Lead Contamination in Ground Venison from Shotgun-Harvested White-Tailed Deer (Odocoileus virginianus) in Illinois.

Ground venison packets from shotgun- and archery-harvested White-tailed Deer in Illinois in 2013 and 2014 were analyzed for metal contamination. Radiographs indicated that 48% of 27 ground venison packets from 10 shotgun-harvested deer contained metal fragments, while none of the 15 packets from three archery-harvested deer contained fragments. ICP-MS analysis verified that all metal fragments from seven of the venison samples from shotgun-harvested deer were composed of lead, with average concentrations from 1.04 to 8.42 µg g-1, dry weight. A single serving of ground venison containing one of these metal fragments embedded in it would be predicted to have a lead concentration ranging from 6.4 to 51.8 µg g-1. Sixty percent of 20 commercial meat processing plants surveyed by phone in 2018 and 2019 indicated that they mixed venison from multiple deer when preparing ground venison products. However, our results do not show any cross-contamination in archery-harvested ground venison processed prior to the firearm hunting seasons.

Development of the Word Auditory Recognition and Recall Measure: A Working Memory Test for Use in Rehabilitative Audiology.

OBJECTIVES: The purpose of this study was to develop the Word Auditory Recognition and Recall Measure (WARRM) and to conduct the inaugural evaluation of the performance of younger adults with normal hearing, older adults with normal to near-normal hearing, and older adults with pure-tone hearing loss on the WARRM. DESIGN: The WARRM is a new test designed for concurrently assessing word recognition and auditory working memory performance in adults who may have pure-tone hearing loss. The test consists of 100 monosyllabic words based on widely used speech-recognition test materials. The 100 words are presented in recall set sizes of 2, 3, 4, 5, and 6 items, with 5 trials in each set size. The WARRM yields a word-recognition score and a recall score. The WARRM was administered to all participants in three listener groups under two processing conditions in a mixed model (between-subjects, repeated measures) design. The between-subjects factor was group, with 48 younger listeners with normal audiometric thresholds (younger listeners with normal hearing [YNH]), 48 older listeners with normal thresholds through 3000 Hz (older listeners with normal hearing [ONH]), and 48 older listeners with sensorineural hearing loss (older listeners with hearing loss [OHL]). The within-subjects factor was WARRM processing condition (no additional task or with an alphabet judgment task). The associations between results on the WARRM test and results on a battery of other auditory and memory measures were examined. RESULTS: Word-recognition performance on the WARRM was not affected by processing condition or set size and was near ceiling for the YNH and ONH listeners (99 and 98%, respectively) with both groups performing significantly better than the OHL listeners (83%). The recall results were significantly better for the YNH, ONH, and OHL groups with no processing (93, 84, and 75%, respectively) than with the alphabet processing (86, 77, and 70%). In both processing conditions, recall was best for YNH, followed by ONH, and worst for OHL listeners. WARRM recall scores were significantly correlated with other memory measures. In addition, WARRM recall scores were correlated with results on the Words-In-Noise (WIN) test for the OHL listeners in the no processing condition and for ONH listeners in the alphabet processing condition. Differences in the WIN and recall scores of these groups are consistent with the interpretation that the OHL listeners found listening to be sufficiently demanding to affect recall even in the no processing condition, whereas the ONH group listeners did not find it so demanding until the additional alphabet processing task was added. CONCLUSIONS: These findings demonstrate the feasibility of incorporating an auditory memory test into a word-recognition test to obtain measures of both word recognition and working memory simultaneously. The correlation of WARRM recall with scores from other memory measures is evidence of construct validity. The observation of correlations between the WIN thresholds with each of the older groups and recall scores in certain processing conditions suggests that recall depends on listeners' word-recognition abilities in noise in combination with the processing demands of the task. The recall score provides additional information beyond the pure-tone audiogram and word-recognition scores that may help rehabilitative audiologists assess the listening abilities of patients with hearing loss.

Style preference survey: a report on the psychometric properties and a cross-validation experiment.

BACKGROUND: Several self-report measures exist that target different aspects of outcomes for hearing aid use. Currently, no comprehensive questionnaire specifically assesses factors that may be important for differentiating outcomes pertaining to hearing aid style. PURPOSE: The goal of this work was to develop the Style Preference Survey (SPS), a questionnaire aimed at outcomes associated with hearing aid style differences. Two experiments were conducted. After initial item development, Experiment 1 was conducted to refine the items and to determine its psychometric properties. Experiment 2 was designed to cross-validate the findings from the initial experiment. RESEARCH DESIGN: An observational design was used in both experiments. STUDY SAMPLE: Participants who wore traditional, custom-fitted (TC) or open-canal (OC) style hearing aids from 3 mo to 3 yr completed the initial experiment. One-hundred and eighty-four binaural hearing aid users (120 of whom wore TC hearing aids and 64 of whom wore OC hearing aids) participated. A new sample of TC and OC users (n = 185) participated in the cross-validation experiment. DATA COLLECTION AND ANALYSIS: Currently available self-report measures were reviewed to identify items that might differentiate between hearing aid styles, particularly preference for OC versus TC hearing aid styles. A total of 15 items were selected and modified from available self-report measures. An additional 55 items were developed through consensus of six audiologists for the initial version of the SPS. In the first experiment, the initial SPS version was mailed to 550 veterans who met the inclusion criteria. A total of 184 completed the SPS. Approximately three weeks later, a subset of participants (n = 83) completed the SPS a second time. Basic analyses were conducted to evaluate the psychometric properties of the SPS including subscale structure, internal consistency, test-retest reliability, and responsiveness. Based on the results of Experiment 1, the SPS was revised. A cross-validation experiment was then conducted using the revised version of the SPS to confirm the subscale structure, internal consistency, and responsiveness of the questionnaire in a new sample of participants. RESULTS: The final factor analysis led to the ultimate version of the SPS, which had a total of 35 items encompassing five subscales: (1) Feedback, (2) Occlusion/Own Voice Effects, (3) Localization, (4) Fit, Comfort, and Cosmetics, and (5) Ease of Use. The internal consistency of the total SPS (Cronbach's α = .92) and of the subscales (each Cronbach's α > .75) was high. Intraclass correlations (ICCs) showed that the test-retest reliability of the total SPS (ICC = .93) and of the subscales (each ICC > .80) also was high. TC hearing aid users had significantly poorer outcomes than OC hearing aid users on 4 of the 5 subscales, suggesting that the SPS largely is responsive to factors related to style-specific differences. CONCLUSIONS: The results suggest that the SPS has good psychometric properties and is a valid and reliable measure of outcomes related to style-specific, hearing aid preference.

Implications of high-frequency cochlear dead regions for fitting hearing aids to adults with mild to moderately severe hearing loss.

OBJECTIVES: A cochlear dead region (DR) occurs at a given frequency when there is a loss of normal functioning of inner hair cells tuned to that frequency. It has been suggested that existence of high-frequency DRs has implications for hearing aid fitting, and that the optimal amount of high-frequency gain is reduced for these patients. However, the data supporting this suggestion has been obtained using listeners with severe or profound hearing loss. It is uncertain whether these results would apply for listeners with the mild to moderately severe hearing loss that is more typical of hearing aid users. This investigation used laboratory and field measurements to examine the effects of reduced high-frequency gain in typical hearing aid users with high-frequency DRs compared with matched users without DRs. DESIGN: The study was a double-blinded, nonrandomized intervention design with 18 matched pairs of adult subjects. In each pair, one subject had high-frequency DRs (usually at one or two test frequencies) and the other subject had no DR. Each subject was fitted unilaterally with a hearing aid having two active programs. One program used a National Acoustics Laboratories (NAL) prescription target for average speech (NAL condition). The other program was identical to NAL except for reduced gain in the high frequencies (low-pass [LP] condition). Outcomes included aided speech recognition in quiet and noise measured in the laboratory, ratings of speech understanding in daily life, and final preference for the NAL or LP program. RESULTS: In laboratory testing, speech recognition in quiet was significantly better when using the NAL program. This result was seen for subjects with DRs and without DRs. When listening in noise, speech recognition was significantly better when using the NAL program for subjects without DRs. For subjects with DRs, results were equivalent for the NAL and LP programs. In daily life, the NAL program received significantly higher ratings for speech understanding, and this result was seen for subjects with and without DRs. When asked about their preference for using the NAL or LP program in daily life, subjects did not always choose the program they had rated as giving better speech understanding, but their preference was not associated with having DRs. About one-third of subjects preferred the LP program. The reason most frequently given for preferring the LP program was that the NAL was too loud. CONCLUSIONS: Overall, adult hearing aid wearers with mild to moderately severe hearing loss benefitted from high-frequency gain whether or not they had DRs. In laboratory testing, but not in daily life, subjects with DRs tended to obtain less benefit than those without DRs. However, provision of NAL high-frequency gain never resulted in poorer performance in either group. These results suggest that identification of high-frequency DRs at one or two frequencies does not call for any a priori modification of the target hearing aid prescription for listeners with mild to moderately severe hearing loss.

The long-term effects of invasive earthworms on plant community composition and diversity in a hardwood forest in northern Minnesota.

Nonnative European earthworms are invading hardwood forests of the Chippewa National Forest, MN. While effects on plant communities at the leading edge of invasion have been studied, little is known about longer-term effects of invasive earthworms. We applied a model using historic O-horizon soil thickness and a chronosequence approach to classify 41 hardwood sites in the Chippewa National Forest as "long-term wormed" (wormed >2 decades), "short-term wormed" or "unwormed/lightly wormed." Graminoids, especially Carex pensylvanica, had the greatest mean percent cover in sites that had been wormed for over two decades. The families with the greatest negative change in mean percent cover after over two decades of earthworm invasion were Asteraceae, Violaceae, and Sapindaceae (specifically Acer species). Across all diversity metrics measured, long-term wormed sites had the lowest understory plant species diversity, short-term wormed sites had intermediate diversity, and unwormed/lightly wormed sites exhibited the highest diversity. Long-term wormed sites had the lowest mean species richness across all sample scales (1-1024 m2). The greatest within-group compositional dissimilarity occurred at sites that had been wormed for over two decades, suggesting that sites that had been wormed for over two decades have not reached a compositionally similar end-state "wormed" community type. Our study suggests that understory diversity will decrease as hardwood forest stands become wormed over time. While our results support other findings that exotic earthworm invasion is associated with lower understory plant diversity in hardwood forests, our study was the first to use space-for-time substitution to document the effects after multiple decades of earthworm invasion.

Cochlear dead regions in typical hearing aid candidates: prevalence and implications for use of high-frequency speech cues.

OBJECTIVES: This study had two purposes. The first was to assess the prevalence of cochlear dead regions (DRs) among listeners with moderate to severe hearing loss that is typical of a large proportion of adult hearing aid wearers. The second was to determine whether subjects who tested positive for DRs differed from those without DRs in their ability to utilize high-frequency speech cues in a laboratory test. DESIGN: One hundred and seventy adults (307 ears) were tested for DRs at frequencies from 0.5 to 4 kHz using the threshold equalizing noise (HL) test. Speech recognition ability was measured for high-frequency emphasis (HFE) stimuli and for low-pass filtered HFE (HFE-LP) stimuli using the Quick Speech In Noise test. Results obtained from the HFE and HFE-LP conditions were compared to examine changes in word recognition when more speech cues were provided above 2.5 kHz. Possible effects of audiogram differences between DR-no and DR-yes groups were examined by estimating the change in audibility for the two Quick Speech In Noise conditions using calculated differences in Speech Intelligibility Index for each condition for every subject. RESULTS: Thirty-one percent of subjects (23% of ears) were found to have a DR at one or more test frequencies. Sixty-eight percent of subjects who tested positive for DR had DRs in one ear only. DRs were most prevalent at frequencies above 1.5 kHz. Comparison of word recognition scores obtained with the HFE and HFE-LP conditions revealed that, on average, both groups scored significantly better when more high-frequency cues were provided. The magnitude of the benefit was small for both groups, but the computed effect size was larger for listeners without DRs than for those with DRs. Further, subjects with contiguous DRs at 2 to 3 frequencies obtained less benefit than subjects with DRs at isolated frequencies. It was determined that the improved audibility of high-frequency cues in the HFE condition was significantly less for listeners with DRs, and this accounted for some, but not all, of the difference in effect sizes. CONCLUSIONS: Although about one-third of listeners with flat or sloping moderate to severe hearing losses tested positive for at least one DR, there was no evidence to support a proposal for reducing high-frequency gain in hearing aid fittings for these types of listeners. Making high frequencies more audible was helpful, on average, regardless of DR status. It is recommended that field trials be undertaken in which subjects with and without DRs wear hearing aids in daily life. This type of study would produce higher level evidence about best practice in hearing aid fitting for patients with flat or sloping moderate to severe hearing loss who test positive for DRs.

Preference for one or two hearing AIDS among adult patients.

OBJECTIVES: Most practitioners believe that use of two hearing aids is the ideal fitting for adults with bilateral symmetrical hearing loss. However, previous research has consistently shown that a substantial proportion of these patients actually prefer to use only one hearing aid. This study explored whether this pattern of preferences is seen with technologically advanced hearing aids. In addition, a selection of variables that were available prefitting were used to attempt to predict which patients will prefer one hearing aid rather than two. DESIGN: The study was designed as a 12-week field trial including structured and unstructured use of one and two hearing aids. Ninety-four subjects with mild to moderate bilaterally symmetrical hearing loss were bilaterally fit with 2005-2007 era hearing aids. Potential predictors included demographic, audiometric, auditory lifestyle, personality, and binaural processing variables. After the field trial, each subject stated his or her preference for one or two hearing aids and completed three self-report outcome questionnaires for their preferred fitting. RESULTS: Previous research was confirmed with modern technology hearing aids: after the field trial, 46% of the subjects preferred to use one hearing aid rather than two. Subjects who preferred two hearing aids tended to report better real-world outcomes than those who preferred one. Subjects who reported more hearing problems in daily life, who experienced more binaural loudness summation, and whose ears were more equivalent in dichotic listening were more likely to prefer to use two hearing aids. Contrary to conventional wisdom (ideas that are generally accepted as true), audiometric hearing loss and auditory lifestyle were not predictive of aiding preference. However, the best predictive approach from these data yielded accurate predictions for only two-thirds of the subjects. CONCLUSIONS: Evidence-based practice calls for a conscientious melding of current evidence, clinical judgment, and patient preferences. The results of this research challenge practitioners to recognize that many patients who seem to be ideal candidates for bilateral aiding will actually prefer to wear only one hearing aid. Furthermore, at this time, there is no accurate method that will predict which patients will prefer one hearing aid rather than two. At present, the most effective approach open to practitioners would be to conduct a candid unbiased systematic field trial allowing each patient to compare unilateral and bilateral fittings in daily life. This might necessitate more fitting sessions and could perhaps add to the practitioner's burden. This downside should be weighed against the additional patient satisfaction that can be anticipated as a result of transparency in the fitting protocol, collaboration with the patient in the treatment decisions, and the knowledge of selecting the most cost-effective patient-centered solution.

Development of APHAB norms for WDRC hearing aids and comparisons with original norms.

OBJECTIVES: This study was undertaken for two purposes: First, to provide a comparison of subjective performance and benefit measured with the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire for two groups. One group included hearing-impaired individuals using 1990s-era linear processing hearing aids. The other group included hearing-impaired individuals using more current wide-dynamic range compression (WDRC)-capable hearing aids fit using current practice protocols. The second purpose of this study was to determine whether APHAB norms derived from scores for current hearing aid users were different from the original 1995 norms. It was hypothesized that technology improvements would result in improved subjective performance for modern hearing aid wearers. DESIGN: A systematic sampling method was used to identify and recruit subjects from seven private-practice audiology clinics located across the United States. Potential subjects were limited to older hearing-impaired individuals who were wearing hearing aids capable of WDRC processing. One hundred fifty-four subjects returned completed APHAB questionnaires. Participants reported mostly moderate to moderately severe subjective hearing difficulty. RESULTS: No differences in perceived difficulty with speech communication were observed between the two groups. However, aversiveness of amplified sound was less frequently reported for users of WDRC-capable hearing aids. Norms were generated using data from all of the operationally defined successful hearing aid users in the sample and compared with the original 1995 norms. Differences between the 1995 and 2005 norms were minimal for the speech communication subscales. However, the 2005 group consistently reported less frequent difficulties with sound aversiveness (AV subscale) in the aided condition. In addition to these findings, an improvement was observed in the rate of successful adjustment to hearing aids between 1995 (43%) and 2005 (82%). CONCLUSIONS: Overall, problems understanding amplified speech did not decrease in frequency when hearing aids transitioned from linear to compression processing; however, the compression capabilities of current hearing aids (with a possible contribution from noise reduction algorithms) have resulted in less negative reactions to amplified environmental sounds. This suggests that modern technology has ameliorated (to some extent) the common complaint that hearing aids cause many everyday sounds to become objectionably loud. Although the results of this study suggest that the advantages of improved technology do not lie in the domains of improved subjective speech communication performance, substantial improvement in the rate of successful adjustment to hearing aids between the 1995 and 2005 subject groups provides evidence that modern hearing aid technology has produced progress in other outcome domains.

Evaluation of the International Outcome Inventory for Hearing Aids in a veteran sample.

BACKGROUND: The International Outcome Inventory for Hearing Aids (IOI-HA) was developed as a global hearing aid outcome measure targeting seven outcome domains. The published norms were based on a private-pay sample who were fitted with analog hearing aids. PURPOSE: The purpose of this study was to evaluate the psychometric properties of the IOI-HA and to establish normative data in a veteran sample. RESEARCH DESIGN: Survey. STUDY SAMPLE: The participants were 131 male veterans (mean age of 74.3 years, SD = 7.4) who were issued hearing aids with digital signal processing (DSP). INTERVENTION: Hearing aids with DSP that were fitted bilaterally between 2005 and 2007. DATA COLLECTION AND ANALYSIS: Veterans were mailed two copies of the IOI-HA. The participants were instructed to complete the first copy of the questionnaire immediately and the second copy in two weeks. The completed questionnaires were mailed to the laboratory. The psychometric properties of the questionnaire were evaluated. As suggested by Cox and colleagues, the participants were divided into two categories based on their unaided subjective hearing difficulty. The two categories were (1) those with less hearing difficulty (none-to-moderate category) and (2) those who report more hearing difficulty (moderately severe+ category). The norms from the current veteran sample then were compared to the original, published sample. For each hearing difficulty category, the critical difference values were calculated for each item and for the total score. RESULTS: A factor analysis showed that the IOI-HA in the veteran sample had the identical subscale structure as reported in the original sample. For the total scale, the internal consistency was good (Chronbach's alpha = 0.83), and the test-retest reliability was high (lambda = 0.94). Group and individual norms were developed for both hearing difficulty categories in the veteran sample. For each IOI-HA item, the critical difference scores were < 1.0. This finding suggests that for any item on the IOI-HA, there is a 95 percent chance that an observed change of one response unit between two test sessions reflects a true change in outcome for a given domain. CONCLUSIONS: The results of this study confirmed that the psychometric properties of the IOI-HA questionnaire are strong and are essentially the same for the veteran sample and the original private-pay sample. The veteran norms, however, produced higher outcomes than those established originally, possibly because of differences in the population samples and/or hearing aid technology. Clinical and research applications of the current findings are presented. Based on the results from the current study, the norms established here should replace the original norms for use in veterans with current hearing aid technology.

Audiometric correlates of the unaided APHAB.

The Abbreviated Profile of Hearing Aid Benefit (APHAB) is a self-report questionnaire that is used to quantify the impact of a hearing problem on an individual's daily life. In this investigation, the relationships were explored between typical clinical audiometric data and the four subscale scores of the APHAB administered in the unaided (without-amplification) condition. Sixty subjects provided APHAB scores, audiograms, and speech recognition data. Analyses revealed significant relationships between audiometric data and each of the three APHAB subscales that reflect speech communication (EC, RV, and BN). None of these subscales was significantly more strongly related to any specific audiological variable. However, the pattern of associations between audiometric variables and subscale scores was consistent with predictions based on item content for subscales EC and RV, but not for BN. As predicted, no relationship was found between audiometric data and scores for the Aversiveness subscale (AV). Even for the subscales with the strongest associations, differences in audiometric data could be used to explain half or less of the variance in self-report data.

Norms for the international outcome inventory for hearing aids.

The International Outcome Inventory for Hearing Aids (IOI-HA) is a seven-item survey that was developed for use in research settings to facilitate comparison of data across diverse investigations. The inventory also has potential applications in clinical evaluation of hearing aid fitting outcomes. This article reports the development of norms for the inventory that are suitable for use with group data in research applications, and individual data in a clinical setting. The normative group was defined as adults fitted bilaterally with analog, single-channel, single-memory, compression processing, in-the-ear hearing aids. There were 154 subjects. Associations between outcomes and demographic variables (e.g., gender, hearing loss, etc.) were explored, and several relationships were seen. Based on these data, two sets of norms were derived. The appropriate set will depend on the individual's reported subjective hearing problems without amplification.

Development of the Device-Oriented Subjective Outcome (DOSO) scale.

BACKGROUND: The empiric basis for this work is derived from previous research completed in our laboratory and published in 2005 and 2007. The previous work suggested that self-report hearing aid outcomes can be viewed as device oriented or wearer oriented. Furthermore, compared with wearer-oriented outcomes, device-oriented outcomes were more independent of personality variables. PURPOSE: The purpose of this study was to develop a device-oriented questionnaire to measure self-report hearing aid outcomes. RESEARCH DESIGN: Design was a descriptive study in which 140 potential questionnaire items were evaluated and a questionnaire was devised. STUDY SAMPLE: A total of 306 adult hearing aid wearers participated: 189 were clinical patients and 117 were participants in hearing aid field trials. DATA COLLECTION AND ANALYSIS: Some items and some participants were removed because of insufficient responses. The final dataset included 295 participants and 66 items. Response data were subjected to exploratory principal component analysis with orthogonal rotation. Six components, explaining 64% of the variance, were retained. Item statistics were examined. RESULTS: Six subscales were identified. Long and short forms of the questionnaire were developed. There are two equivalent versions of the short form. CONCLUSIONS: The Device-Oriented Subjective Outcome (DOSO) questionnaire is suitable for quantifying subjective hearing aid outcomes in both research and clinical settings. The DOSO is especially suited for comparing outcomes with different hearing aids. Future research is needed to cross-validate the results, determine retest consistency, and to explore the extent to which data from the DOSO is independent of personality.

Personality, hearing problems, and amplification characteristics: contributions to self-report hearing aid outcomes.

OBJECTIVE: When we evaluate the success of a hearing aid fitting, or the effectiveness of new amplification technology, self-report data occupy a position of critical importance. Unless patients report that our efforts are helpful, it is difficult to justify a conclusion that the intervention has been successful. Although it is generally assumed that subjective reports primarily reflect the excellence of the fitted hearing aid(s) within the context of the patient's everyday circumstances, there is relatively little research that assesses the validity of this assumption. In previous work, we have reported some contributions of the service delivery setting (private practice versus public health) to self-report outcomes. The purpose of the present investigation was to assess the relative contributions of patient variables (such as personality and hearing problems) and amplification variables (such as soft sound audibility, gain and maximum output) to self-reports of hearing aid fitting outcomes. DESIGN: A cross-sectional survey of 205 patients was conducted with cooperation of eleven Audiology clinics. All subjects were recruited when they were seeking new hearing aids. Before the hearing aid fitting, measurements of personality and response bias were made, as well as measures of hearing problems and expectations about amplification. At the fitting, traditional verification data were measured including sound field thresholds, preferred gain for conversation, and maximum output. Six months after the fitting, a set of 12 standardized self-report outcomes was completed. Analyses concerned: (1) the associations among personality, response bias, and self-reports about hearing problems that are available before the hearing aid fitting, and (2) the associations of these precursor variables, and fitting verification data, with self-report data assessing the outcome of hearing aid provision. RESULTS: Self-reports of hearing problems, sound aversiveness, and hearing aid expectations obtained before the fitting were found to be more closely related to the strength of certain personality traits than to audiometric hearing loss. Response bias also was associated with personality variables. Analyses of the collection of outcome measures produced a set of three components that were interpreted as a Device component, a Success component, and an Acceptance component. The Device component was construed as reflecting characteristics of the hearing aid whereas the two other components were construed as reflecting attributes of the wearer. The Success and Acceptance components were each significantly associated with several personality traits, but the Device component was not associated with personality. Variables available before the fitting accounted for 20 to 30% of each outcome component whereas amplification variables measured to verify the fitting accounted for only 10% on only one component. CONCLUSIONS: As reported in previous research, personality is associated with self-report outcome data. However, if practitioners utilize existing measures of hearing problems at the prefitting stage, separate personality data will not yield additional leverage in prediction of long-term fitting outcomes. Traditional fitting verification data as measured in this study, proved minimally useful in prediction of long-term outcomes of the fitting. A large proportion of variance in self-report fitting outcomes has yet to be accounted for. Finally, it appears that certain types of questionnaires might be more appropriate for research evaluating new amplification devices, whereas a different questionnaire approach might be optimal for evaluating intervention effectiveness in a clinical context.

Who wants a hearing aid? Personality profiles of hearing aid seekers.

OBJECTIVE: Evidence indicates that elderly hearing-impaired people who use amplification live happier, healthier, and longer lives than those who do not. Nevertheless, only a small fraction (approximately 23%) of hearing-impaired adults actually seek and use hearing aids. This study explored the personalities of hearing aid seekers in an attempt to determine whether those who seek hearing aids are systematically different from the general population. DESIGN: In this cross-sectional survey, self-report data were obtained from 230 older adults with bilateral, symmetrical, sensorineural, mild to moderately severe hearing impairment. Subjects were representative of patients served either in a publicly funded hospital-based system (VA) or in a free-standing private practice system (PP). All subjects were seeking new hearing aids. Subjects completed a comprehensive personality questionnaire (NEO-Five-Factor Inventory) as well as questionnaires determining locus of control and preferred coping strategies. RESULTS: Individuals who seek amplification are not simply a random sample of the general population and presumably not a random sample of the hearing-impaired population. Compared with the typical adult, hearing aid seekers tended to be more pragmatic and routine-oriented and probably less imaginative in coming up with novel approaches to dealing with a complex problem such as hearing impairment. These individuals also were found to feel relatively more personally powerful in dealing with life's challenges. Further, hearing aid seekers reported using social support coping strategies less frequently than their non-hearing-impaired peers. In addition, there were significant differences in personality patterns between hearing aid seekers in the PP and VA systems. Differences noted in the personality traits of Openness and Neuroticism might be a useful guide to selecting treatment approaches and expectations for patients in each setting. Additional differences in Agreeableness imply that patients in the private practice system were more trusting than those in the general population, whereas this was not seen for patients in the public health VA system. One interpretation of this finding is that hearing-impaired individuals who are more suspicious and cynical are reluctant to try amplification in the PP system. This observation underscores the need to improve the public image of hearing health care to increase the uptake of hearing aids in general. CONCLUSIONS: Although individual hearing aid seekers display personality characteristics within the range of normal, this study suggested that they are not simply a random sample of the general population. Possible explanations are offered for significant personality differences, and potential clinical relevance is noted for some effects. The data also point to a need to improve the public image of hearing health care in the PP system.

Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

OBJECTIVE: In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. DESIGN: The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. RESULTS: Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. CONCLUSIONS: These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.

The International Outcome Inventory for Hearing Aids (IOI-HA): psychometric properties of the English version.

The International Outcome Inventory for Hearing Aids (IOI-HA) is a seven-item questionnaire designed to be generally applicable in evaluating the effectiveness of hearing aid treatments. The inventory was developed to facilitate cooperation among researchers and program evaluators in diverse settings. It is brief and general enough to be appended to other outcome measures that might be planned in a particular application, and will provide directly comparable data across otherwise incompatible projects. For this plan to be successful, it is essential to generate psychometrically equivalent translations in the languages in which hearing aid research and treatment assessments are performed. This article reports the psychometric properties of the inventory for the original English version. The items are reasonably internally consistent, providing adequate statistical support for summing the scores to generate a total outcome score. However, for maximum internal consistency, it would be desirable to generate two scores for the inventory.