The effect of age on the hearing-related quality of life in normal-hearing adults.

INTRODUCTION: Recently, a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life was developed, named the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). The purpose of the current study was to evaluate if the hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life. METHODS: One-hundred thirteen normal-hearing participants (mean age: 42.13; range: 19 to 69 years) filled in the entire hAVICOP questionnaire online through the Research Electronic Data Capture surface. The hAVICOP consists of 27 statements, across three major subdomains (auditory-visual, cognitive, and psychosocial functioning), which have to be rated on a visual analogue scale ranging from 0 (rarely to never) to 100 (almost always). Mean scores were calculated for each subdomain separately as well as combined within a total score; the worse one's hearing-related quality of life, the lower the score. Linear regression models were run to predict the hAVICOP total as well as the three subdomain scores from age and sex. RESULTS: A significant main effect of age was observed for the total hAVICOP and all three subdomain scores, indicating a decrease in hearing-related quality of life with increasing age. For none of the analyses, a significant sex effect was found. CONCLUSION: The hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life within a large group of normal-hearing adults, emphasizing its clinical utility. This age effect on the hearing-related quality of life might be related to the interplay of age-related changes in the bottom-up and top-down processes involved during speech processing.

Envelope following responses for hearing diagnosis: Robustness and methodological considerations.

Recent studies have found that envelope following responses (EFRs) are a marker of age-related and noise- or ototoxic-induced cochlear synaptopathy (CS) in research animals. Whereas the cochlear injury can be well controlled in animal research studies, humans may have an unknown mixture of sensorineural hearing loss [SNHL; e.g., inner- or outer-hair-cell (OHC) damage or CS] that cannot be teased apart in a standard hearing evaluation. Hence, a direct translation of EFR markers of CS to a differential CS diagnosis in humans might be compromised by the influence of SNHL subtypes and differences in recording modalities between research animals and humans. To quantify the robustness of EFR markers for use in human studies, this study investigates the impact of methodological considerations related to electrode montage, stimulus characteristics, and presentation, as well as analysis method on human-recorded EFR markers. The main focus is on rectangularly modulated pure-tone stimuli to evoke the EFR based on a recent auditory modelling study that showed that the EFR was least affected by OHC damage and most sensitive to CS in this stimulus configuration. The outcomes of this study can help guide future clinical implementations of electroencephalography-based SNHL diagnostic tests.

Development of the hearing-related quality of life questionnaire for auditory-visual, cognitive and psychosocial functioning (hAVICOP).

INTRODUCTION: There is a need for a validated and standardized self-assessment instrument to assess the subjective effect of hearing aid (HA) use and/or cochlear implantation (CI) on different aspects of functioning in daily life. The aim of this study was to develop a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life. The new PROM is titled the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). METHODS: A conceptual framework was set up and test items were prepared per domain. Preliminary testing involved a semi-structured interview-based assessment in normal-hearing and hearing-impaired adults and an expert panel. For the further psychometric evaluation, a new sample of 15 adult HA users, 20 adult CI users and 20 normal-hearing adults filled in the refined version of the hAVICOP, the Speech, Spatial and Qualities of Hearing Scale, the Nijmegen Cochlear Implant Questionnaire and the TNO-AZL Questionnaire for Adult's Health-Related Quality of Life. Based on these results, a factor analysis was conducted and internal consistency, discriminant validity and concurrent construct validity were determined. RESULTS: The final version of the hAVICOP consists of three domains for hearing-related quality of life: (1) auditory-visual functioning, (2) cognitive functioning, and (3) psychosocial functioning. A sufficient internal consistency was found, and discriminant validity and concurrent construct validity were good. CONCLUSIONS: A new PROM to assess hearing-related quality of life was developed, named the hAVICOP. In the future the validity and reliability should be examined further.

Short-Term Test-Retest Reliability of Contralateral Suppression of Click-Evoked Otoacoustic Emissions in Normal-Hearing Subjects.

Purpose The objective of the current study was to investigate the short-term test-retest reliability of contralateral suppression (CS) of click-evoked otoacoustic emissions (CEOAEs) using commercially available otoacoustic emission equipment. Method Twenty-three young normal-hearing subjects were tested. An otoscopic evaluation, admittance measures, pure-tone audiometry, measurements of CEOAEs without and with contralateral acoustic stimulation (CAS) to determine CS were performed at baseline (n = 23), an immediate retest without and with refitting of the probe (only CS of CEOAEs; n = 11), and a retest after 1 week (n = 23) were performed. Test-retest reliability parameters were determined on CEOAE response amplitudes without and with CAS, and on raw and normalized CS indices between baseline and the other test moments. Results Repeated-measures analysis of variance indicated no random or systematic changes in CEOAE response amplitudes without and with CAS, and in raw and normalized CS indices between the test moments. Moderate-to-high intraclass correlation coefficients with mostly high significant between-subjects variability between baseline and each consecutive test moment were found for CEOAE response amplitude without and with CAS, and for the raw and normalized CS indices. Other reliability parameters deteriorated between CEOAE response amplitudes with CAS as compared to without CAS, between baseline and retest with probe refitting, and after 1 week, as well as for frequency-specific raw and normalized CS indices as compared to global CS indices. Conclusions There was considerable variability in raw and normalized CS indices as measured using CEOAEs with CAS using commercially available otoacoustic emission equipment. More research is needed to optimize the measurement of CS of CEOAEs and to reduce influencing factors, as well as to make generalization of test-retest reliability data possible.

Analysis of probe fitting stimulus properties on transient evoked otoacoustic emissions.

Objective: The objectives of the current study are first, to evaluate the subjective evaluation of probe fitting stimulus properties, and second, to analyse the effects of different probe fittings on transient evoked otoacoustic emission (TEOAE) response and noise amplitudes in subjects.Design: The Q methodology was used to sort 48 probe fittings differing in stimulus properties in seven categories from totally unacceptable to certainly acceptable. Further, TEOAE response and noise amplitudes were measured in one baseline condition with optimal probe fitting and eight experimental conditions with less than optimal probe fittings.Study sample: The probe fittings were ranked by 18 participants, while the repeated measures design was performed in 34 ear.Results: First, it was found that only 19.61% of all distributions of the probe fittings by the participants had a mutual correlation of at least 70.00%. Almost 60% of the variance of distributions was explained by 83.33% of the participants, although most probe fittings significantly differed from other fittings based on spectral broadness. Second, significant differences in TEOAE response and especially noise amplitudes between conditions were found. Further, TEOAE response and noise amplitudes between the baseline and experimental conditions were significantly different depending on ringing and spectral flatness of the stimulus.Conclusion: A substantial amount of subjectivity during TEOAE measurements is involved with regard to the evaluation of probe fitting stimulus properties. TEOAE response but especially noise amplitudes are influenced by varying stimulus parameters which stresses the importance of inspecting these parameters prior to or during EOAE measurements. Although more research is needed, some guidelines regarding these parameters are given which could improve the accuracy of TEOAEs in practice.

Speech recognition in noise with active and passive hearing protectors: a comparative study.

The perceived negative influence of standard hearing protectors on communication is a common argument for not wearing them. Thus, "augmented" protectors have been developed to improve speech intelligibility. Nevertheless, their actual benefit remains a point of concern. In this paper, speech perception with active earplugs is compared to standard passive custom-made earplugs. The two types of active protectors included amplify the incoming sound with a fixed level or to a user selected fraction of the maximum safe level. For the latter type, minimal and maximal amplification are selected. To compare speech intelligibility, 20 different speech-in-noise fragments are presented to 60 normal-hearing subjects and speech recognition is scored. The background noise is selected from realistic industrial noise samples with different intensity, frequency, and temporal characteristics. Statistical analyses suggest that the protectors' performance strongly depends on the noise condition. The active protectors with minimal amplification outclass the others for the most difficult and the easiest situations, but they also limit binaural listening. In other conditions, the passive protectors clearly surpass their active counterparts. Subsequently, test fragments are analyzed acoustically to clarify the results. This provides useful information for developing prototypes, but also indicates that tests with human subjects remain essential.

Determination and evaluation of clinically efficient stopping criteria for the multiple auditory steady-state response technique.

OBJECTIVE: The present study aimed at establishing clinically efficient stopping criteria for a multiple 80-Hz auditory steady-state response (ASSR) system. METHODS: In Experiment 1, data of 31 normal-hearing subjects were analyzed off-line to propose stopping rules. Consequently, ASSR recordings will be stopped when (1) all 8 responses reach significance and significance can be maintained for 8 consecutive sweeps; or (2) the mean noise levels were 4nV (if p-values were between 0.05 and 0.1, measurements were extended once by 8 sweeps); or (3) a maximum amount of 48 sweeps was attained; whichever occurred first. In Experiment 2, these stopping criteria were applied on 10 normal hearing and 10 hearing-impaired adults to assess the efficiency. RESULTS: The application of these stopping rules resulted in ASSR threshold values that were comparable to other ASSR research. Furthermore, preliminary analysis of the response and noise amplitudes demonstrated slightly higher values for hearing impaired than normal-hearing subjects. CONCLUSIONS: The proposed stopping rules can be used in adults to determine accurate ASSR thresholds within a time-frame of about 1h. SIGNIFICANCE: The use of these a priori stopping criteria might assist the clinician in their decision to terminate ASSR recordings.

The effects of aging on evoked otoacoustic emissions and efferent suppression of transient evoked otoacoustic emissions.

OBJECTIVE: There is still controversy regarding the effects of aging on evoked otoacoustic emissions (EOAEs), as well as on the efferent system measured by contralateral acoustic stimulation of EOAEs. The purpose of this study was to investigate the deterioration in EOAEs and efferent suppression (ES) in a representative sample statistically controlling for the differences in hearing thresholds. METHODS: Seventy-one ears (20-79years) were included in the study, 47 of which had normal hearing thresholds, and 24 ears had a sensorineural high-frequency hearing loss caused by presbycusis. The effects of aging on transient evoked (TEOAEs) and distortion product OAEs (DPOAEs), and on ES were evaluated using multiple regression and correlation coefficients. RESULTS: EOAEs and ES were more strongly correlated with age, than with pure-tone thresholds (PTTs). Moreover, the increase in the amount of variance explained by the regression model using both predictors was larger for PTTs as compared to the variable age. CONCLUSIONS: The deterioration of EOAEs and ES with advancing age is caused mainly by pure age-effects, and additionally by the reduction in hearing thresholds. SIGNIFICANCE: The relative contribution of age and hearing thresholds on EOAEs, as well as on ES is important for their interpretation in clinical settings.

The clinical value of the multiple-frequency 80-Hz auditory steady-state response in adults with normal hearing and hearing loss.

OBJECTIVES: To determine the ability of the air-conduction multiple-frequency auditory steady-state response (ASSR) technique to diagnose normal hearing (NH) and mild and moderate degrees of sensorineural hearing loss (SNHL), to assess patients with conductive hearing loss (CHL), to evaluate flat and sloping configurations of hearing impairment, and to provide sensitivity and specificity values for various ASSR cutoff criteria. DESIGN: A comparative study between ASSR and criterion-standard behavioral thresholds. SETTING: Ear, nose, and throat department at a university hospital. PATIENTS: The study population comprised 40 adults with NH, 17 with SNHL, and 7 with CHL. MAIN OUTCOME MEASURES: The measure of interest was the difference between ASSR and behavioral thresholds at 0.5, 1.0, 2.0, and 4.0 kHz. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were calculated for several ASSR cutoff criteria. RESULTS: The ASSR technique clearly distinguished moderate SNHL from NH, but the "mild SNHL and NH" and "mild SNHL and moderate SNHL" differentiation was particularly difficult at 0.5 and 2.0 kHz, respectively. Air-conduction ASSR thresholds accurately predicted behavioral thresholds in CHL. The ASSR system precisely reflected the flat and sloping configurations. Finally, the most appropriate ASSR cutoff point for normality seems to be the 30-dB-or-lower criterion. CONCLUSIONS: In adults, the multiple-frequency 80-Hz ASSR technique can be used to determine the degree and configuration of hearing loss. Although air-conduction ASSR thresholds accurately predicted behavioral thresholds in CHL, future research with bone-conduction ASSRs is necessary to establish the type of hearing loss. Furthermore, the applicability of these findings still needs to be confirmed for infants.