Adjustment to hearing impairment II: audiological and demographic correlates.

To study adjustment to hearing impairment, clinical records from a five-center consortium (N = 1,008) were used to create a heterogeneous clinical database with results of audiometric tests, demographic and case history information, and responses to the Communication Profile for the Hearing Impaired (CPHI; Demorest & Erdman, 1986, 1987). Normative findings have been described previously (Erdman & Demorest, 1998). Hierarchical regression analyses revealed that audiometric variables were moderately correlated with communication performance, behavioral strategies, and personal adjustment. With hearing impairment controlled statistically, age and education effects were evident in many areas of adjustment; correlations between adjustment and gender were relatively weak; and marital status, employment status, and race/ethnicity were rarely significant correlates.

Adjustment to hearing impairment I: description of a heterogeneous clinical population.

To obtain data on adjustment to hearing impairment and its potential predictors, a consortium of five audiology clinics was established. Clinical records generated over 19-27 months were reviewed, and a database (N = 1,008) was compiled that contained standard audiometric test results, demographic and case history information, and responses to the Communication Profile for the Hearing Impaired (CPHI; Demorest & Erdman, 1986, 1987). Clinic populations differed on audiometric measures, gender, race/ethnicity, educational level, employment, marital, and hearing aid status, and on CPHI profiles, but not on age. Internal consistency of CPHI scales was higher than reported by Demorest and Erdman (1987), and standard errors of measurement were smaller for Communication Performance scales. The consortium database is sufficiently heterogeneous to provide normative data applicable to a wide range of local clinical populations and to support investigation of the correlates of adjustment to hearing impairment (see Erdman & Demorest, 1998).

Retest stability of the communication profile for the hearing impaired.

Retest stability of the Communication Profile for the Hearing Impaired (CPHI) was assessed in a sample of 101 active-duty military personnel who attended the Aural Rehabilitation Program at Walter Reed Army Medical Center. Pretests were administered by referring audiologists; retests were administered from 6 to 40 weeks later, at the beginning of the rehabilitation program. Mean scores on 5 of the 25 scales of the CPHI decreased significantly (p less than 0.01) over time, but the changes were small in magnitude (approximately -0.20). Distributions of retest-test differences were used to establish criteria for inferring significant improvement in scores over time. Retest correlations for scales in the communication environment, communication strategies, and personal adjustment areas ranged from 0.58 to 0.78. Communication performance and communication importance were less stable (r = 0.28 to 0.54). Retest correlations were comparable for short versus long retest intervals, but varied as a function of military rank. Implications of the results for clinical use of the CPHI are discussed.

Scale composition and item analysis of the Communication Profile for the Hearing Impaired.

The Communication Profile for the Hearing Impaired (CPHI) is a self-assessment inventory that provides 25 scores describing the Communication Performance, Communication Environment, Communication Strategies, and Personal Adjustment of hearing-impaired adults (Demorest & Erdman, 1986). Description of the content and measurement objective for each scale is given and an analysis of the psychometric properties of the 145 items in the CPHI is presented. Results are based on a sample of 433 active-duty military personnel tested at Walter Reed Army Medical Center during the final phase of CPHI development. Included are frequency distributions, descriptive statistics, item-total correlations, and factor structure of the items within each scale and across scales within each of the areas assessed by the CPHI. Applications of these data in clinical interpretation, construct validation, and further development of the CPHI scales are discussed.

Development of the communication profile for the hearing impaired.

The rehabilitative needs of hearing-impaired adults depend on the degree of communication handicap experienced and on many other factors (environmental, behavioral, emotional, and attitudinal) that contribute to communication problems. The Communication Profile for the Hearing Impaired (CPHI) is a 145-item self-assessment inventory for adults. Its 25 scales encompass four areas: Communication Performance, Communication Environment, Communication Strategies, and Personal Adjustment. The inventory was developed at Walter Reed Army Medical Center and pilot tested over a 3-year period on 827 patients who attended the Aural Rehabilitation Program at the Army Audiology and Speech Center. The rationale and methods used to develop the CPHI are discussed, and normative data for the Walter Reed population are presented.

Relationships among behavioral, environmental, and affective communication variables: a canonical analysis of the CPHI.

Relationships among the four content domains assessed by the Communication Profile for the Hearing Imparied (Demorest & Erdman, 1986, 1987) were examined in two samples (N = 433 and N = 486) drawn from the Aural Rehabilitation Program at Walter Reed Army Medical Center. Communication performance was weakly related to communication environment, communication strategies, and personal adjustment (average canonical r = .34). However, strong associations were observed among the latter three areas (average canonical r = .59). Eight specific relationships were identified. The nature of these relationships and implications for clinical intervention are discussed.

Subjective comparisons of binaural versus monaural amplification.

Patient preference for monaural versus binaural hearing aids was studied to evaluate the subjective differences noted between these two types of fittings. Subjects were 30 patients with bilateral hearing impairment who were being fit with amplification for the first time. Subjects wore both monaural and binaural hearing aids for controlled periods of 1 hr each and 2 days each. This was followed by an additional 3 days during which the fittings were alternated at the subjects' own discretion. Subjects reported preferences and subjective differences after each experimental phase. Interviews were conducted 3 months after participation in the study to determine actual hearing aid use. Binaural amplification was preferred by 90% of the subjects for consistently similar reasons. Results also suggest that consistency of preferences throughout an initial trial period may be predictive of successful adjustment to and use of amplification. Findings indicate that the routine practice of fitting monaural hearing aids may not provide optimum fittings for many patients.

Factor structure of the communication profile for the hearing impaired.

Factor structure of 23 scales of the Communication Profile for the Hearing Impaired (CPHI) (Demorest & Erdman, 1986, 1987) was examined in a sample of 1,226 patients who participated in the Aural Rehabilitation Program at Walter Reed Army Medical Center from 1985 through 1987. Five factors were identified: Adjustment, Reaction, Interaction, Communication Performance, and Communication Importance. To enhance clinical interpretation of the CPHI, it is recommended that factor scores be added to the communication profile.

Some effects of training on speech recognition by hearing-impaired adults.

The purpose of this research was to determine some of the effects of consonant recognition training on the speech recognition performance of hearing-impaired adults. Two groups of ten subjects each received seven hours of either auditory or visual consonant recognition training, in addition to a standard two-week, group-oriented, inpatient aural rehabilitation program. A third group of fifteen subjects received the standard two-week program, but no supplementary individual consonant recognition training. An audiovisual sentence recognition test, as well as tests of auditory and visual consonant recognition, were administered both before and following training. Subjects in all three groups significantly increased in their audiovisual sentence recognition performance, but subjects receiving the individual consonant recognition training improved significantly more than subjects receiving only the standard two-week program. A significant increase in consonant recognition performance was observed in the two groups receiving the auditory or visual consonant recognition training. The data are discussed from varying statistical and clinical perspectives.