the clinic for adult cochlear implant users.

Self speech recognition tests in quiet and noise at home are compared to the standard tests performed in the clinic. Potential effects of stimuli presentation modes (loudspeaker or audio cable) and assessment (clinician or self-assessment at home) on test results were investigated. Speech recognition in quiet was assessed using the standard Dutch test with monosyllabic words. Speech recognition in noise was assessed with the digits-in-noise test. Sixteen experienced CI users (aged between 44 and 83 years) participated. No significant difference was observed in speech recognition in quiet between and presentation modes. Speech recognition in noise was significantly better with the audio cable than with the loudspeaker. There was no significant difference in speech recognition in quiet at 65 dB and in speech recognition in noise between self-assessment at home and testing in the clinic. At 55 dB, speech recognition assessed at home was slightly but significantly better than that assessed in the clinic. The results demonstrate that it is feasible for experienced CI users to perform self-administered speech recognition tests at home. Self-assessment by CI users of speech recognition in quiet and noise within the home environment could serve as an alternative to the tests performed in the clinic.

Audiological Assessment of Word Recognition Skills in Persons With Aphasia.

PURPOSE: The purpose of this study was to evaluate the ability of persons with aphasia, with and without hearing loss, to complete a commonly used open-set word recognition test that requires a verbal response. Furthermore, phonotactic probabilities and neighborhood densities of word recognition errors were assessed to explore potential underlying linguistic complexities that might differentially influence performance among groups. METHOD: Four groups of adult participants were tested: participants with no brain injury with normal hearing, participants with no brain injury with hearing loss, participants with brain injury with aphasia and normal hearing, and participants with brain injury with aphasia and hearing loss. The Northwestern University Auditory Test No. 6 (NU-6; Tillman & Carhart, 1966) was administered. Those participants who were unable to respond orally (repeating words as heard) were assessed with the Picture Identification Task (Wilson & Antablin, 1980), permitting a picture-pointing response instead. Error patterns from the NU-6 were assessed to determine whether phonotactic probability influenced performance. RESULTS: All participants with no brain injury and 72.7% of the participants with aphasia (24 out of 33) completed the NU-6. Furthermore, all participants who were unable to complete the NU-6 were able to complete the Picture Identification Task. There were significant group differences on NU-6 performance. The 2 groups with normal hearing had significantly higher scores than the 2 groups with hearing loss, but the 2 groups with normal hearing and the 2 groups with hearing loss did not differ from one another, implying that their performance was largely determined by hearing loss rather than by brain injury or aphasia. The neighborhood density, but not phonotactic probabilities, of the participants' errors differed across groups with and without aphasia. CONCLUSIONS: Because the vast majority of the participants with aphasia examined could be tested readily using an instrument such as the NU-6, clinicians should not be reticent to use this test if patients are able to repeat single words, but routine use of alternative tests is encouraged for populations of people with brain injuries.

Development and evaluation of the British English coordinate response measure speech-in-noise test as an occupational hearing assessment tool.

OBJECTIVE: The studies described in this article outline the design and development of a British English version of the coordinate response measure (CRM) speech-in-noise (SiN) test. Our interest in the CRM is as a SiN test with high face validity for occupational auditory fitness for duty (AFFD) assessment. DESIGN: Study 1 used the method of constant stimuli to measure and adjust the psychometric functions of each target word, producing a speech corpus with equal intelligibility. After ensuring all the target words had similar intelligibility, for Studies 2 and 3, the CRM was presented in an adaptive procedure in stationary speech-spectrum noise to measure speech reception thresholds and evaluate the test-retest reliability of the CRM SiN test. STUDY SAMPLE: Studies 1 (n = 20) and 2 (n = 30) were completed by normal-hearing civilians. Study 3 (n = 22) was completed by hearing impaired military personnel. RESULTS: The results display good test-retest reliability (95% confidence interval (CI) < 2.1 dB) and concurrent validity when compared to the triple-digit test (r ≤ 0.65), and the CRM is sensitive to hearing impairment. CONCLUSION: The British English CRM using stationary speech-spectrum noise is a "ready to use" SiN test, suitable for investigation as an AFFD assessment tool for military personnel.

Speech audiometric assessment of informational masking.

BACKGROUND: In communication situations with multiple speakers, speech recognition is adversely affected by energetic masking (EM) and informational masking (IM). IM characterizes masking effects caused by irrelevant information from competing speakers. This work investigates an approach to assess IM based on the Oldenburg Sentence Test (OLSA). Furthermore, the influence of interaural time differences (ITD) and aging effects on IM are considered. MATERIALS AND METHODS: IM was measured by superimposing two sentences from the OLSA. The beginning of the target sentence was indicated by the keyword "Stefan". To segregate between target and masker sentences, ITDs from 50 to 400 µs were included. The participants were asked to selectively attend to the target sentence and repeat the spoken words. Potential factors associated with speech recognition results were assessed by an auditory measure of temporal fine structure and a neuropsychological profile. The study comprised 16 normal-hearing listeners between 18 and 77 years of age. RESULTS: Despite the clinically normal hearing participants, the analysis showed a significant relationship between speech recognition outcome and pure tone thresholds. All participants benefited from small ITDs between the target and masker sentence with regard to the unmasking of IM. The magnitude of unmasking could not be explained by any of the factors assessed in this study. Error analysis and the comparison with the literature reveal that the OLSA could be a useful tool to assess IM. Also in line with the current literature is the relationship between speech recognition outcome and pure tone thresholds, as well as the strong effect of ITDs on the release from IM. CONCLUSION: Speech audiometric assessment of IM is of high relevance with regard to everyday communication situations. Due to its structure, the OLSA seems to be a useful tool for determining IM.

[Speech audiometric assessment of informational masking. German version]. / Sprachaudiometrische Erfassung von "informational masking".

BACKGROUND: In communication situations with multiple speakers, speech recognition is adversely affected by energetic masking (EM) and informational masking (IM). IM characterizes masking effects caused by irrelevant information from competing speakers. This work investigates an approach to assess IM based on the Oldenburg Sentence Test (OLSa). Furthermore, the influence of interaural time differences (ITD) and aging effects on IM are considered. MATERIALS AND METHODS: IM was measured by superimposing two sentences from the OLSa. The beginning of the target sentence was indicated by the keyword "Stefan". To segregate between target and masker sentences, ITDs from 50 to 400 µs were included. The participants were asked to selectively attend to the target sentence and repeat back the spoken words. Potential factors associated with speech recognition results were assessed by an auditory measure of temporal fine structure and a neuropsychological profile. 16 normal-hearing listeners between 18 and 77 years of age participated in the study. RESULTS: Despite the clinically normal-hearing participants, the analysis showed a significant relationship between speech recognition outcome and pure-tone thresholds. All participants benefited from small ITDs between the target and masker sentence with regard to the unmasking of IM. The magnitude of unmasking could not be explained by any of the factors assessed in this study. Error analysis and the comparison to the literature reveal that the OLSa could be a useful tool to assess IM. Also in line with the current literature is the relationship between speech recognition outcome and pure-tone thresholds, as well as the strong effect of ITDs on the release from IM. CONCLUSION: Speech audiometric assessment of IM is of high relevance with regard to everyday communication situations. Due to its structure, the OLSa seems to be a useful tool for determining IM.

[Speech audiometry in expert assessment of hearing impairment]. / Sprachaudiometrie in der Begutachtung des Hörvermögens.

In the assessment process of hearing impairment the medical expert has to verify its causality and to quantify its severity as hearing loss in percentage. Based on the determined hearing loss in percentage, the degree of impairment/disability or, in the case of work-related noise-induced hearing loss, the reduction in earning capacity is estimated. In Germany the guideline for the expert assessment of work-related noise-induced hearing loss is the Königstein Guideline. Currently, the 5th edition from 2012 is used. Here, the hearing loss quantification depends mainly on the results of speech audiometry. Based on the Freiburg speech test, the hearing loss in percentage is determined using approved tables. For patients with a mild hearing loss, typically characterized by a high-frequency hearing loss, tone audiometry results are consulted additionally. Speech-in-noise tests are available and are frequently used to measure the benefit of hearing systems. They allow for the detection of these patients' hearing impairment, which generally occurs in noisy environments. The first suggestions for a table to determine hearing loss in noise in percent are available. In experimental studies it was shown that tests in quiet, other than the Freiburg speech test, can be used and the same tables can be applied. In this article the current use of speech audiometry for expert assessment is presented, and options of using further developed speech test material are discussed.

Reference-Free Assessment of Speech Intelligibility Using Bispectrum of an Auditory Neurogram.

Sensorineural hearing loss occurs due to damage to the inner and outer hair cells of the peripheral auditory system. Hearing loss can cause decreases in audibility, dynamic range, frequency and temporal resolution of the auditory system, and all of these effects are known to affect speech intelligibility. In this study, a new reference-free speech intelligibility metric is proposed using 2-D neurograms constructed from the output of a computational model of the auditory periphery. The responses of the auditory-nerve fibers with a wide range of characteristic frequencies were simulated to construct neurograms. The features of the neurograms were extracted using third-order statistics referred to as bispectrum. The phase coupling of neurogram bispectrum provides a unique insight for the presence (or deficit) of supra-threshold nonlinearities beyond audibility for listeners with normal hearing (or hearing loss). The speech intelligibility scores predicted by the proposed method were compared to the behavioral scores for listeners with normal hearing and hearing loss both in quiet and under noisy background conditions. The results were also compared to the performance of some existing methods. The predicted results showed a good fit with a small error suggesting that the subjective scores can be estimated reliably using the proposed neural-response-based metric. The proposed metric also had a wide dynamic range, and the predicted scores were well-separated as a function of hearing loss. The proposed metric successfully captures the effects of hearing loss and supra-threshold nonlinearities on speech intelligibility. This metric could be applied to evaluate the performance of various speech-processing algorithms designed for hearing aids and cochlear implants.

Assessment of auditory processing disorder in children using an adaptive filtered speech test.

OBJECTIVE: One type of test commonly used to assess auditory processing disorder (APD) is the 'filtered words test' (FWT), in which a monaural, low-redundancy speech sample is distorted by using filtering to modify its frequency content. One limitation of the various existing FWTs is that they are performed using a constant level of low-pass filtering, making them prone to ceiling and floor effects that compromise their efficiency and accuracy. A recently developed computer-based test, the University of Canterbury Adaptive Speech Test- Filtered Words (UCAST-FW), uses an adaptive procedure intended to improve the efficiency and sensitivity of the test over its constant-level counterparts. DESIGN: The UCAST-FW was administered to school-aged children to investigate the ability of the test to distinguish between children with and without APD. STUDY SAMPLE: Fifteen children aged 7-13 diagnosed with APD, and an aged-matched control group of 10 children with no history of listening difficulties. RESULTS: Data obtained demonstrates a significant difference between the UCAST-FW results obtained by children with APD and those with normal auditory processing. CONCLUSIONS: These findings provide evidence that the UCAST-FW may discriminate between children with and without APD with greater sensitivity than its constant-level counterparts.

Automatic estimation of voice onset time for word-initial stops by applying random forest to onset detection.

The voice onset time (VOT) of a stop consonant is the interval between its burst onset and voicing onset. Among a variety of research topics on VOT, one that has been studied for years is how VOTs are efficiently measured. Manual annotation is a feasible way, but it becomes a time-consuming task when the corpus size is large. This paper proposes an automatic VOT estimation method based on an onset detection algorithm. At first, a forced alignment is applied to identify the locations of stop consonants. Then a random forest based onset detector searches each stop segment for its burst and voicing onsets to estimate a VOT. The proposed onset detection can detect the onsets in an efficient and accurate manner with only a small amount of training data. The evaluation data extracted from the TIMIT corpus were 2344 words with a word-initial stop. The experimental results showed that 83.4% of the estimations deviate less than 10 ms from their manually labeled values, and 96.5% of the estimations deviate by less than 20 ms. Some factors that influence the proposed estimation method, such as place of articulation, voicing of a stop consonant, and quality of succeeding vowel, were also investigated.

Assessment of the peripheral hearing system of sport divers.

OBJECTIVE: To investigate the effect of regular scuba diving on the hearing thresholds of sport divers who have no history of noise exposure or ear-related accidents. Comprehensive topographic examination of the peripheral hearing system of sport divers. DESIGN: Cross-sectional study. SETTINGS: General sport diving community. PARTICIPANTS: 81 sport divers with a mean of 300 dives each were compared to a control group of 81 non-divers. MAIN OUTCOME MEASURE: Participants were classified into three age groups. Examination included microscopic otoscopy, tympanometry, pure-tone audiometry (PTA) including air and bone conduction, speech audiometry and otoacoustic emissions (OAE). RESULTS: PTA suggested significant differences of the hearing thresholds at several frequencies between sport divers and non-divers in all age groups, although a Bonferroni correction for multiple testing was applied. Interestingly, the results were contradictory. Divers obtained better hearing results in air conduction, whereas non-divers showed better results in bone conduction. Speech audiometry and OAE did not reveal significant differences. CONCLUSION: There are no published studies of the peripheral cochlear system of divers that have used a combination of PTA, speech audiometry and OAE. All studies suggesting hearing impairment in divers were based on PTA and might have been influenced by a lack of accuracy of PTA. Our results suggest that diving does not adversely affect the hearing system of sport divers. A thorough test battery of audiological methods implying PTA, speech audiometry and OAE may contribute to offer more reliable results to answer the question of whether commercial or military divers are at higher risk for hearing detoriation.

Assessment of dysarthric speech and an analysis on velopharyngeal incompetence.

In the present work the role of a speech recognition system in the assessment of dysarthric speech is studied. Initially a continuous speech recognition system is developed for the assessment of dysarthric speech. The performance of the continuous speech recognition system on the assessment of dysarthric speech is found to be dis-satisfactory due to greater number of insertions. Analysis conducted on duration of phoneme and speech rate confirms the fact that the more number of insertions in the recognizer output is due to lower speech rate of dysarthric speakers. To overcome the problem with the continuous speech recognition system an isolated-style speech recognition system is developed. The performance of this system on the assessment is compared with the Frenchay dysarthric assessment (FDA) scores provided with the Nemours speech corpus. From the performance of the isolated-style speech recognition system it is observed that apart from the articulatory problems, some of the speakers are affected with velopharyngeal incompetence also and is analyzed with group delay function based acoustic measure for the detection of hypernasality on dysarthric speech.

Tri-word presentations with phonemic scoring for practical high-reliability speech recognition assessment.

Speech recognition test reliability is optimized with 450 test items, and the Computer Assisted Speech Recognition Assessment (CASRA) test is a practical approach for achieving this goal by combining 50 presentations of 3 consonant-vowel nucleus-consonant (CNC) words each with phonemic scoring (S. A. Gelfand, 1998). However, optimized reliability might not be essential if reliability is as high as possible in light of practical constraints and what the clinician is trying to do with the results. The CASRA paradigm addresses these compromise goals with a reduced number of 3-word sets: 25 sets yield 25 (groups) x 3 (words) x 3 (phonemes) = 225 test items, 20 sets give 20 x 3 x 3 = 180 items, and 10 sets provide 10 x 3 x 3 = 90 items. This study addressed the empirical reliability of such an approach, and the extent to which results on shortened versions predict full-test scores. Test and retest scores were obtained for 10-, 20-, and 25-set versions of the CASRA for 144 participants with a wide range of hearing ability. For group data, first and second scores were highly correlated and not significantly different from each other for all 3 test sizes. Performance based on 20 and 25 sets accounted for roughly 97% of the variance of full (50-set) test scores, and scores based on 10 sets accounted for about 88% of the full-test variance. Individual test-retest reliability agreed with theoretical expectations based on 95% binomial confidence intervals. Cases outside the 95% confidence limits were 7.6% for 10 sets, and 3.5% for 20 and 25 sets with phoneme scoring, and 4.9% for 10 and 20 sets and 3.5% for 25 sets with word scoring. The shortened CASRA is a practical way to achieve improvements in reliability over traditional word tests. The 20-set version may approximate the strongest compromise when trying to shorten test size without appreciably reducing reliability for clinical purposes. However, the 10-set version is probably a more practical approach for routine use because it accounts for 88% of full-test variance, is more reliable than a traditional 75-word test, and does not appear to be subject to significant short-term learning effects.

Topodiagnostic assessment of occupational noise-induced hearing loss using distortion-product otoacoustic emissions compared to the short increment sensitivity index test.

Because the efforts needed to produce an "automatic audiogram" by means of distortion-product otoacoustic emissions (DPOAE) are still experimental, their capacity to produce objective topodiagnostic information must still be defined. In the present study results of the short increment sensitivity index testing (SISI) test in 97 patients with noise-induced hearing loss (NIHL) were compared with those of a DP-gram. Pure tone, speech and impedance audiometry, SISI tests and DPOAE measurements were performed on all patients. SISI was measured in both ears of 93 patients and unilaterally in 4 patients. SISI was also determined at two frequencies in 46 patients. Six measurements were rejected because of conductive hearing losses in adjacent frequencies. In all, 230 measurements could be compared. After classifying topodiagnostic results of the SISI test and DP-gram into cochlear, inconclusive and retrocochlear lesions, statistically significant correlations were found and differences were noted in only 18% of cases. Findings demonstrated the superiority of DPOAE to the SISI test in obtaining topodiagnostic information about inner ear disease.

Prediction of conductive hearing loss based on acoustic ear-canal response using a multivariate clinical decision theory.

This study evaluated the accuracy of acoustic response tests in predicting conductive hearing loss in 161 ears of subjects from the age of 2 to 10 yr, using as a "gold standard" the air-bone gap to classify ears as normal or impaired. The acoustic tests included tympanometric peak-compensated static admittance magnitude (SA) and tympanometric gradient at 226 Hz, and admittance-reflectance (YR) measurements from 0.5 to 8 kHz. The performance of individual, frequency-specific, YR test variables as predictors was assessed. By applying logistic regression (LR) and discriminant analysis (DA) techniques to the multivariate YR response, two univariate functions were calculated as the linear combinations of YR variables across frequency that best separated normal and impaired ears. The tympanometric and YR tests were also combined in a multivariate manner to test whether predictive efficacy improved when 226-Hz tympanometry was added to the predictor set. Conductive hearing loss was predicted based on air-bone gap thresholds at 0.5 and 2 kHz, and on a maximum air-bone gap at any octave frequency from 0.5 to 4 kHz. Each air-bone gap threshold ranged from 5 to 30 dB in 5-dB steps. Areas under the relative operating characteristic curve for DA and LR were larger than for reflectance at 2 kHz, SA and Gr. For constant hit rates of 80% and 90%, both DA and LR scores had lower false-alarm rates than tympanometric tests-LR achieved a false-alarm rate of 6% for a sensitivity of 90%. In general, LR outperformed DA as the multivariate technique of choice. In predicting an impairment at 0.5 kHz, the reflectance scores at 0.5 kHz were less accurate predictors than reflectance at 2 and 4 kHz. This supports the hypothesis that the 2-4-kHz range is a particularly sensitive indicator of middle-ear status, in agreement with the spectral composition of the output predictor from the multivariate analyses. When tympanometric and YR tests were combined, the resulting predictor performed slightly better or the same as the predictor calculated from the use of the YR test alone. The main conclusion is that these multivariate acoustic tests of the middle ear, which are analyzed using a clinical decision theory, are effective predictors of conductive hearing loss.

[Quantitative evaluation of hearing disorders in expert assessment. A recent recommendation for calculating the percentage of hearing loss]. / Die Problematik der quantitativen Bewertung von Hörstörungen in der Begutachtung. Ein neuer Vorschlag zur Berechnung des prozentualen Hörverlustes.

A short historical survey is given of grading the severity of hearing disorders and assessing the relevant disability for recompensation purposes according to the tables of Boenninghaus, Röser, and Feldmann. The present situation and the reasons giving rise to dissatisfaction with this procedure are analysed. They are the high threshold of 20% disability for recompensation, the rigidity of the tables, and the technical development of speech audiometry without concomitant adaptation of the tables. The following possible solutions are discussed and rejected: changing the tables, substituting speech audiometry by tone audiometry, speech audiometry with interfering noise, filtered speech audiometry, special bonus for recruitment. The following feasible solution is proposed: Retaining all tables in use up to this time, however, instead of using the sum of discrimination scores which simply adds the scores at 60, 80 and 100 dB SRL, weighting factors are introduced according to the formula [3 x (% at 60 dB) + 2 x (% at 80 dB) + 1 x (% at 100 dB)]: 2 The advantages and the effect of this procedure on calculating hearing loss and disability are discussed.

Self-assessment of communication skills: toward the development of a new speech audiometric tool.

This investigation was carried out in an effort to characterize differences between groups of normal-hearing and hearing-impaired listeners on a speech perception test based on the theory of signal detection (TSD). TSD allows the quantification of two performance measures designed to evaluate listeners' ability to assess the accuracy of their own identifications and their level of confidence in the self-assessment task. It is hoped that these measures will provide a meaningful way to quantify communication skills beyond the percent correct word recognition score routinely measured in the audiology clinic. Nonparametric indices of self-assessment ability and confidence level, P(A) and B, respectively, were measured for ten normal-hearing and ten hearing-impaired subjects at two signal-to-noise ratios (S/N). In addition, percent correct word recognition scores (%C) were measured. Results indicated that %C differed across groups and across S/Ns. In contrast, P(A) and B differed as a function of S/N but did not differ between hearing-impaired and normal-hearing groups.