Hearing and Functioning in Everyday Life Questionnaire: Development and Validation of an ICF-Based Instrument.

OBJECTIVES: Self-assessment instruments are commonly used in audiological rehabilitation. However, several studies highlight the lack of multidimensionality in existing outcome measures, with the consequence that they only partially capture aspects of functioning in everyday life for people living with hearing loss. This study aimed to develop and investigate the content validity of a self-assessment instrument based on the validated Brief International Classification of Functioning, Disability, and Health Core Set for Hearing Loss. DESIGN: The design was a two-part instrument development study. The first part focused on the item-generation process of the instrument, named the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) during an experts' workshop. The second part focused on international content validation of the instrument using group interviews. Strategic sampling was used and 30 adults with hearing loss from India, South Africa, and the United States participated in the group interviews. RESULTS: The expert's workshop resulted in the first version of the HFEQ containing 30 items. The results from group interviews show that the content of the HFEQ was considered to be valid concerning its relevance, comprehensiveness, and comprehensibility. A majority (73%) of the HFEQ items were perceived by the participants as relevant and easy to comprehend. For the remaining 27% of the items, the content was perceived to be relevant in all countries, but some terms and expressions were reported to require rewording or clearer examples. These modifications will be made in the next step of the development process. CONCLUSION: Content validation of the HFEQ demonstrates promising results, with participants perceiving the content as relevant and comprehensible. Further psychometric validation is required to investigate other psychometric properties, such as construct validity and reliability. The HFEQ has the potential to become a valuable new instrument for assessing everyday functioning in people with hearing loss in audiological rehabilitation and in research.

Validation of the Brief International Classification of Functioning, Disability and Health (ICF) core set for hearing loss: an international multicentre study.

OBJECTIVE: Hearing loss (HL) affects the everyday functioning of millions of people worldwide. The Brief International Classification of Functioning Disability and Health (ICF) core sets for HL was developed to meet the complex health care needs of adults with HL. Because the brief core set for HL has not yet been validated internationally, this study aimed to investigate its validity from an international perspective. DESIGN: A cross-sectional validation study based on data from structured interviews with adults with HL. STUDY SAMPLE: Participants (n = 571) from India, South Africa, Sweden and the US were included. RESULTS: A six-factor solution explained 71% of the variance, focussing on issues related to communication, the social environment, participation in society, health care services, support, relationships and emotions (α = 0.915). Three ICF categories demonstrated low reliability - temperament and personality functions, seeing functions and school education. CONCLUSION: The Brief ICF core set for HL is valid for adults with HL internationally. However, to further increase its international validity, we recommend adding the categories d920 recreation and leisure and replacing d850 school education with the more inclusive block, d810-d839 education.

Prevalence, diagnoses and rehabilitation services related to severe dual sensory loss (DSL) in older persons: a cross-sectional study based on medical records.

OBJECTIVE: To estimate the prevalence of severe dual sensory loss (DSL) among older persons (aged ≥65 years) in the Swedish population, to identify the diagnoses that cause severe DSL, and to identify rehabilitation services in which the participants have been involved. DESIGN: A cross-sectional design was applied. Medical records from Audiological, Low Vision, and Vision clinics from two Swedish counties were used. STUDY SAMPLE: 1257 adults, aged ≥65 years with severe hearing loss (HL) (≥70 dB HL) were included, whereof 101 had decimal visual acuity ≤0.3. RESULTS: Based on the population size in the two counties (≥65 years, n = 127,638), the prevalence of severe DSL was approximately 0.08% in the population. Within the group having DSL (n = 101), 61% were women and 71% were aged ≥85 years. Common diagnoses were cataract and/or age-related macular degeneration (AMD) in combination with HL. The rehabilitation services offered were mainly hearing aids and various magnifiers. CONCLUSIONS: The study confirmed previous results, indicating that the prevalence of severe DSL increases with age and that sensorineural HL and cataract, AMD or glaucoma coexist. The identified rehabilitation services mainly focussed on either vision loss or HL but not on severe DSL as a complex health condition.

Regulons and protein-protein interactions of PRD-containing Bacillus anthracis virulence regulators reveal overlapping but distinct functions.

Bacillus anthracis produces three regulators, AtxA, AcpA and AcpB, which control virulence gene transcription and belong to an emerging class of regulators termed 'PCVRs' (Phosphoenolpyruvate-dependent phosphotransferase regulation Domain-Containing Virulence Regulators). AtxA, named for its control of toxin gene expression, is the master virulence regulator and archetype PCVR. AcpA and AcpB are less well studied. Reports of PCVR activity suggest overlapping function. AcpA and AcpB independently positively control transcription of the capsule biosynthetic operon capBCADE, and culture conditions that enhance AtxA level or activity result in capBCADE transcription in strains lacking acpA and acpB. We used RNA-Seq to assess the regulons of the paralogous regulators in strains constructed to express individual PCVRs at native levels. Plasmid and chromosome-borne genes were PCVR controlled, with AtxA, AcpA and AcpB having a ≥ 4-fold effect on transcript levels of 145, 130 and 49 genes respectively. Several genes were coregulated by two or three PCVRs. We determined that AcpA and AcpB form homomultimers, as shown previously for AtxA, and we detected AtxA-AcpA heteromultimers. In co-expression experiments, AcpA activity was reduced by increased levels of AtxA. Our data show that the PCVRs have specific and overlapping activity and that PCVR stoichiometry and potential heteromultimerization can influence target gene expression.

Headphone listening habits, hearing thresholds and listening levels in Swedish adolescents with severe to profound HL and adolescents with normal hearing.

OBJECTIVE: Research has minimally focussed on the music listening habits and preferred sound volumes among adolescents with severe to profound congenital HL. Listening to music played at loud sound volumes and for a long duration of time could imply risks of worsening the HL. Therefore, it is important to investigate the listening habits in adolescents with HL. The aim of the present study was to describe the use of personal music devices, subjective estimated sound levels, measured sound levels, listening habits, and hearing symptoms in adolescents with severe to profound hearing loss compared with adolescents with normal hearing. DESIGN: The study was conducted in two steps. First, a questionnaire was given to students with or without hearing loss. In step two, hearing and sound level measurements were made in a subsample from both groups. STUDY SAMPLE: The study sample were based on 112 seventeen-year-old students with severe to profound hearing loss and 279 adolescents with normal hearing. Hearing thresholds and listening levels was measured on two subsamples based on 29 adolescents with severe to profound hearing loss and 50 adolescents from the group with normal hearing. RESULTS: The results showed that adolescents with severe to profound hearing loss listened to significantly louder sound levels for longer periods. For both groups, those listening at louder sound levels had poorer hearing thresholds. This finding is especially alarming for subjects with hearing loss. Among those listening above 85 dB per occasion, the sound level ranged between 85.8 dB up to 109 dB for those with hearing loss, whereas the sound level ranged between 85.5 dB and 100 dB for those with normal hearing. CONCLUSIONS: Adolescents with congenital hearing loss used portable music devices in the same manner as adolescents with normal hearing. However, adolescents with hearing loss listened to louder sound volumes most likely to compensate for their hearing loss, which significantly increases the risk of further damage to their hearing. From a hearing rehabilitation perspective it could be concluded that aspect of music listening habits should be focussed in order to prevent noise induced hearing loss among individuals with congenital hearing loss.

Social representation of "music" in young adults: a cross-cultural study.

OBJECTIVE: This study was aimed to explore perceptions of and reactions to music in young adults (18-25 years) using the theory of social representations (TSR). DESIGN: The study used a cross-sectional survey design and included participants from India, Iran, Portugal, USA and UK. Data were analysed using various qualitative and quantitative methods. STUDY SAMPLE: The study sample included 534 young adults. RESULTS: The Chi-square analysis showed significant differences between the countries regarding the informants' perception of music. The most positive connotations about music were found in the responses obtained from Iranian participants (82.2%), followed by Portuguese participants (80.6%), while the most negative connotations about music were found in the responses obtained from Indian participants (18.2%), followed by Iranian participants (7.3%). The participants' responses fell into 19 main categories based on their meaning; however, not all categories were found in all five countries. The co-occurrence analysis results generally indicate that the category "positive emotions or actions" was the most frequent category occurring in all five countries. CONCLUSIONS: The results indicate that music is generally considered to bring positive emotions for people within these societies, although a small percentage of responses indicate some negative consequences of music.

Headphone listening habits and hearing thresholds in swedish adolescents.

INTRODUCTION: The aim of this study was to investigate self-reported hearing and portable music listening habits, measured hearing function and music exposure levels in Swedish adolescents. The study was divided into two parts. MATERIALS AND METHODS: The first part included 280 adolescents, who were 17 years of age and focused on self-reported data on subjective hearing problems and listening habits regarding portable music players. From this group, 50 adolescents volunteered to participate in Part II of the study, which focused on audiological measurements and measured listening volume. RESULTS: The results indicated that longer lifetime exposure in years and increased listening frequency were associated with poorer hearing thresholds and more self-reported hearing problems. A tendency was found for listening to louder volumes and poorer hearing thresholds. Women reported more subjective hearing problems compared with men but exhibited better hearing thresholds. In contrast, men reported more use of personal music devices, and they listen at higher volumes. DISCUSSION: Additionally, the study shows that adolescents listening for ≥3 h at every occasion more likely had tinnitus. Those listening at ≥85 dB LAeq, FF and listening every day exhibited poorer mean hearing thresholds, reported more subjective hearing problems and listened more frequently in school and while sleeping. CONCLUSION: Although the vast majority listened at moderate sound levels and for shorter periods of time, the study also indicates that there is a subgroup (10%) that listens between 90 and 100 dB for longer periods of time, even during sleep. This group might be at risk for developing future noise-induced hearing impairments.

Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

OBJECTIVE: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. DESIGN: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. STUDY SAMPLE: A total of 415 children aged nine years. RESULTS: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones. CONCLUSION: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children's hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

Conceptions of working life among employees with mild-moderate aided hearing impairment: A phenomenographic study.

OBJECTIVES: The aim was to explore the conceptions of working life among employees with mild-moderate aided hearing impairment (HI). DESIGN: This study has a descriptive design, in which data was collected by means of semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. The text was analysed in accordance with the phenomenographic approach. STUDY SAMPLE: Fifteen participants with mild-moderate aided HI were recruited to the current study. RESULTS: The analysis of the interviews resulted in four main categories describing the participants' conceptions of working life: (1) diffiiculties in daily work, (2) communication strategies, (3) facilitating factors in work environment, and (4) impact on daily life. The four identified descriptive categories show that the effects of HI on the lives of working adults generate far-reaching psychosocial consequences for the individual. CONCLUSIONS: This study demonstrates that difficulties and impact of having a HI interact with strategies used by the individual and contextual facilitators made in the work environment. We argue that there is a need for extensive services in aural rehabilitation for this population. This includes identifying the need of assistive listening devices, teaching the individual with HI about communication strategies and informing stakeholders about the consequence of having a HI.

Cognitive skills and the effect of noise on perceived effort in employees with aided hearing impairment and normal hearing.

The aim of the following study was to examine the relationship between working memory capacity (WMC), executive functions (EFs) and perceived effort (PE) after completing a work-related task in quiet and in noise in employees with aided hearing impairment (HI) and normal hearing. The study sample consisted of 20 hearing-impaired and 20 normally hearing participants. Measures of hearing ability, WMC and EFs were tested prior to performing a work-related task in quiet and in simulated traffic noise. PE of the work-related task was also measured. Analysis of variance was used to analyze within- and between-group differences in cognitive skills, performance on the work-related task and PE. The presence of noise yielded a significantly higher PE for both groups. However, no significant group differences were observed in WMC, EFs, PE and performance in the work-related task. Interestingly, significant negative correlations were only found between PE in the noise condition and the ability to update information for both groups. In summary, noise generates a significantly higher PE and brings explicit processing capacity into play, irrespective of hearing. This suggest that increased PE involves other factors such as type of task that is to be performed, performance in the cognitive skill required solving the task at hand and whether noise is present. We therefore suggest that special consideration in hearing care should be made to the individual's prerequisites on these factors in the labor market.

How to remain in working life with hearing loss - health factors for a sustainable work situation.

BACKGROUND: Persons with hearing loss (HL) are a vulnerable group in working life. Studies have shown that they are more likely than the general population to be in part-time work, to be unemployed, receive disability pension, and to be on sick leave. Many workers with HL also experience unhealthy work conditions, such as jobs where they experience high demands combined with low control as well as safety concerns and social isolation. There is a lack of studies that focus on factors that promote a healthy, sustainable work situation for the target group. OBJECTIVE: To investigate health factors that contribute to a sustainable work situation for employees with HL. METHODS: The current study was a comparative, observational study with a cross-sectional design including a clinical population of adults with HL. Comparisons were made between workers with HL "in work" and workers with HL on "HL-related sick leave". RESULTS: Seven health factors were identified. Those "in work" experienced a healthier work environment as well as lower levels of mental strain, hearing-related work characteristics and content, cognitively demanding work content, hearing-related symptoms, energy-demanding activities, and bodily aches and pain than those on "HL-related sick leave". CONCLUSION: The results demonstrate a clear pattern regarding health factors for a sustainable working life. The type of job was not related to whether an individual was on sick leave or working. Rather, the work climate and the content of the work mattered.

Associations Between Recreational Noise Exposure and Hearing Function in Adolescents and Young Adults: A Systematic Review.

PURPOSE: There is an increasing concern regarding hazardous recreational noise exposure among adolescents and young adults. Daily exposure to loud sound levels over a long period of time can increase the risk of noise-induced hearing loss. The full extent of the impact of recreational noise on hearing is not yet fully understood. The purpose of this review was to synthesize research that investigated hearing function in relation to recreational noise exposure in adolescents and young adults. METHOD: A systematic literature search of five databases covering the years 2000-2023 was performed. The articles included investigated audiological measurements of hearing function in relation to recreational noise exposure. RESULTS: Four hundred sixty records were identified, of which 20 met the inclusion criteria and were included in the results. This review showed that although some recreational noise activities can be potentially harmful, there is an unclear relationship between exposure and outcome. Some findings indicated hearing threshold shifts or reduced otoacoustic emission amplitudes after recreational noise exposure, but most changes were short term and in the extended high-frequency range. CONCLUSIONS: There seemed to be inconsistencies regarding the utilization of methods of measuring exposure and outcome between studies. This might be one reason for the differing results in studies on the reported impact on hearing function from recreational noise exposure. To draw more certain conclusions about long-term effects, there is a need for longitudinal research that utilizes sound level measurements to assess low and high degrees of recreational noise exposure in relation to hearing function. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25114193.

Longitudinal associations between sensory and cognitive functioning in adults 60 years or older in Sweden and Denmark.

BACKGROUND: The objective of this study is to explore the bidirectional, longitudinal associations between self-reported sensory functions (hearing/vision) and cognitive functioning among older adults in Sweden and Denmark during the period 2004-2017. METHODS: The study is based on data from The Survey of Health, Ageing and Retirement in Europe and consists of 3164 persons aged 60 to 93 years. Within-person associations between sensory and cognitive functions were estimated using random intercept cross-lagged panel models. RESULTS: The results indicated that cognitive and sensory functions were associated within their respective domains over time. The results on the bidirectional associations between sensory functions and cognition over time showed weak and statistically non-significant estimates. CONCLUSION: Our study showed no clear evidence for cross-lagged effects between sensory functions and cognitive functioning. Important to note, however, is that using longitudinal data to estimate change within persons is a demanding statistical test and various factors may have contributed to the absence of conclusive evidence in our study. We discuss several of these factors.

Hearing and Functioning in Everyday Life Questionnaire: Psychometric Evaluation and Revision.

PURPOSE: The aim of the current study was to explore the construct validity and internal consistency reliability of the International Classification of Functioning, Disability and Health (ICF)-based original English version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) and to revise the HFEQ based on the results. METHOD: This study used a cross-sectional survey design. The data were collected using an online survey. Adults with self-reported hearing disability (n = 513) from the United States were included. The ICF components of body functions, activity and participation, and environmental factors were tested as the underlying structure of the HFEQ using confirmatory factor analysis and then adjusted by triangulation with previous content validation. RESULTS: The results of the current study confirmed the ICF components of body functions, activity and participation, and environmental factors as underlying constructs of the HFEQ. However, after triangulation with previous content validation, fine adjustments were made. The revised version of the HFEQ includes two removed items and a fine-tuned factor structure. CONCLUSION: The results confirm that the structure of the HFEQ aligns with the ICF, and the overall results indicate that HFEQ has acceptable construct validity and internal consistency.

A suggested model for decision-making regarding hearing conservation: towards a systems theory approach.

OBJECTIVE: The aim of the study was to investigate potential health promotion variables associated with adolescents' hearing protection use at concerts. STUDY SAMPLE: The sample consisted of 242 upper secondary school students aged 15-19 years. DESIGN: Variables defined by the theory of planned behaviour (TBP) and health belief model were tested in this quantitative study. RESULTS: Fifty-three percent of the adolescents reported that they used hearing protection at concerts to some degree, and 33 individuals (14%) reported that they used hearing protection in 50% of cases or more. The average degree of hearing protection use was reported to be 17% of the visits at concerts. Norms, perceived control, barriers, and noise sensitivity were associated with attitudes towards loud music. In addition, norms, barriers, permanent tinnitus, and noise sensitivity were significantly correlated with hearing protection use. However, intention was not significantly correlated with hearing protection use. CONCLUSIONS: From a systems theoretical approach it can be suggested that preventive strategies must consider more levels than just the individual, in order to achieve long lasting behavioural changes in adolescents' listening habits. To be able to get useful knowledge about preventive strategies, it is necessary to add context-specific variables into generic models such as TPB.

Quality of life, effort and disturbance perceived in noise: a comparison between employees with aided hearing impairment and normal hearing.

OBJECTIVES: The aims were to compare health-related quality of life (HRQOL) and hearing handicap between two groups of employees with normal hearing and aided hearing impairment (HI). HRQOL was also compared to a normative population. The second aim was to compare perceived effort (PE) and disturbance after completing a task in office noise between the two study groups. DESIGN: A Swedish version of the short form-36 (SF-36) and the hearing handicap inventory for adults (HHIA) was used to determine HRQOL and hearing handicap. The Borg-CR 10 scale was used to measure PE and disturbance. STUDY SAMPLE: Hearing impaired (n = 20) and normally hearing (n = 20) participants. The normative sample comprised of 597 matched respondents. RESULTS: Hearing-impaired employees report relatively good HRQOL in relation to the normative population, but significantly lower physical functioning and higher PE than their normally-hearing peers in noise. Results from the HHIA showed mild self-perceived hearing handicap. CONCLUSIONS: The current results demonstrate that physical health status can be negatively affected even at a mild-moderate severity of HI, and that a higher PE is reported from this group when performing a task in noise, despite the regular use of hearing aids.

Adolescents' reported hearing symptoms and attitudes toward loud music.

The aim of the present study was to compare the adolescents' attitudes toward loud music in relation to a set of self-perceived auditory symptoms and psychological variables such as norms, preparedness to take risks and risk-judgment in noisy situations. A questionnaire on hearing and preventive behavior was distributed to 281 upper secondary school students aged 15-19 years. The questionnaire included youth attitude to noise scale, questions about perceived hearing symptoms such as tinnitus and sound sensitivity and finally statements on perceived behavioral norms regarding hearing protection use, risk-taking and risk-judgment in noisy settings. Self-perceived auditory symptoms such as sound sensitivity and permanent tinnitus had a significant relationship with less tolerant attitudes toward loud music. Permanent tinnitus and sound sensitivity together accounted for 15.9% of the variation in attitudes toward loud music. Together with the psychological variables norms, preparedness to take risks and risk-judgment 48.0% of the variation in attitudes could be explained. Although perceived hearing symptoms (sound sensitivity and permanent tinnitus) was associated with less tolerant attitudes toward loud music, psychological variables such as norms, preparedness to take risks and risk-judgment were found to be more strongly associated with attitudes toward loud music and should therefore be considered more in future preventive work. Health promotive strategies should focus on changing not merely individual attitudes, but also societal norms and regulations in order to decrease noise induced auditory symptoms among adolescents.

The experience of noise in communication-intense workplaces: A qualitative study.

OBJECTIVE: The aim of the study was to explore and describe how workers in communication-intense workplaces in health care and preschools experience the sound environment. The dependence on vocal communication and social interaction poses a challenge using hearing protection in these working environments. METHOD: A qualitative method was used, more specifically inductive thematic analysis was used, as this approach was deemed suitable to explore the staff's experiences of the sound environment. Data were collected by interviews and to increase trustworthiness, several researchers were involved in the data collection and analysis. STUDY SAMPLE: Workers from two preschools, one obstetrics ward and one intensive care unit took part in the study. RESULTS: Four main themes emerged from the thematic analysis: A challenging and harmful sound environment; Health-related effects of a challenging and harmful sound environment; A good sound environment is not prioritised; and Resourceful and motivated staff. CONCLUSIONS: Workers in communication-intense workplaces in preschools, obstetrics care and intensive care reported that there was a relationship between the sound environment and negative health effects. In addition, the results suggests that the high motivation for change among staff should be utilised together with an increased prioritization from the management to reach innovative context specific improvements to the sound environment in communication intense working environments.

Why Are Old-Age Disabilities Decreasing in Sweden and Denmark? Evidence on the Contribution of Cognition, Education, and Sensory Functions.

OBJECTIVES: Improvements in educational attainment, cognitive and sensory functions, and a decline in the prevalence of disabilities have been observed in older adults in Sweden and Denmark. In the present study, it was investigated whether better cognition, higher educational attainment, and improved sensory function among older adults aged 60 and older in these countries have contributed to decreasing rates of old-age disabilities. METHODS: The analyses were based on repeated cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe for the 2004-2017 period. Descriptive data were used to benchmark the declining prevalence of disabilities, improving cognitive and sensory functions, and increased educational level. The association between time and disabilities was analyzed with logistic regression models, and the contribution of the improved cognitive function, education, and sensory function to the declining prevalence of old-age disabilities was estimated using the Karlson-Holm-Breen method for mediation analysis. RESULTS: The analysis suggests that the declining prevalence of old-age disabilities in Sweden and Denmark between 2004 and 2017 can largely be attributed to improved cognitive function and vision and to a lesser extent by education and hearing ability. DISCUSSION: These findings raise important questions about the causal mechanisms producing the associations between cognition, education, and sensory functions and disability in older age. Future studies should explore the causal nature of the associations between these mediators and old-age disabilities. In addition, they should explore whether these findings differ across regional and cultural contexts and over different time periods.

Occupational noise exposure, noise annoyance, hearing-related symptoms, and emotional exhaustion - a participatory-based intervention study in preschool and obstetrics care.

A participatory-based intervention was performed in Sweden, aimed at improving the sound environment in one preschool (n = 20) and one obstetric ward (n = 50), with two controls each (n = 28, n = 66). Measured sound levels, and surveys of noise annoyance, hearing-related symptoms and emotional exhaustion were collected before, and three and nine months after the interventions, comparing intervention and control groups over time. The results of this first implementation in a limited number of workplaces showed significantly worsening of hyperacusis, sound-induced auditory fatigue, emotional exhaustion and increased sound levels in the preschool, and worsening of noise annoyance in both intervention groups. Increased risk awareness, limited implementation support and lack of psychosocial interventions may explain the worsening in outcomes, as might the worse baseline in the intervention groups. The complexity of the demands in human-service workplaces calls for further intervention studies.