Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities. DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round. STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round. RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified. CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

[Speech audiometry for indication of conventional and implantable hearing aids]. / Sprachaudiometrie bei der Indikation von Hörhilfen und Hörimplantaten.

The social function of the human hearing apparatus is comprehension of speech. Auditory rehabilitation aims to enhance speech perception in everyday life. Consequently, audiological evaluation contains speech perception measurement. Many speech audiometric methods have been developed in German-speaking countries, which are suitable for quantification of speech perception abilities in quiet and in noise to address specific diagnostic questions. For establishment of the indication for technical hearing systems such as hearing aids and cochlear implants, the Freiburg monosyllabic test has been employed successfully for many years. Particularly sentence tests have been suggested as a complementary measure for hearing aid indication and assessment. This paper describes the characteristics and range of application of various speech audiometric methods, and highlights the methodological limitations of the individual tests.

Functional performance in older adults with hearing loss: Application of the International Classification of Functioning brief core set for hearing loss: A pilot study.

OBJECTIVES: The beta version of the International Classification of Functioning, Disability, and Health (ICF) brief core set for hearing loss in adults was developed and recommended to be validated through the audiologic rehabilitation clinical practice. The aims of this pilot study were to validate the ICF brief core set by examining the dimensions of hearing performance measures used in a standard care university clinic specializing in amplification, and seeing if those dimensions support the structure provided by the core set. DESIGN: ICF linking, classification, and qualifier coding procedures were applied on a data set identified from clinical records and two paper-pencil questionnaires; and completed by consensus of two experienced audiologists. STUDY SAMPLE: Forty-nine participants were recruited from an out-patient population at an audiology clinic. RESULTS: Eighteen of 27 items from the brief core set were able to be linked and validated. Four factors were identified, and confirmed the structure of ICF concept: Auditory function, Other functions, Activities/contextual interaction, and Third-party disability. Further, three predictors significantly discriminated performance in 28 participants: the use of hearing assistive devices, speech-reading, and active social life. CONCLUSIONS: The ICF brief core set is a valuable tool for use in audiologic rehabilitation clinical practice and research design.

Proposed norms for the Glasgow hearing-aid benefit profile (Ghabp) questionnaire.

OBJECTIVE: To form a normative set of responses to the GHABP questionnaire from a large regional dataset. DESIGN: Participants were asked to rate their hearing disability, handicap, hearing-aid (HA) use, HA benefit, HA satisfaction, and residual (aided) disability on a five-point scale for four situations: quiet conversation, television (TV) listening, noisy conversation, and group conversation. A subset of participants also estimated the time spent in these situations. STUDY SAMPLE: A group of 1574 adults with normal to profound hearing thresholds participated. RESULTS: There was a significant relationship between increasing perceived disability and increasing hearing loss as given by the better-ear audiometric average (BEA). Responses for HA measures did not vary greatly with hearing loss: HA use was reported as high, whereas residual disability, HA benefit, and satisfaction were all reported on average as moderate. CONCLUSIONS: The results can be used as a normative dataset with which to evaluate individual responses in the clinic, where the GHABP provides a useful short-form questionnaire to engage the patient. The lack of systematic changes in hearing-aid related responses shows room for improvement in the benefit afforded by amplification.

Patient-centred audiological rehabilitation: perspectives of older adults who own hearing aids.

OBJECTIVE: Patient-centred care is a term frequently associated with quality health care. Despite extensive literature from a range of health-care professions that provide description and measurement of patient-centred care, a definition of patient-centredness in audiological rehabilitation is lacking. The current study aimed to define patient-centred care specific to audiological rehabilitation from the perspective of older adults who have owned hearing aids for at least one year. DESIGN: Research interviews were conducted with a purposive sample of older adults concerning their perceptions of patient-centredness in audiological rehabilitation, and qualitative content analysis was undertaken. STUDY SAMPLE: The participant sample included ten adults over the age of 60 years who had owned hearing aids for at least one year. RESULTS: Data analysis revealed three dimensions to patient-centred audiological rehabilitation: the therapeutic relationship, the players (audiologist and patient), and clinical processes. Individualised care was seen as an overarching theme linking each of these dimensions. CONCLUSIONS: This study reported two models: the first model describes what older adults with hearing aids believe constitutes patient-centred audiological rehabilitation. The second provides a guide to operationalised patient-centred care. Further research is required to address questions pertaining to the presence, nature, and impact of patient-centred audiological rehabilitation.

An Australian survey of audiologists' preferences for patient-centredness.

OBJECTIVE: Patient-centredness is becoming a core value of health services worldwide, however it remains largely unexplored in audiology. This study investigated audiologists' preferences for patient-centredness and identified factors that explain audiologists' preferences for patient-centredness. DESIGN: All members of the Audiological Society of Australia received two questionnaires: (1) a descriptive questionnaire (e.g. age, gender, place of residence, years in practice, employment characteristics), and (2) a modified patient-practitioner orientation scale (PPOS; Krupat et al, 2000) which measures preferences for two aspects of patient-centredness, sharing and caring. STUDY SAMPLE: In total 663 (46%) audiologists returned both questionnaires fully completed. RESULTS: Mean PPOS scores indicated that audiologists prefer patient-centredness. Linear regression modelling identified that older audiologists, that had practiced longer, and who worked in community education, industrial audiology, or teaching had a significantly greater preference for patient-centredness than their peers. In contrast, audiologists who practiced in a private environment and who worked in the area of assessment of adults had a significantly lesser preference for patient-centredness than their peers. CONCLUSIONS: Audiologists prefer client-centredness and age, years of experience, and employment characteristics can partly explain preferences for patient-centredness. Future research should explore the relationships between patient-centredness and intervention outcomes in audiology.

Patient-centred care: a review for rehabilitative audiologists.

OBJECTIVE: This discussion paper aims to synthesise the literature on patient-centred care from a range of health professions and to relate this to the field of rehabilitative audiology. Through review of the literature, this paper addresses five questions: What is patient-centred care? How is patient-centred care measured? What are the outcomes of patient-centred care? What are the factors contributing to patient-centred care? What are the implications for audiological rehabilitation? DESIGN: Literature review and synthesis. STUDY SAMPLE: Publications were identified by structured searches in PubMed, Cinahl, Web of Knowledge, and PsychInfo, and by inspecting the reference lists of relevant articles. RESULTS: Few publications from within the audiology profession address this topic and consequently a review and synthesis of literature from other areas of health were used to answer the proposed questions. CONCLUSION: This paper concludes that patient-centred care is in line with the aims and scope of practice for audiological rehabilitation. However, there is emerging evidence that we still need to inform the conceptualisation of patient-centred audiological rehabilitation. A definition of patient-centred audiological rehabilitation is needed to facilitate studies into the nature and outcomes of it in audiological rehabilitation practice.

[The experience of the work of a regional cochlear implantation center].

The objective of the present study was to determine the main lines of the development of a regional cochlear implantation centre and to estimate the effectiveness of rehabilitation of the children treated with the use of cochlear implantation. Analysis of the results of the work of the branch of the Russian Research and Practical Centre of Audiology and Hearing Rehabilitation based at Voronezh Regional Children's Clinical Hospital No 1 provided materials for the establishment of the principle directions of activities of the regional cochlear implantation centre where a total of 161 children have been kept under observation during the last years. Fifty six of the 138 children at the age varying from 1 to 12 years were given the surgical treatment. The patients were followed up within two and more years after connection of the speech processor. The study group was comprised only of the pre-lingually deaf children. It is concluded that the performance of most cochlear implantation procedures based at local centres allows to reduce the cost of rehabilitation and makes the high-tech medical aid more readily available to the patients; moreover, the practical introduction of remote speech processor programming software into the work of regional cochlear implantation centres enhances the effectiveness of the rehabilitative measures based at local medical facilities.

On a reference-free speech quality estimator for hearing aids.

A reference-free speech quality measure is proposed and assessed for hearing aid applications. The proposed speech quality metric is validated with subjective ratings obtained from hearing impaired listeners under a number of noisy and reverberant conditions. In addition, a comparison is drawn between the proposed measure and a state-of-the-art electroacoustic measure that relies on a clean reference signal. The results showed that the reference-free measure had a lower correlation with the subjective ratings of hearing aid speech quality in comparison to the correlations achieved by the measure utilizing a reference signal. Nevertheless, advantages of the reference-free approach are discussed.

Validation of the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale.

BACKGROUND: The Parents' Evaluation of Aural/Oral Performance of Children (PEACH) is a caregiver report questionnaire that is suitable for use with children who wear hearing aids. It is available in both a Diary format and a Rating Scale format. Following a critical review of subjective outcome evaluation tools for infants, toddlers, and preschool children (Bagatto, Moodie, Seewald et al, 2011), the Rating Scale version of the PEACH was included in a recently developed guideline for monitoring real-world auditory performance of children who have hearing loss (Bagatto, Moodie, Malandrino et al, 2011). Normative data exist only for the PEACH Diary, not the Rating Scale. PURPOSE: This article evaluates whether published normative data for the PEACH Diary (Ching and Hill, 2007) are replicated on a different sample of children using the PEACH Rating Scale. RESEARCH DESIGN: Fifty-nine children with normal hearing aged 2 mo to 83 mo and their primary caregivers participated in the study. Caregivers completed the PEACH Rating Scale for each child with normal hearing. RESULTS: Results indicated close agreement to existing normative data collected with the PEACH Diary, with no differences in scores between males and females and good internal consistency. Age-related trends published for the Diary version were replicated using the Rating Scale version, as significantly lower scores were observed for children 20 mo of age and younger compared to those older than 20 mo of age. CONCLUSIONS: The currently published norms for the PEACH Diary are valid for use with the PEACH Rating Scale with caregivers of normal hearing children. This validation work adds to the evidence base of the PEACH Rating Scale and supports its use in clinical practice.

The AMA method of estimation of hearing disability: a validation study.

OBJECTIVE: To test the assumptions of the 1979 American Medical Association (AMA) method for estimation of hearing disability. DESIGN: One thousand and one patients attending five regional audiology centers competed conventional audiometric testing and the Communication Profile for the Hearing Impaired. A Communication Performance (CP) score calculated from scales of the Communication Profile for the Hearing Impaired served as the gold standard for self-assessed hearing disability. Pure-tone thresholds and word recognition scores (WRSs), and combinations thereof, were compared with the CP scores using correlation and multiple regression analysis. RESULTS: Several different better-ear pure-tone averages (PTAs) correlated reasonably well with self-assessed CP; none were significantly better than the 0.5, 1, 2, and 3 kHz PTA used in the current AMA method. Better-ear to worse-ear weights ranging from 3:1 to 9:1 performed similarly, but none were better than the AMA better-ear weight of 5:1. The AMA method assumes no disability below 25 dB HL and linear growth of disability above this "low fence"; this study showed a similar relationship between PTA and self-assessed hearing disability. There were too few subjects with severe and profound speech-frequency losses to permit validation of the AMA "high fence" of 92 dB HL. Combining pure-tone thresholds and WRSs improved prediction of hearing disability only very slightly. CONCLUSIONS: This study supports the continued use of the 1979 AMA method. Incorporation of WRSs, as typically measured clinically, into methods of estimating hearing disability is not supported because of negligible improvement in accuracy and inability to control exaggeration for speech tests in medical-legal settings.

Development of the ORCA nonsense syllable test.

OBJECTIVES: Many new processing features in hearing aids have their primary effects on information located in the high frequencies. Speech perception tests that are optimized for evaluating high-frequency processing are needed to adequately study its effects on speech identification. The goal of the current research was to develop a medium for evaluating the effects of high-frequency processing in hearing aids. DESIGN: A list of 115 consonant-vowel-consonant-vowel-consonant nonsense syllables with American English consonants in all word positions was created in an open-set phoneme identification format. The source material was spoken by a male and a female speaker. A custom computer program was developed for administration of the test and automatic analysis of the test results. Nine normal-hearing listeners were employed in the collection of the normative data. The test was presented to the listeners in quiet (at 68 dB SPL), in noise at five signal-to-noise ratios (SNRs; -10, -5, 0, 5, and 10), and in a low-pass filter condition with cutoff frequencies at 500, 1000, 1500, 2000, and 4000 Hz. The data were examined to evaluate the psychometric properties of the test for different phoneme positions and phoneme classes. In addition, a shortened version of the test was developed based on the data from normal-hearing listeners. The test-retest reliability was verified at 0 dB SNR. The full and shortened versions of the test were repeated in 10 hearing-impaired listeners at their most comfortable listening level in quiet and in noise at various SNRs. RESULTS: The availability of high-frequency output was verified with acoustic analysis. The performance intensity functions for both versions of the test (i.e., male and female speakers) showed expected monotonic growth with SNR and cutoff frequencies. High reliability was seen between test and retest identification scores in normal-hearing and hearing-impaired listeners. CONCLUSIONS: The current nonsense syllable test provided a reliable and efficient means for phoneme identification testing.

International classification of functioning, disability, and health core sets for hearing loss: a discussion paper and invitation.

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) has adopted a multifactorial understanding of functioning and disability, merging a biomedical paradigm with a social paradigm into a wider understanding of human functioning. Altogether there are more than 1400 ICF-categories describing different aspects of human functioning and there is a need to developing short lists of ICF categories to facilitate use of the classification scheme in clinical practice. To our knowledge, there is currently no such standard measuring instrument to facilitate a common validated way of assessing the effects of hearing loss on the lives of adults. The aim of the project is the development of an internationally accepted, evidence-based, reliable, comprehensive and valid ICF Core Sets for Hearing Loss. The processes involved in this project are described in detail and the authors invite stakeholders, clinical experts and persons with hearing loss to actively participate in the development process.

The design and validation of a parent-report questionnaire for assessing the characteristics and quality of early intervention over time.

This article concerns a parent-report repeat questionnaire to evaluate the quality of multiprofessional early intervention following early identification of deafness. It discusses the rationale for the design of the instrument, its theoretical underpinnings, its psychometric properties, and its usability. Results for the validity and reliability of the instrument are based on completion by 82 parents. The questionnaire is divided into four sections. "The description of the structure of professional services" demonstrated good face and content validity; the "content of intervention scale" yielded high internal consistency (Cronbach's alpha = 0.88) and reliability (6-month test-retest correlations, rho = 0.88, r = .68; 12-month test-retest correlations, rho = 0.60, r = .82); the "process of intervention" scale yielded high internal consistency (Cronbach's alpha = 0.93) and high reliability on test-retest administration (6-month test-retest correlations, r = 0.64; 12 month test-retest correlations, r = .82); and the short "overall impact" questions were answered well. The Trait Emotional Intelligence Questionnaire was used to control for influence of parental disposition on ratings of quality of intervention. Evaluating the goodness of fit between early intervention and parental priorities/values is discussed as a vital component in improving child and family outcomes.

[Hearing aid efficacy according to the data from the Tula regional Deaf and Dumb Centre].

Auditory inefficiency creates a serious social problem due to the ever increasing number of people with this pathology. The use of hearing aids constitutes the basis of rehabilitative measures for these patients. The authors present results of the analysis of hearing aid efficacy among adult subjects residing in the Tula region carried out in the framework of the relevant Federal program during the last 3 years. Criteria for the assessment of the efficacy of hearing aids are proposed and factors on which it depends are considered.

Hearing instrument fittings of pre-school children: do we meet the prescription goals?

Verifying the match to prescribed electro-acoustic performance is essential in a scientific approach to pediatric hearing instrument fittings. This study aimed to compare hearing instrument output values, at 65 and 90 dB sound-pressure level (SPL) input signals, of instruments fitted to pre-school children in South Africa to the targets prescribed by the DSLm [i/o] (version 5.0) across the frequency range. Outputs of 31 BTE hearing instruments (20 children, 3-6 years) were verified using coupler-based SPL measurements and measured real-ear-to-coupler differences (RECDs). Results revealed that most of the hearing instrument fittings (regardless of the degree of hearing loss) did not match the prescribed targets. Only 25% of the fittings matched three or more output targets at 65 dB SPL input signal. Output values at 90 dB SPL input signal were far below the prescribed targets. It can be concluded that the lack of a systematic evidence-based approach might lead to inconsistent hearing instrument fittings. Findings may be used to educate clinicians to ensure optimal pediatric hearing instrument fittings.

Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide.

OBJECTIVES: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation. METHODS: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children? SUMMARY: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.

Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: a randomised controlled trial.

OBJECTIVE: Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population. OUTCOME MEASURES: The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Communication Strategies Scale (CSS) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. All questionnaires were administered before and directly after the intervention and at 6 months postintervention. METHODS: We used a parallel group design (RCT). The data were collected in 2013-2014 at three different clinics. Seventy-four HA users were randomly assigned to receive either full internet-based AR (intervention group, n=37) or one element of the internet-based AR (control group, n=37). RESULTS: Data were analysed following the intention-to-treat principle. Each group showed improved HHIE scores over time and did not differ significantly from each other. The intervention group showed significantly greater improvement compared with the control group for the CSS total and the non-verbal subscale scores. The intervention group and control group were also subdivided into two age groups: 20-59 years and 60-80 years. Significantly better improvement on the CSS total and non-verbal subscale scores was found in the older group compared with the younger participants. CONCLUSIONS: This study indicates that participants in an internet-based intervention applied in general clinical practice showed improved self-reported communication skills compared with a control group. Receiving a full intervention was not more effective in improving self-reported hearing problems than receiving just one element of the internet-based intervention. TRIAL REGISTRATION NUMBER: This trial is registered at ClinicalTrals.gov, NCT01837550; results.

Pediatric Minimum Speech Test Battery.

BACKGROUND: Assessment of patient outcomes and documentation of treatment efficacy serves as an essential component of (re)habilitative audiology; however, no standardized protocol exists for the assessment of speech perception abilities for children with hearing loss. This presents a significant challenge in tracking performance of children who utilize various hearing technologies for within-subjects assessment, between-subjects assessment, and even across different facilities. PURPOSE: The adoption and adherence to a standardized assessment protocol could help facilitate continuity of care, assist in clinical decision making, allow clinicians and researchers to define benchmarks for an aggregate clinical population, and in time, aid with patient counseling regarding expectations and predictions regarding longitudinal outcomes. DESIGN: The Pediatric Minimum Speech Test Battery (PMSTB) working group-comprised of clinicians, scientists, and industry representatives-commenced in 2012 and has worked collaboratively to construct the first PMSTB, which is described here. CONCLUSIONS: Implementation of the PMSTB in clinical practice and dissemination of associated data are both critical for achieving the next level of success for children with hearing loss and for elevating pediatric hearing health care ensuring evidence-based practice for (re)habilitative audiology.

The need for and development of an adaptive Listening and Communication Enhancement (LACE) Program.

Auditory training has long been advocated to enhance communication but has never been time or cost-effective. This article describes the concepts underlying the development of a home-based, interactive adaptive computer program designed to engage the adult hearing-impaired listener in the hearing-aid-fitting process, provide listening strategies, build confidence, and address cognitive changes characteristic of the aging process. An investigation using a between-group, within-subject design with pre- and post-test objective and subjective measures was conducted at five clinical sites. Sixty-five subjects were randomly placed into two groups, one receiving LACE (Listening and Communication Enhancement) immediately following baseline testing and one serving as a control for one month and then receiving training as a crossover group. Results showed statistically significant improvements for the trained subjects on all but one of the outcome measures. Barriers facing the widespread implementation of home-based aural rehabilitation are discussed.