The Finnish simplified matrix sentence test for the assessment of speech intelligibility in the elderly.

Objective: A simplified version of the Finnish matrix sentence test (FMST) was developed to improve the reliability of hearing diagnostic for children and for patients with limited working memory capacity and/or vocabulary.Design: Study 1 evaluated the word matrix of the Finnish simplified matrix sentence test (FINSIMAT) to rule out systematic differences between the new FINSIMAT test lists, and to provide reference values for normal-hearing (NH) young adults (YA). In Study 2, the FINSIMAT and the FMST were evaluated in elderly listeners with mild-to-moderate hearing impairment (HI).Study sample: Twenty NH YAs participated in Study 1, and 16 elderly HI adults participated in Study 2.Results: For NH YAs, the reference speech reception threshold (SRT50) estimate and the slope for the FINSIMAT were -11.2 ± 1.0 dB signal-to-noise ratio (SNR) and 19.4 ± 1.9%/dB SNR. For the elderly HI listeners, the mean SRT50 estimates for the FINSIMAT and FMST were -4.1 and -3.6 dB SNR, respectively. The correlation between the FMST and FINSIMAT results was strong (r2 = 0.78, p < 0.001).Conclusion: The FINSIMAT showed comparable characteristics to the FMST and proved feasible for measurements in elderly HI listeners.

Development of the Continuous Number Identification Test (CNIT): feasibility of dynamic assessment of speech intelligibility.

Objective: The present study was motivated by a need for a speech intelligibility test capable of indexing dynamic changes in the environment and adaptive processing in hearing aids. The Continuous Number Identification Test (CNIT) was developed to meet these aims.Design: From one location in the free field, speech was presented in noise (∼2 words/s) with a 100-ms inter-word interval. On average, every fourth word was a target digit and all other words were monosyllabic words. Non-numeric words had a fixed presentation level such that the dominant signal-to-noise-ratio (SNR) was held at +6 dB SNR relative to background maskers. To prevent ceiling effects, however, targets were presented at a user-specific SNR, determined by an initial adaptive-tracking procedure that estimated the 79.4% speech reception threshold.Study sample: Ten normal-hearing listeners participated.Results: The CNIT showed comparable psychometric qualities of other established speech tests for long time scales (Exp. 1). Target-location changes did not affect performance on the CNIT (Exp. 2), but the test did show high temporal resolution in assessing sudden changes to SNR (Exp. 3).Conclusions: The CNIT is highly customisable, and the initial experiments tested feasibility of its primary features which set it apart from currently available speech-in-noise tests.

Clinical Assessment of Functional Hearing Deficits: Speech-in-Noise Performance.

OBJECTIVE: The clinical evaluation of hearing loss, using a pure-tone audiogram, is not adequate to assess the functional hearing capabilities (or handicap) of a patient, especially the speech-in-noise communication difficulties. The primary objective of this study was to measure the effect of elevated hearing thresholds on the recognition performance in various functional speech-in-noise tests that cover acoustic scenes of different complexities and to identify the subset of tests that (a) were sensitive to individual differences in hearing thresholds and (b) provide complementary information to the audiogram. A secondary goal was to compare the performance on this test battery with the self-assessed performance level of functional hearing abilities. DESIGN: In this study, speech-in-noise performance of normal-hearing listeners and listeners with hearing loss (audiometric configuration ranging from near-normal hearing to moderate-severe hearing loss) was measured on a battery of 12 different tests designed to evaluate speech recognition in a variety of speech and masker conditions, and listening tasks. The listening conditions were designed to measure the ability to localize and monitor multiple speakers or to take advantage of masker modulation, spatial separation between the target and the masker, and a restricted vocabulary. RESULTS: Listeners with hearing loss had significantly worse performance than the normal-hearing control group when speech was presented in the presence of a multitalker babble or in the presence of a single competing talker. In particular, the ability to take advantage of modulation benefit and spatial release from masking was significantly affected even with a mild audiometric loss. Elevated thresholds did not have a significant effect on the performance in the spatial awareness task. A composite score of all 12 tests was considered as a global metric of the overall speech-in-noise performance. Perceived hearing difficulties of subjects were better correlated with the composite score than with the performance on a standardized clinical speech-in-noise test. Regression analysis showed that scores from a subset of these tests, which could potentially take less than 10 min to administer, when combined with the better-ear pure-tone average and the subject's age, accounted for as much as 93.2% of the variance in the composite score. CONCLUSIONS: A test that measures speech recognition in the presence of a spatially separated competing talker would be useful in measuring suprathreshold speech-in-noise deficits that cannot be readily predicted from standard audiometric evaluation. Including such a test can likely reduce the gap between patient complaints and their clinical evaluation.

Efficient Adaptive Speech Reception Threshold Measurements Using Stochastic Approximation Algorithms.

This study examines whether speech-in-noise tests that use adaptive procedures to assess a speech reception threshold in noise (SRT50n) can be optimized using stochastic approximation (SA) methods, especially in cochlear-implant (CI) users. A simulation model was developed that simulates intelligibility scores for words from sentences in noise for both CI users and normal-hearing (NH) listeners. The model was used in Monte Carlo simulations. Four different SA algorithms were optimized for use in both groups and compared with clinically used adaptive procedures. The simulation model proved to be valid, as its results agreed very well with existing experimental data. The four optimized SA algorithms all provided an efficient estimation of the SRT50n. They were equally accurate and produced smaller standard deviations (SDs) than the clinical procedures. In CI users, SRT50n estimates had a small bias and larger SDs than in NH listeners. At least 20 sentences per condition and an initial signal-to-noise ratio below the real SRT50n were required to ensure sufficient reliability. In CI users, bias and SD became unacceptably large for a maximum speech intelligibility score in quiet below 70%. In conclusion, SA algorithms with word scoring in adaptive speech-in-noise tests are applicable to various listeners, from CI users to NH listeners. In CI users, they lead to efficient estimation of the SRT50n as long as speech intelligibility in quiet is greater than 70%. SA procedures can be considered as a valid, more efficient, and alternative to clinical adaptive procedures currently used in CI users.

Construction and evaluation of the Mandarin Chinese matrix (CMNmatrix) sentence test for the assessment of speech recognition in noise.

OBJECTIVE: Development of the Mandarin Chinese matrix (CMNmatrix) sentence test for speech intelligibility measurements in noise according to the international standard procedure. DESIGN: A 50-word base matrix representing the distribution of phonemes and lexical tones of spoken Mandarin was established. Hundred sentences capturing all the co-articulations of two consecutive words were recorded. Word-specific speech recognition functions, speech reception thresholds (SRT: signal-to-noise ratio (SNR), that provides 50% speech intelligibility) and slopes were obtained from measurements at fixed SNRs. The speech material was homogenised in intelligibility by applying level corrections up to ± 2 dB. Subsequently, the CMNmatrix test was evaluated, the comparability of test lists was measured at two fixed SNRs. To investigate the training effect and establish the reference data, speech recognition was measured adaptively. STUDY SAMPLE: Overall, the study sample contained 80 normal-hearing native Mandarin-speaking listeners. RESULTS: Multi-centre evaluation measurements confirmed that test lists are equivalent in intelligibility, with a mean SRT of -10.1 ± 0.1 dB SNR and a slope of 13.1 ± 0.9 %/dB. The reference SRT is -9.3 ± 0.8 and -11.2 ± 1.2 dB SNR for the open- and closed-set response format, respectively. CONCLUSION: The CMNmatrix test is suitable for accurate and internationally comparable speech recognition measurements in noise.

Is the use of a bone conduction hearing device on a softband a useful tool in the pre-operative assessment of suitability for other hearing implants?

OBJECTIVE: To assess whether pre-operative assessment with a bone conduction hearing device on a softband is an accurate predictor of performance with one of two transcutaneous hearing implants.Study designCohort study comparing pre-and post-operative speech audiometry using correlation analysis. METHODS: Pre-operative pure tone audiometry and aided half optimum speech recognition thresholds were compared with post-operative aided results for each ear that had undergone implantation. Data were collected prospectively. RESULTS: Full data were available in 24 ears. In 19 out of 24 ears (79 per cent), the difference between pre- and post-operative speech scores was less than 10 dB, demonstrating a good clinical correlation. The Pearson correlation coefficient was calculated at 0.66 (95 per cent confidence interval = 0.357-0.842), indicating a strong statistical correlation. CONCLUSION: Pre-operative softband testing shows good clinical correlation and strong statistical correlation with hearing implant performance. The findings suggest there is value in using the test to predict performance and guide patients' expectations.

Clinical and economic evaluation of minimally invasive cartilaginous palisade myringoplasty.

OBJECTIVES: To test the clinical and audiometric efficacy of a minimally invasive myringoplasty technique, combining cartilaginous palisades while avoiding flap elevation, for small and wide perforations. METHODS: Over 4 years, this retrospective study included all patients over 6 years of age presenting an indication for myringoplasty. Several clinical and economic criteria were noted at 7 d, 2 months, 6 months and 2 years postoperative. The main outcome was the absence of perforation 2 years postoperative. The secondary outcomes were an audiometric gain at 6 months and the evaluation of the treatment cost. RESULTS: Thirty patients underwent the minimally invasive technique and 28 patients the technique with an elevation of the tympanomeatal flap. The minimally invasive surgical procedure was shorter (p = .001). At 2 years, the tympanic closure rate was equivalent (95% versus 89.5%, p = .77). The audiometric gain was similar between the two techniques (p = .09). From a medico-economic point of view, the minimally invasive procedure was the most effective because it was three times less expensive than the conventional technique with no reduction in efficacy (p = .02). CONCLUSION: This quick and easy technique could be developed in an ambulatory setting or even in conditions adapted to consultation.

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.

Objective Assessment of Listening Effort: Coregistration of Pupillometry and EEG.

Listening to speech in noise is effortful, particularly for people with hearing impairment. While it is known that effort is related to a complex interplay between bottom-up and top-down processes, the cognitive and neurophysiological mechanisms contributing to effortful listening remain unknown. Therefore, a reliable physiological measure to assess effort remains elusive. This study aimed to determine whether pupil dilation and alpha power change, two physiological measures suggested to index listening effort, assess similar processes. Listening effort was manipulated by parametrically varying spectral resolution (16- and 6-channel noise vocoding) and speech reception thresholds (SRT; 50% and 80%) while 19 young, normal-hearing adults performed a speech recognition task in noise. Results of off-line sentence scoring showed discrepancies between the target SRTs and the true performance obtained during the speech recognition task. For example, in the SRT80% condition, participants scored an average of 64.7%. Participants' true performance levels were therefore used for subsequent statistical modelling. Results showed that both measures appeared to be sensitive to changes in spectral resolution (channel vocoding), while pupil dilation only was also significantly related to their true performance levels (%) and task accuracy (i.e., whether the response was correctly or partially recalled). The two measures were not correlated, suggesting they each may reflect different cognitive processes involved in listening effort. This combination of findings contributes to a growing body of research aiming to develop an objective measure of listening effort.

Robust and efficient Bayesian adaptive psychometric function estimation.

The efficient measurement of the threshold and slope of the psychometric function (PF) is an important objective in psychoacoustics. This paper proposes a procedure that combines a Bayesian estimate of the PF with either a look one-ahead or a look two-ahead method of selecting the next stimulus presentation. The procedure differs from previously proposed algorithms in two respects: (i) it does not require the range of possible PF parameters to be specified in advance and (ii) the sequence of probe signal-to-noise ratios optimizes the threshold and slope estimates at a performance level, ϕ, that can be chosen by the experimenter. Simulation results show that the proposed procedure is robust and that the estimates of both threshold and slope have a consistently low bias. Over a wide range of listener PF parameters, the root-mean-square errors after 50 trials were ∼1.2 dB in threshold and 0.14 in log-slope. It was found that the performance differences between the look one-ahead and look two-ahead methods were negligible and that an entropy-based criterion for selecting the next stimulus was preferred to a variance-based criterion.

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.

Simulated Critical Differences for Speech Reception Thresholds.

Purpose: Critical differences state by how much 2 test results have to differ in order to be significantly different. Critical differences for discrimination scores have been available for several decades, but they do not exist for speech reception thresholds (SRTs). This study presents and discusses how critical differences for SRTs can be estimated by Monte Carlo simulations. As an application of this method, critical differences are proposed for a 5-word sentences test (a matrix test) using 2 widely implemented adaptive test procedures. Method: For each procedure, simulations were performed for different parameters: the number of test sentences, the j factor, the distribution of the subjects' true SRTs, and the slope of the discrimination function. For 1 procedure and 1 parameter setting, simulation data are compared with results found by listening tests (experimental data). Results: The critical differences were found to depend on the parameters tested, including interactive effects. The critical differences found by simulation agree with data found experimentally. Conclusions: As the critical differences for SRTs rely on multiple parameters, they must be determined for each parameter setting individually. However, with knowledge of the test setup, rules of thumb can be derived.

Mono-syllabic word test score as a pre-operative assessment criterion for cochlear implant candidature in adults with acquired hearing loss.

RATIONALE: Cochlear Implant (CI) candidates with a ski-slope hearing loss may be outside current implantation criteria [< 50% on Bamford-Kowal-Bench (BKB) sentence testing], despite having a significant hearing disability and limited benefit from conventional amplification. AIM: To use existing post-operative performance data to establish a criterion for Arthur Boothroyd (AB) word test for CI candidacy assessment. METHODOLOGY: Retrospective analysis of post-operative AB words scores for 64 CI users was performed and the 10th percentile score selected as a criterion of reasonable chance for post-operative improvement. A follow-up audit was performed 4 years later with a larger patient group of 127 CI users. OUTCOMES: An AB word score of 15% was determined using this method and became the pre-implant criterion for future patients. The same score was achieved on the follow-up audit and was adopted as an All Wales criterion as part of the National Audit process.

Preliminary assessment of the feasibility of using AB words to assess candidacy in adults.

BACKGROUND: Adult cochlear implant (CI) candidacy is assessed in part by the use of speech perception measures. In the United Kingdom the current cut-off point to fall within the CI candidacy range is a score of less than 50% on the BKB sentences presented in quiet (presented at 70 dBSPL). GOAL: The specific goal of this article was to review the benefit of adding the AB word test to the assessment test battery for candidacy. RESULTS: The AB word test scores showed good sensitivity and specificity when calculated based on both word and phoneme scores. The word score equivalent for 50% correct on the BKB sentences was 18.5% and it was 34.5% when the phoneme score was calculated; these scores are in line with those used in centres in Wales (15% AB word score). CONCLUSION: The goal of the British Cochlear Implant Group (BCIG) service evaluation was to determine if the pre-implant assessment measures are appropriate and set at the correct level for determining candidacy, the future analyses will determine whether the speech perception cut-off point for candidacy should be adjusted and whether other more challenging measures should be used in the candidacy evaluation.

Construct Validity of the Ecological Momentary Assessment in Audiology Research.

BACKGROUND: Ecological momentary assessment (EMA) is a methodology involving repeated assessments/surveys to collect data describing respondents' current or very recent experiences and related contexts in their natural environments. The use of EMA in audiology research is growing. PURPOSE: This study examined the construct validity (i.e., the degree to which a measurement reflects what it is intended to measure) of EMA in terms of measuring speech understanding and related listening context. Experiment 1 investigated the extent to which individuals can accurately report their speech recognition performance and characterize the listening context in controlled environments. Experiment 2 investigated whether the data aggregated across multiple EMA surveys conducted in uncontrolled, real-world environments would reveal a valid pattern that was consistent with the established relationships between speech understanding, hearing aid use, listening context, and lifestyle. RESEARCH DESIGN: This is an observational study. STUDY SAMPLE: Twelve and twenty-seven adults with hearing impairment participated in Experiments 1 and 2, respectively. DATA COLLECTION AND ANALYSIS: In the laboratory testing of Experiment 1, participants estimated their speech recognition performance in settings wherein the signal-to-noise ratio was fixed or constantly varied across sentences. In the field testing the participants reported the listening context (e.g., noisiness level) of several semicontrolled real-world conversations. Their reports were compared to (1) the context described by normal-hearing observers and (2) the background noise level measured using a sound level meter. In Experiment 2, participants repeatedly reported the degree of speech understanding, hearing aid use, and listening context using paper-and-pencil journals in their natural environments for 1 week. They also carried noise dosimeters to measure the sound level. The associations between (1) speech understanding, hearing aid use, and listening context, (2) dosimeter sound level and self-reported noisiness level, and (3) dosimeter data and lifestyle quantified using the journals were examined. RESULTS: For Experiment 1, the reported and measured speech recognition scores were highly correlated across all test conditions (r = 0.94 to 0.97). The field testing results revealed that most listening context properties reported by the participants were highly consistent with those described by the observers (74-95% consistency), except for noisiness rating (58%). Nevertheless, higher noisiness rating was associated with higher background noise level. For Experiment 2, the EMA results revealed several associations: better speech understanding was associated with the use of hearing aids, front-located speech, and lower dosimeter sound level; higher noisiness rating was associated with higher dosimeter sound level; listeners with more diverse lifestyles tended to have higher dosimeter sound levels. CONCLUSIONS: Adults with hearing impairment were able to report their listening experiences, such as speech understanding, and characterize listening context in controlled environments with reasonable accuracy. The pattern of the data aggregated across multiple EMA surveys conducted in a wide range of uncontrolled real-world environment was consistent with the established knowledge in audiology. The two experiments suggested that, regarding speech understanding and related listening contexts, EMA reflects what it is intended to measure, supporting its construct validity in audiology research.

Systematic review of outcome of cochlear implantation in superficial siderosis.

BACKGROUND: Superficial siderosis is a progressive disease of the central nervous system associated with chronic subarachnoid hemorrhage. Sensorineural hearing loss occurs early in the disease typically progressing to a profound hearing loss during several years and ultimately affecting 95% of patients. OBJECTIVE: There are published reports of variable outcomes regarding auditory performance for cochlear implantation in cases of superficial siderosis: the objective of this article was to systematically review this evidence. DATA SOURCES: A systematic search of NHS Evidence electronic journal databases AMED (1985 to present), BNI (1985 to present), CINAHL (1981 to present), EMBASE (1980 to present), HEALTH BUSINESS ELITE, HMIC, MEDLINE (1950 to present), and PsycINFO (1806 to present) was performed. Further research using personal communication, Google Scholar, hand searching Otology & Neurotology (2008-2011), and assessment of reference lists identified in other relevant articles yielded additional articles. STUDY SELECTION: A total of 24 articles were short-listed based on relevance; no studies were excluded on a basis of quality. Of these 24 articles, 11 were excluded. DATA EXTRACTION AND SYNTHESIS: The 13 articles included in this review report 15 cases of cochlear implantation in superficial siderosis. Of these 15 individual cases, 7 (47%) showed clear sustained benefit from cochlear implantation, 6 showed limited/no benefit from the onset, and the remaining 2 patients' initial benefit was not maintained. CONCLUSION: Outcomes will depend on the site of lesion and the degree of cochlear nerve functionality, as well as ongoing neural deterioration. Comprehensive assessment of the auditory pathway including electrical auditory brainstem response and magnetic resonance imaging as well as pre/postimplantation counseling is indicated, but these preoperative measures are imperfect predictors of outcomes. There are indications that, where the underlying disease is stable, cochlear implant performance may be sustained, and where there is disease progression (specifically regarding involvement of auditory brainstem nuclei), cochlear implant performance may deteriorate. Further data are needed in this regard; however, results suggest that earlier implantation would provide benefit for a longer period and increase cost-effectiveness.

Hearing aids reduce overestimation in pre-fitting self-assessment.

OBJECTIVE: When asking about hearing disability, the self-reported answers are not always equivalent to those of their family and neighbors. It is often experienced that family and neighbors indicate more severe hearing disability. Hearing difficulty itself may prevent hearing impaired subjects from understanding the degree of their own hearing disability. If their hearing impairment interferes with self-assessment of unaided hearing ability, it may change after a non-hearing aid user begins using hearing aids. METHODS: Thirty-four adults who had almost no experience with using hearing aids participated in this study. Unaided hearing disability was assessed with visual analog scale (VAS) and ten 5-point category scales. The assessment was performed not only by the subject (pre-fitting self-assessment) but also by his/her family members, presumed to be understanding persons regarding the degree of his/her hearing disability (family-assessment). For evaluating the effect of amplification on self-assessment, re-assessment was performed more than three months later (post-fitting self-assessment). The overestimation in the pre-fitting self-assessment and the effect of amplification were investigated in comparison to the family- and post-fitting self-assessments. RESULTS: The pre-fitting self-, family- and post-fitting self-VAS values for total hearing abilities were 50.5±15.6, 45.1±14.7 and 34.3±18.8, respectively. The pre-fitting self-VAS value was significantly higher than the family- and post-fitting self-VAS values (p<0.05 and p<0.01, respectively). For the 5-point category scale, the pre-fitting self-assessment was better than the family- and post-fitting self-assessments. Significant differences were observed in 1 and 2 situations, as compared with the family- and post-fitting self-assessments, respectively. These findings suggest the involvement of overestimation in pre-fitting self-assessment and its reduction after amplification with hearing aids. Although the pre-fitting self- and the family-VAS values were independent of the results of audiometric tests, the post-fitting self-VAS value was significantly related to the pure tone threshold and maximum speech recognition score (p<0.05). Regarding the changes in self-VAS values after amplification, the higher the pre-fitting self-VAS value, the larger the decrease in the self-VAS value. Thus, amplification with hearing aids may reduce overestimation and change self-assessment to reflect the audiometric assessments. CONCLUSION: The pre-fitting self-assessment of hearing disability involves over estimation which is exacerbated by hearing difficulty. A high pre-fitting VAS value may reflect a large overestimation in hearing ability. This overestimation can be improved by the amplification with hearing aids.

Comparing health care use and related costs between groups with and without hearing impairment.

This study aims to compare the use (and related costs) of different health care resources between groups of normally-hearing and hearing-impaired people. A distinction was made between hearing-related and other health care contacts. Data were collected at the baseline measurement of the national longitudinal study on hearing, and at each month during a subsequent period of six months. Hearing status was determined using an internet speech-in-noise test. The sample comprised 1295 normally-hearing and hearing-impaired subjects, aged 18-65 years. Adjusting for confounders, regression models showed that hearing-impaired respondents had significantly more contacts and higher costs for primary, secondary, and occupational care than normally-hearing respondents during the period under investigation. The differences were due to a larger number of health care contacts for which hearing impairment was the main motive to seek help. After excluding these contacts, the differences in health care use and costs between the groups were not significant. This suggests that besides hearing-related contacts, adults with hearing impairment do not make more use of health care resources than adults without hearing difficulties.