A Randomized Control Trial: Supplementing Hearing Aid Use with Listening and Communication Enhancement (LACE) Auditory Training.

OBJECTIVE: To examine the effectiveness of the Listening and Communication Enhancement (LACE) program as a supplement to standard-of-care hearing aid intervention in a Veteran population. DESIGN: A multisite randomized controlled trial was conducted to compare outcomes following standard-of-care hearing aid intervention supplemented with (1) LACE training using the 10-session DVD format, (2) LACE training using the 20-session computer-based format, (3) placebo auditory training (AT) consisting of actively listening to 10 hr of digitized books on a computer, and (4) educational counseling-the control group. The study involved 3 VA sites and enrolled 279 veterans. Both new and experienced hearing aid users participated to determine if outcomes differed as a function of hearing aid user status. Data for five behavioral and two self-report measures were collected during three research visits: baseline, immediately following the intervention period, and at 6 months postintervention. The five behavioral measures were selected to determine whether the perceptual and cognitive skills targeted in LACE training generalized to untrained tasks that required similar underlying skills. The two self-report measures were completed to determine whether the training resulted in a lessening of activity limitations and participation restrictions. Outcomes were obtained from 263 participants immediately following the intervention period and from 243 participants 6 months postintervention. Analyses of covariance comparing performance on each outcome measure separately were conducted using intervention and hearing aid user status as between-subject factors, visit as a within-subject factor, and baseline performance as a covariate. RESULTS: No statistically significant main effects or interactions were found for the use of LACE on any outcome measure. CONCLUSIONS: Findings from this randomized controlled trial show that LACE training does not result in improved outcomes over standard-of-care hearing aid intervention alone. Potential benefits of AT may be different than those assessed by the performance and self-report measures utilized here. Individual differences not assessed in this study should be examined to evaluate whether AT with LACE has any benefits for particular individuals. Clinically, these findings suggest that audiologists may want to temper the expectations of their patients who embark on LACE training.

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.

The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus.

OBJECTIVES: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. DESIGN: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1.Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent-constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2.Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. RESULTS: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions.In the final TFI, Cronbach's alpha was 0.97 and test-retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. CONCLUSIONS: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

Speech-in-noise measures: variable versus fixed speech and noise levels.

OBJECTIVE: The purpose was to determine if speech-recognition performances were the same when the speech level was fixed and the noise level varied as when the noise level was fixed and the speech level varied. DESIGN: A descriptive/quasi-experimental experiment was conducted with Lists 3 and 4 of the revised speech perception in noise (R-SPIN) test, which involves high predictability (HP) and low predictability (LP) words. The R-SPIN was modified into a multiple signal-to-noise paradigm (23- to -1-dB in 3-dB decrements) from which the 50% points were calculated with the Spearman-Kärber equation. STUDY SAMPLE: Sixteen young listeners with normal hearing and 48 older listeners with pure-tone hearing losses participated. RESULTS: The listeners with normal hearing performed better than the listeners with hearing loss on both the HP and LP conditions. For both groups of listeners, (1) performance on the HP sentences was better than on the LP sentences, and (2) the mean 50% points were 0.1 to 0.4 dB lower (better) on the speech-variable, babble-fixed condition than on the speech-fixed, babble-variable condition. CONCLUSIONS: For practical purposes the ≤ 0.4-dB differences are not considered noteworthy as the differences are smaller than the decibel value of one word on the test (0.6 dB).

Subjective and objective outcomes from new BiCROS technology in a veteran sample.

BACKGROUND: Patients with single-sided deafness (SSD), where one ear has an unaidable hearing loss and the other ear has normal or aidable hearing, often complain of difficulties understanding speech and localizing sound sources, and report a higher self-perceived hearing disability. Patients with SSD may benefit from using contralateral routing of signal (CROS) or bilateral contralateral routing of the signal (BiCROS) amplification. Dissatisfaction of previously available (Bi)CROS devices has been reported, such as, interfering transmissions, low-fidelity sound quality, poor "user-friendly" set-up, and a bulky and cosmetically cumbersome appearance. PURPOSE: Recent advances in hearing aid technology have improved (Bi)CROS hearing aids; however, these devices have not been experimentally evaluated. We hypothesized that newer technology with reports of improved digital signal processing, wireless transmission, and physical design would be as good, or better than, our participants' previous-generation BiCROS systems. RESEARCH DESIGN: A within-subjects, pretest-posttest design was executed. STUDY SAMPLE: Thirty-nine veterans (one female, 38 males; mean age = 74 yr, range = 49-85 yr) from the Audiology Section of the Bay Pines Veterans Affair Healthcare System participated. All participants were previously experienced BiCROS hearing aid users with varying degrees of sensorinerual hearing impairment in their better ear. INTERVENTION: Participants were provided at least 4 wk of consistent use with the new BiCROS. DATA COLLECTION AND ANALYSES: Participants completed three research visits. At Visit 1, with their previous BiCROS, and at Visit 3, with their new BiCROS, the following objective and subjective measures were obtained: (1) soundfield speech-in-noise testing using the Words-In-Noise (WIN) test; (2) speech, spatial, and qualities of the hearing scale (SSQ) questionnaire; (3) selected questions from the MarkeTrak questionnaire; and, (4) three open-ended questions. Data were analyzed using parametric and nonparametric statistics. RESULTS: Overall, the objective (WIN) and subjective (SSQ, MarkeTrak, and open-ended questions) measures indicated that the new BiCROS provided better outcomes than the previous BiCROS system. In addition, an overlap of favorable results was seen across measures. CONCLUSIONS: Of the 39 participants, 95% reported improvements with the new BiCROS and chose to utilize the device regularly. The favorable objective and subjective outcomes indicate that the new BiCROS system is as good, or better than, what was previously utilized by our sample of veterans.

Are two ears not better than one?

BACKGROUND: The decision to fit one or two hearing aids in individuals with binaural hearing loss has been debated for years. Although some 78% of U.S. hearing aid fittings are binaural (Kochkin , 2010), Walden and Walden (2005) presented data showing that 82% (23 of 28 patients) of their sample obtained significantly better speech recognition in noise scores when wearing one hearing aid as opposed to two. PURPOSE: To conduct two new experiments to fuel the monaural/binaural debate. The first experiment was a replication of Walden and Walden (2005), whereas the second experiment examined the use of binaural cues to improve speech recognition in noise. RESEARCH DESIGN: A repeated measures experimental design. STUDY SAMPLE: Twenty veterans (aged 59-85 yr), with mild to moderately severe binaurally symmetrical hearing loss who wore binaural hearing aids were recruited from the Audiology Department at the Bay Pines VA Healthcare System. DATA COLLECTION AND ANALYSIS: Experiment 1 followed the procedures of the Walden and Walden study, where signal-to-noise ratio (SNR) loss was measured using the Quick Speech-in-Noise (QuickSIN) test on participants who were aided with their current hearing aids. Signal and noise were presented in the sound booth at 0° azimuth under five test conditions: (1) right ear aided, (2) left ear aided, (3) both ears aided, (4) right ear aided, left ear plugged, and (5) unaided. The opposite ear in (1) and (2) was left open. In Experiment 2, binaural Knowles Electronics Manikin for Acoustic Research (KEMAR) manikin recordings made in Lou Malnati's pizza restaurant during a busy period provided a typical real-world noise, while prerecorded target sentences were presented through a small loudspeaker located in front of the KEMAR manikin. Subjects listened to the resulting binaural recordings through insert earphones under the following four conditions: (1) binaural, (2) diotic, (3) monaural left, and (4) monaural right. RESULTS: Results of repeated measures ANOVAs demonstrated that the best speech recognition in noise performance was obtained by most participants with both ears aided in Experiment 1 and in the binaural condition in Experiment 2. CONCLUSIONS: In both experiments, only 20% of our subjects did better in noise with a single ear, roughly similar to the earlier Jerger et al (1993) finding that 8-10% of elderly hearing aid users preferred one hearing aid.

Initial-fit approach versus verified prescription: comparing self-perceived hearing aid benefit.

BACKGROUND: Despite evidence suggesting inaccuracy in the default fittings provided by hearing aid manufacturers, the use of probe-microphone measures for the verification of fitting accuracy is routinely used by fewer than half of practicing audiologists. PURPOSE: The present study examined whether self-perception of hearing aid benefit, as measured through the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), differed as a function of hearing aid fitting method, specifically, manufacturer's initial-fit approach versus a verified prescription. The prescriptive fit began at NAL-NL1 targets, with adjustments based on participant request. Each of the two fittings included probe-microphone measurement. RESEARCH DESIGN: A counterbalanced, cross-over, repeated-measures, single-blinded design was utilized to address the research objectives. STUDY SAMPLE: Twenty-two experienced hearing aid users from the general Bay Pines VA Healthcare System audiology clinic population were randomized into one of two intervention groups. INTERVENTION: At the first visit, half of the participants were fit with new hearing aids via the manufacturer's initial fit while the second half were fit to a verified prescription using probe-microphone measurement. After a wear period of 4-6 wk, the participants' hearing aids were refit via the alternate method and worn for an additional 4-6 wk. Participants were blinded to the method of fitting by utilizing probe-microphone measures with both approaches. DATA COLLECTION AND ANALYSIS: The APHAB was administered at baseline and at the end of each intervention trial. At the end of the second trial period, the participants were asked to identify which hearing aid fitting was "preferred." The APHAB data were subjected to a general linear model repeated-measures analysis of variance. RESULTS: For the three APHAB communication subscales (i.e., Ease of Communication, Reverberation, and Background Noise) mean scores obtained with the verified prescription were higher than those obtained with the initial-fit approach, indicating greater benefit with the former. The main effect of hearing aid fitting method was statistically significant [F (1, 21) = 4.69, p = 0.042] and accounted for 18% of the variance in the data (partial eta squared = 0.183). Although the mean benefit score for the APHAB Aversiveness subscale was also better (i.e., lower) for the verified prescription than the initial-fit approach, the difference was not statistically significant. Of the 22 participants, 7 preferred their hearing aids programmed to initial-fit settings and 15 preferred their hearing aids programmed to the verified prescription. CONCLUSIONS: The data support the conclusion that hearing aids fit to experienced hearing aid wearers using a verified prescription are more likely to yield better self-perceived benefit as measured by the APHAB than if fit using the manufacturer's initial-fit approach.

The Revised Speech Perception in Noise Test (R-SPIN) in a multiple signal-to-noise ratio paradigm.

BACKGROUND: The Revised Speech Perception in Noise Test (R-SPIN; Bilger, 1984b) is composed of 200 target words distributed as the last words in 200 low-predictability (LP) and 200 high-predictability (HP) sentences. Four list pairs, each consisting of two 50-sentence lists, were constructed with the target word in a LP and HP sentence. Traditionally the R-SPIN is presented at a signal-to-noise ratio (SNR, S/N) of 8 dB with the listener task to repeat the last word in the sentence. PURPOSE: The purpose was to determine the practicality of altering the R-SPIN format from a single SNR paradigm into a multiple SNR paradigm from which the 50% points for the HP and LP sentences can be calculated. RESEARCH DESIGN: Three repeated measures experiments were conducted. STUDY SAMPLE: Forty listeners with normal hearing and 184 older listeners with pure-tone hearing loss participated in the sequence of experiments. DATA COLLECTION AND ANALYSIS: The R-SPIN sentences were edited digitally (1) to maintain the temporal relation between the sentences and babble, (2) to establish the SNRs, and (3) to mix the speech and noise signals to obtain SNRs between -1 and 23 dB. All materials were recorded on CD and were presented through an earphone with the responses recorded and analyzed at the token level. For reference purposes the Words-in-Noise Test (WIN) was included in the first experiment. RESULTS: In Experiment 1, recognition performances by listeners with normal hearing were better than performances by listeners with hearing loss. For both groups, performances on the HP materials were better than performances on the LP materials. Performances on the LP materials and on the WIN were similar. Performances at 8 dB S/N were the same with the traditional fixed level presentation and the descending presentation level paradigms. The results from Experiment 2 demonstrated that the four list pairs of R-SPIN materials produced good first approximation psychometric functions over the -4 to 23 dB S/N range, but there were irregularities. The data from Experiment 2 were used in Experiment 3 to guide the selection of the words to be used at the various SNRs that would provide homogeneous performances at each SNR and would produce systematic psychometric functions. In Experiment 3, the 50% points were in good agreement for the LP and HP conditions within both groups of listeners. The psychometric functions for List Pairs 1 and 2, 3 and 4, and 5 and 6 had similar characteristics and maintained reasonable separations between the HP and LP functions, whereas the HP and LP functions for List Pair 7 and 8 bisected one another at the lower SNRs. CONCLUSIONS: This study indicates that the R-SPIN can be configured into a multiple SNR paradigm. A more in-depth study with the R-SPIN materials is needed to develop lists that are systematic and reasonably equivalent for use on listeners with hearing loss. The approach should be based on the psychometric characteristics of the 200 HP and 200 LP sentences with the current R-SPIN lists discarded. Of importance is maintaining the synchrony between the sentences and their accompanying babble.

Hearing Health Care Utilization Following Automated Hearing Screening.

BACKGROUND: The study examined follow-up rates for pursuing hearing health care (HHC) 6 to 8 months after participants self-administered one of three hearing screening methods: an automated method for testing of auditory sensitivity (AMTAS), a four-frequency pure-tone screener (FFS), or a digits-in-noise test (DIN), with and without the presentation of a 2-minute educational video about hearing. PURPOSE: The study aims to determine if the type of self-administered hearing screening method (with or without an educational video) affects HHC follow-up rates. RESEARCH DESIGN: The study is a randomized controlled trial of three automated hearing screening methods, plus control group, with and without an educational video. The control group completed questionnaires and provided follow-up data but did not undergo a hearing screening test. STUDY SAMPLE: The study sample includes 1,665 participants (mean age 50.8 years; 935 males) at two VA Medical Centers and at university and community centers in Portland, OR; Bay Pines, FL; Minneapolis, MN; Mauston, WI; and Columbus, OH. DATA COLLECTION AND ANALYSIS: HHC follow-up data at 6 to 8 months were obtained by contacting participants by phone or mail. Screening methods and participant characteristics were compared in relation to the probability of participants pursuing HHC during the follow-up period. RESULTS: The 2-minute educational video did not have a significant effect on HHC follow-up rates. When all participants who provided follow-up data are considered (n = 1012), the FFS was the only test that resulted in a significantly greater percentage of HHC follow-up (24.6%) compared with the control group (16.8%); p = 0.03. However, for participants who failed a hearing screening (n = 467), follow-up results for all screening methods were significantly greater than for controls. The FFS resulted in a greater probability for HHC follow-up overall than the other two screening methods. Moreover, veterans had higher follow-up rates for all screening methods than non-veterans. CONCLUSION: The FFS resulted in a greater HHC follow-up rate compared with the other screening methods. This self-administered test may be more motivational for HHC follow-up because participants who fail the screening are aware of sounds they could not hear which does not occur with adaptive assessments like AMTAS or the DIN test. It is likely that access to and reduced personal cost of audiological services for veterans contributed to higher HHC follow-up rates in this group compared with non-veteran participants.

Word-recognition performance in interrupted noise by young listeners with normal hearing and older listeners with hearing loss.

BACKGROUND: The most common complaint of adults with hearing loss is understanding speech in noise. One class of masker that may be particularly useful in the assessment of speech-in-noise abilities is interrupted noise. Interrupted noise usually is a continuous noise that has been multiplied by a square wave that produces alternating intervals of noise and silence. Wilson and Carhart found that spondaic word thresholds for listeners with normal hearing were 28 dB lower in an interrupted noise than in a continuous noise, whereas listeners with hearing loss experienced only an 11 dB difference. PURPOSE: The purpose of this series of experiments was to determine if a speech-in-interrupted-noise paradigm differentiates better (1) between listeners with normal hearing and listeners with hearing loss and (2) among listeners with hearing loss than do traditional speech-in-continuous-noise tasks. RESEARCH DESIGN: Four descriptive/quasi-experimental studies were conducted. STUDY SAMPLE: Sixty young adults with normal hearing and 144 older adults with pure-tone hearing losses participated. DATA COLLECTION AND ANALYSIS: A 4.3 sec sample of speech-spectrum noise was constructed digitally to form the 0 interruptions per second (ips; continuous) noise and the 5, 10, and 20 ips noises with 50% duty cycles. The noise samples were mixed digitally with the Northwestern University Auditory Test No. 6 words at selected signal-to-noise ratios and recorded on CD. The materials were presented through an earphone, and the responses were recorded and analyzed at the word level. Similar techniques were used for the stimuli in the remaining experiments. RESULTS: In Experiment 1, using 0 ips as the reference condition, the listeners with normal hearing achieved 34.0, 30.2, and 28.4 dB escape from masking for 5, 10, and 20 ips, respectively. In contrast, the listeners with hearing loss only achieved 2.1 to 2.4 dB escape from masking. Experiment 2 studied the 0 and 5 ips conditions on 72 older listeners with hearing loss, who were on average 13 yr younger and more varied in their hearing loss than the listeners in Experiment 1. The mean escape from masking in Experiment 2 was 7dB, which is 20-25 dB less than the escape achieved by listeners with normal hearing. Experiment 3 examined the effects that duty cycle (0-100% in 10% steps) had on recognition performance in the 5 and 10 ips conditions. On the 12 young listeners with normal hearing, (1) the 50% correct point increased almost linearly between the 0 and 60% duty cycles (slope = 4.2 dB per 10% increase in duty cycle), (2) the slope of the function was steeper between 60 and 80% duty cycles, and (3) about the same masking was achieved for the 80-100% duty cycles. The data from the listeners with hearing loss were inconclusive. Experiment 4 varied the interburst ratios (0, -6, -12, -24, -48, and -infinity dB) of 5 ips noise and evaluated recognition performance by 24 young adults. The 50% points were described by a linear regression (R2 = 0.98) with a slope of 0.55 dB/dB. CONCLUSION: The current data indicate that interrupted noise does provide a better differentiation both between listeners with normal hearing and listeners with hearing loss and among listeners with hearing loss than is provided by continuous noise.

A comparison of recognition performances in speech-spectrum noise by listeners with normal hearing on PB-50, CID W-22, NU-6, W-1 spondaic words, and monosyllabic digits spoken by the same speaker.

BACKGROUND: So that portions of the classic Miller, Heise, and Lichten (1951) study could be replicated, new recorded versions of the words and digits were made because none of the three common monosyllabic word lists (PAL PB-50, CID W-22, and NU-6) contained the 9 monosyllabic digits (1-10, excluding 7) that were used by Miller et al. It is well established that different psychometric characteristics have been observed for different lists and even for the same materials spoken by different speakers. The decision was made to record four lists of each of the three monosyllabic word sets, the monosyllabic digits not included in the three sets of word lists, and the CID W-1 spondaic words. A professional female speaker with a General American dialect recorded the materials during four recording sessions within a 2-week interval. The recording order of the 582 words was random. PURPOSE: To determine-on listeners with normal hearing-the psychometric properties materials presented in speech-spectrum noise. RESEARCH DESIGN: A quasi-experimental, repeated-measures design was used. STUDY SAMPLE: Twenty-four young adult listeners (M = 23 years) with normal pure-tone thresholds (< or = 20-dB HL at 250 to 8000 Hz) participated. The participants were university students who were unfamiliar with the test materials. DATA COLLECTION AND ANALYSIS: The 582 words were presented at four signal-to-noise ratios (SNRs; -7-, -2-, 3-, and 8-dB) in speech-spectrum noise fixed at 72-dB SPL. Although the main metric of interest was the 50% point on the function for each word established with the Spearman-Kärber equation (Finney, 1952), the percentage correct on each word at each SNR was evaluated. The psychometric characteristics of the PB-50, CID W-22, and NU-6 monosyllabic word lists were compared with one another, with the CID W-1 spondaic words, and with the 9 monosyllabic digits. RESULTS: Recognition performance on the four lists within each of the three monosyllabic word materials were equivalent, +/- 0.4 dB. Likewise, word-recognition performance on the PB-50, W-22, and NU-6 word lists were equivalent, +/- 0.2 dB. The mean recognition performance at the 50% point with the 36 W-1 spondaic words was approximately 6.2 dB lower than the 50% point with the monosyllabic words. Recognition performance on the monosyllabic digits was 1-2 dB better than mean performance on the monosyllabic words. CONCLUSIONS: Word-recognition performances on the three sets of materials (PB-50, CID W-22, and NU-6) were equivalent, as were the performances on the four lists that make up each of the three materials. Phonetic/phonemic balance does not appear to be an important consideration in the compilation of word-recognition lists used to evaluate the ability of listeners to understand speech. A companion paper examines the acoustic, phonetic/phonological, and lexical variables that may predict the relative ease or difficulty for which these monosyllable words were recognized in noise (McArdle and Wilson, this issue).

Predicting word-recognition performance in noise by young listeners with normal hearing using acoustic, phonetic, and lexical variables.

PURPOSE: To analyze the 50% correct recognition data that were from the Wilson et al (this issue) study and that were obtained from 24 listeners with normal hearing; also to examine whether acoustic, phonetic, or lexical variables can predict recognition performance for monosyllabic words presented in speech-spectrum noise. RESEARCH DESIGN: The specific variables are as follows: (a) acoustic variables (i.e., effective root-mean-square sound pressure level, duration), (b) phonetic variables (i.e., consonant features such as manner, place, and voicing for initial and final phonemes; vowel phonemes), and (c) lexical variables (i.e., word frequency, word familiarity, neighborhood density, neighborhood frequency). DATA COLLECTION AND ANALYSIS: The descriptive, correlational study will examine the influence of acoustic, phonetic, and lexical variables on speech recognition in noise performance. RESULTS: Regression analysis demonstrated that 45% of the variance in the 50% point was accounted for by acoustic and phonetic variables whereas only 3% of the variance was accounted for by lexical variables. These findings suggest that monosyllabic word-recognition-in-noise is more dependent on bottom-up processing than on top-down processing. CONCLUSIONS: The results suggest that when speech-in-noise testing is used in a pre- and post-hearing-aid-fitting format, the use of monosyllabic words may be sensitive to changes in audibility resulting from amplification.

Evidence for the use of hearing assistive technology by adults: the role of the FM system.

Hearing assistive technologies include listening, alerting, and/or signaling devices that use auditory, visual, and/or tactile modalities to augment communication and/or facilitate awareness of environmental sounds. The importance of hearing assistive technologies in the management of adults with hearing loss was recently acknowledged in an evidence-based clinical practice guideline developed by the American Academy of Audiology. Most currently available evidence for hearing assistive technology use by adults focuses on frequency-modulated (FM) technology. Previous research is reviewed that demonstrates the efficacy of FM devices for adults in terms of laboratory measures of speech understanding in noise. Also reviewed are the outcomes from field trials of FM use by community-dwelling adults, which, to date, have been disappointing. Few to no individuals, in previous studies, elected to use FM devices at the end of the trial periods. Data are presented from a 1-group pretest-posttest study examining the role of extensive counseling, coaching, and instruction on FM use by adults. In addition, the potential influence of the cost of devices to the individual was eliminated by conducting the study with veterans who were eligible to receive FM systems through the Veterans Affairs National Hearing Aid Program. Positive outcomes were obtained at the end of a 6-week trial period and were found to remain 1 year after study completion. Implications for increasing the evidence base for the use of FM devices by adults are discussed.

An Evaluation of the BKB-SIN, HINT, QuickSIN, and WIN Materials on Listeners With Normal Hearing and Listeners With Hearing Loss.

PURPOSE: The purpose of this study was to examine in listeners with normal hearing and listeners with sensorineural hearing loss the within- and between-group differences obtained with 4 commonly available speech-in-noise protocols. METHOD: Recognition performances by 24 listeners with normal hearing and 72 listeners with sensorineural hearing loss were compared for 4 speech-in-noise protocols that varied with respect to the amount of contextual cues conveyed in the target signal. The protocols studied included the Bamford-Kowal-Bench Speech-in-Noise Test (BKB-SIN; Etymotic Research, 2005; J. Bench, A. Kowal, & J. Bamford, 1979; P. Niquette et al., 2003), the Quick Speech-in-Noise Test (QuickSIN; M. C. Killion, P. A. Niquette, G. I. Gudmundsen, L. J. Revit, & S. Banerjee, 2004), and the Words-in-Noise test (WIN; R. H. Wilson, 2003; R. H. Wilson & C. A. Burks, 2005), each of which used multitalker babble and a modified method of constants, as well as the Hearing in Noise Test (HINT; M. Nilsson, S. Soli, & J. Sullivan, 1994), which used speech-spectrum noise and an adaptive psychophysical procedure. RESULTS: The 50% points for the listeners with normal hearing were in the 1- to 4-dB signal-to-babble ratio (S/B) range and for the listeners with hearing loss in the 5- to 14-dB S/B range. Separation between groups was least with the BKB-SIN and HINT (4-6 dB) and most with the QuickSIN and WIN (8-10 dB). CONCLUSION: The QuickSIN and WIN materials are more sensitive measures of recognition performance in background noise than are the BKB-SIN and HINT materials.

Intra- and inter-session test, retest reliability of the Words-in-Noise (WIN) test.

Retest stability and retest reliability were assessed for the Words-in-Noise Test (WIN) in two experiments involving older listeners with sensorineural hearing loss. In Experiment 1, the 70-item WIN protocol was administered during two sessions 12 months apart to examine retest stability on a sample of 315 veterans from four VA Medical Centers. The mean 50% points on the WIN were 12.5- and 12.8-dB S/N for the two sessions with a critical difference of 3.5 dB and an intra-class correlation coefficient of 0.88. [Normal recognition performance on the WIN (50% point) is < or =6-dB S/N.] In Experiment 2, intra- and inter-session retest reliability was examined for the two 35-word WIN protocols on 96 veterans, 48 of whom had mild-to-severe hearing loss (Group 1) and 48 of whom had a moderate-to-severe hearing loss (Group 2). The mean 50% points on the WIN during the two sessions (separated by 40 days) were 13.0- and 13.4-dB S/N (Group 1) and 15.3- and 15.8-dB S/N (Group 2) with no significant intra-session differences. A 3.1-dB critical difference was calculated for the groups combined with intra-class correlations of 0.89 and 0.91 for Group 1 and Group 2, respectively.

Homogeneity of the 18 QuickSIN lists.

The purpose of this study was to determine the list equivalency of the 18 QuickSIN (Quick Speech in Noise test) lists. Individuals with normal hearing (n = 24) and with sensorineural hearing loss (n = 72) were studied. Mean recognition performances on the 18 lists by the listeners with normal hearing were 2.8 to 4.3 dB SNR (signal-to-noise ratio), whereas the range was 10.0 to 14.3 dB SNR for the listeners with hearing loss. The psychometric functions for each list showed high performance variability across lists for listeners with hearing loss but not for listeners with normal hearing. For listeners with hearing loss, Lists 4, 5, 13, and 16 fell outside of the critical difference. The data from this study suggest nine lists that provide homogenous results for listeners with and without hearing loss. Finally, there was an 8.7 dB difference in performances between the two groups indicating a more favorable signal-to-noise ratio required by the listeners with hearing loss to obtain equal performance.

Health-related quality of life and hearing aids: a tutorial.

Health-related quality-of-life (HRQoL) instruments measure the impact of a disorder and treatment on several attributes that are thought to constitute the self-perceived health status of an individual. This tutorial reviews the conceptual framework of HRQoL, including the challenges associated with defining and measuring HRQoL, specifically as it applies to audiologic care. A relatively new instrument, the World Health Organization-Disability Assessment Schedule II, will be discussed as a potentially valuable instrument to measure the impact of hearing loss and hearing aid intervention on self-perceived HRQoL.

The WHO-DAS II: measuring outcomes of hearing aid intervention for adults.

The World Health Organization's Disability Assessment Scale II (WHO-DAS II) is a generic health-status instrument that provides six domain scores and a total, aggregate score. Two of the domain scores, communication and participation, and the total score, have good validity, internal-consistency reliability, and test-retest stability in individuals with adult-onset hearing loss. As such, these two domain scores and the total WHO-DAS II score may be useful as generic outcome measures to assess the effectiveness of hearing aid intervention for this population. Before the use of the WHO-DAS II in hearing aid clinical trials, however, the responsiveness of the instrument and the short- and long-term outcomes to hearing aid intervention had to be determined. Responsiveness and outcomes were assessed in 380 veterans (approximately half received hearing aids and half served as controls) by examining group differences, effect-size estimates, and individual differences as a function of hearing aid intervention. For comparison, data also were obtained on two disease-specific measures, the APHAB and the HHIE. The WHO-DAS II communication domain and total scores were sufficiently responsive to hearing aid intervention for use in future studies in which group differences are to be detected. The WHO-DAS II participation domain was not sufficiently responsive to hearing aid intervention. The APHAB and HHIE, both disease-specific measures, were more sensitive to hearing aid intervention than the generic measure. The short- and long-term outcomes of hearing aid intervention were also examined in the present study. Group outcomes for hearing aid intervention can be expected to be stable for at least 6 months when measured by WHO-DAS II total score and for at least 12 months when measured by the WHO-DAS II communication domain scores. Effect-size estimates and examination of the number of individuals exhibiting change scores exceeding 90% critical differences for true changes in scores indicate that for clinical applications, disease-specific instruments are more useful than the WHO-DAS II. The findings of this study support the use of the WHO-DAS II as a generic measure in hearing aid trials research so as to allow for comparisons of health-status outcomes across different diseases or disorders.

The WHO-DAS II: psychometric properties in the measurement of functional health status in adults with acquired hearing loss.

The World Health Organization's (WHO) Disability Assessment Scale II (WHO-DAS II) is a generic health-status instrument firmly grounded in the WHO's International Classification of Functioning, Disability and Health (WHO-ICF). As such, it assesses functioning for six domains: communication, mobility, self-care, interpersonal, life activities, and participation. Domain scores aggregate to a total score. Because the WHO-DAS II contains questions relevant to hearing and communication, it has good face validity for use as an outcome measure for audiologic intervention. The purpose of the present study was to determine the psychometric properties of the WHO-DAS II on a sample of individuals with adult-onset hearing loss, including convergent validity, internal consistency, and test-retest stability. Convergent validity was established by examining correlations between the WHO-DAS II (domain and total scores) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Hearing Aid Handicap for the Elderly (HHIE), two disease-specific measures, as well as with the Short Form-36 for veterans (SF-36V), a second generic measure. Data on all four measures were collected from 380 older individuals with adult-onset hearing loss who were not hearing aid users. The results of the convergent validity analysis revealed that the WHODAS II communication domain score was moderately and significantly correlated with scores on the APHAB and the HHIE. WHO-DAS II interpersonal and participation domain scores and the total scores were also moderately and significantly correlated with HHIE scores. These findings support the validity of using the WHO-DAS II for assessing activity limitations and participation restrictions of adult-onset hearing loss. Several WHO-DAS II domain scores and the total score were also significantly and moderately-markedly correlated with scores from the SF-36V. These findings support the validity of the WHO-DAS II as a generic health-status instrument. Internal consistency reliability for all the domain scores was adequate for all but the interpersonal domain. Test-retest stability for all the domain scores was adequate. Critical difference values were calculated for use in clinical application of the WHO-DAS II. From these findings, we concluded that the WHO-DAS II communication, participation, and total scores can be used to examine the effects of adult-onset hearing loss on functional health status. Further work examining the utility of the WHO-DAS II as an outcome measure for hearing aid intervention is warranted.

When hearing aids go bad: an FM success story.

Both clinical and research findings support the effectiveness of frequency-modulated (FM) technology among individuals who continue to encounter significant communication problems despite the use of conventional hearing instruments. The use rate of FM devices throughout the nation, however, remains disappointingly low. The authors present a case of a longtime hearing aid user whose hearing aids provided decreasing benefit as his hearing impairment increased to the extent that cochlear implantation was considered. Through the establishment of patient-specific treatment goals, the provision of appropriate FM technology as verified through real-ear measurements, and careful and deliberate counseling and follow-up, this patient was able to realize significant communication benefits as reported through several self-assessment measures. The cost-benefit implications of FM technology versus cochlear implantation are discussed.