Reading and spelling profiles of adult poor readers: Phonological, orthographic and morphological considerations.

Reading and spelling skills are important to communicate in today's literate society, however, the underlying processes of spelling skills are under-researched compared to reading skills. Our goals were to (a) study how the component skills of phonological, orthographic and morphological awareness are different in adults with and without reading difficulties, and (b) characterize the relationship between the component skills and reading and spelling performance in both skilled and poor readers. Participants (N = 37, N = 15 with reading impairments and N = 22 skilled readers) took part in the study where they completed several literacy-based measures. We performed a series of mixed ANOVAs to study the between-group differences in performance and the relationship between different literacy outcomes, respectively. We found evidence for poor phonological and morphological awareness in the poor readers compared to the skilled readers. We also found differential relationships between the component skills and reading and spelling behavior. Specifically, sound awareness was significantly related to reading and spelling measures in the skilled readers, whereas morphological and sound awareness played an important role in the same skills in the poor readers. We discuss these findings in the context of potential remediation strategies for adults with persistent literacy impairments.

Be Part of the Conversation: Audiology Messaging During a Hearing Screening.

OBJECTIVES: The moment patients learn the results from a hearing assessment can be a critical juncture on their journey to rehabilitation. Message framing (e.g., the positive or negative manner in which information is presented) has been explored in a wide range of health contexts as a method for shaping patients' decision-making. This study investigated whether attitudes toward hearing loss treatment varied as a function of how messages about treatment were framed, and whether such attitudes differed as a function of participants being led to believe they had failed a hearing screening. METHODS: Sixty-four participants (18 to 39 years of age) took the Hearing in Noise Test. In the sound booth, participants saw a poster bearing either a gain-framed or loss-framed message about hearing loss treatment. During the test, half the participants were interrupted by the researcher who stated that their performance appeared to suggest a hearing loss, with the caveat that it might be due to an equipment malfunction. While the researcher investigated the problem, the participants completed an 11-item questionnaire asking about their attitudes toward help seeking for hearing loss. Participants in the control group completed the same questionnaire with no interruption. RESULTS: Statistical analyses revealed no significant interaction effect between message type and experimenter feedback condition, though a significant main effect was present for message type. Post hoc testing showed medium to large effect sizes as a function of message type on five of the 11-questionnaire items. These data indicated that participants were more likely to endorse health-positive responses (i.e., greater interest in hearing treatment) when exposed to the gain-framed message than the loss-framed message. CONCLUSIONS: The greater likelihood of health-positive responses in the presence of the gain-framed message suggests that this framing strategy may have a positive influence on attitudes toward hearing health behaviors among individuals under 40 years of age with no history of hearing loss.

Listen before you drive: the effect of voice familiarity on listening comprehension and driving performance.

OBJECTIVE: Voice familiarity has been reported to reduce cognitive load in complex listening environments. The extent to which the reduction in listening effort allows for mental resources to be reallocated to other complex tasks needs further investigation. We sought to answer whether a familiar audiobook narrator provides benefits to (1) listening comprehension and/or (2) driving performance. DESIGN: A double-blind between-groups design was implemented. Participants were randomly assigned to the Familiar group or the Unfamiliar group. STUDY SAMPLE: Participants (n = 30) were normal-hearing adults, 18 to 28-years-old (M = 23, SD = 2.6) (n = 18 female). Participants first listened to an audiobook read by either Voice 1 (Familiar condition) or Voice 2 (Unfamiliar condition). Then they completed a virtual reality driving task while listening to a second audiobook, always read by Voice 1. Audiobook comprehension (30-question multiple-choice test) and driving performance (number of driving errors made) were recorded. RESULTS: Participants in the Familiar group made fewer driving errors than participants in the Unfamiliar group. There were no differences in listening comprehension. CONCLUSIONS: Increased voice familiarity positively impacts behaviour (i.e. reduced driving errors) in normal-hearing adults. We discuss our findings in the context of effortful listening frameworks.

Psychosocial outcome measures for conductive and mixed hearing loss treatment: An overview of the relevant literature.

OBJECTIVE: To identify the psychosocial assessments utilized with individuals with conductive and/or mixed hearing loss as part of a broader effort by the Auditory Rehabilitation Outcomes Network (AURONET) group to develop a core set of patient-centred outcome measures. DESIGN: A review of articles published between 2006 and 2016 was completed. Included studies had more than three adult participants, were available in English, and reported a psychosocial outcome from any treatment of mixed and/or conductive hearing loss. STUDY SAMPLE: Sixty-six articles from seven databases. RESULTS: Sixty-six articles met our inclusion/exclusion criteria. Within this set, 15 unique psychosocial or patient-reported outcome measures (PROs) were identified, with the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Glasgow Benefit Inventory (GBI) being the most frequently dispensed. Five of the fifteen were only administered in one study. In-house questionnaires (IHQs) were reported in 19 articles. CONCLUSIONS: Only 66 (22%) of the 300 articles with outcomes contained a PRO. Some of the mostly frequently employed PROs (e.g., APHAB) were judged to include only social items and no psychological items. Lack of PRO standardization and the use of IHQs make psychosocial comparisons across treatments in this population difficult for patients, clinicians and stakeholders.

Hearing outcome measures for conductive and mixed hearing loss treatment in adults: a scoping review.

OBJECTIVE: Rehabilitation options for conductive and mixed hearing loss are continually expanding, but without standard outcome measures comparison between different treatments is difficult. To meaningfully inform clinicians and patients core outcome sets (COS), determined via a recognised methodology, are needed. Following our previous work that identified hearing, physical, economic and psychosocial as core areas of a future COS, the AURONET group reviewed hearing outcome measures used in existing literature and assigned them into different domains within the hearing core area. DESIGN: Scoping review. STUDY SAMPLE: Literature including hearing outcome measurements for the treatment of conductive and/or mixed hearing loss. RESULTS: The literature search identified 1434 studies, with 278 subsequently selected for inclusion. A total of 837 hearing outcome measures were reported and grouped into nine domains. The largest domain constituted pure-tone threshold measurements accounting for 65% of the total outcome measures extracted, followed by the domains of speech testing (20%) and questionnaires (9%). Studies of hearing implants more commonly included speech tests or hearing questionnaires compared with studies of middle ear surgery. CONCLUSIONS: A wide range of outcome measures are currently used, highlighting the importance of developing a COS to inform individual practice and reporting in trials/research.

Evaluation of word recognition and word recall with bone conduction devices: do directional microphones free up cognitive resources?

Objective: To determine if directional microphones improve cognitive capacity in typically hearing adults. The study objectives are to evaluate differences in (1) speech recognition and (2) working memory through a word recall task between bilateral directional and omnidirectional microphone settings.Design: A conductive hearing loss was artificially induced while participants wore bilateral bone conduction hearing aids on softbands. For each hearing aid setting (bilateral omnidirectional and bilateral directional), seven blocks of seven sentences from the Hearing in Noise Test (HINT) were presented at a signal-to-noise ratio of +2 dB. Participants repeated each sentence aloud and after each block, wrote down as many of the last words as they could recall.Study sample: Thirty-five typical hearing adults and a subset (n = 20) achieving ≥80% recognition.Results: The directional microphone setting showed significant improvement over the omnidirectional setting for recognition and recall for both the full set of participants and the subset of participants with ≥ 80% recognition.Conclusions: This study demonstrated that features such as directional microphones can improve both speech recognition and working memory. Even in listening situations where participants can understand the majority of speech, directional microphones may offer improvements to cognitive capacity and reduce listening effort.

Cerebellar Activation During Reading Tasks: Exploring the Dichotomy Between Motor vs. Language Functions in Adults of Varying Reading Proficiency.

The nature and extent to which the cerebellum contributes to language processing is not clear. By using fMRI to examine differences in activation intensity in areas associated with motor and language processes, we advance our understanding of how this subcortical structure contributes to language and, more specifically, reading. Functional magnetic resonance imaging data was collected from two groups of adults. One group was classified as typical (proficient) readers, and the other as atypical (less proficient) readers. fMRI was used to measure cerebellar activation during silent reading and silent rapid naming tasks, which differed in degree of language and motor/articulatory processing. Regions of interest associated with motor and language processing were examined in order to compare how cerebellar activation in typical and atypical readers differed as a function of task both within and between groups. Significant differences in activation intensity were noted between individuals of typical and atypical reading proficiency in cerebellar regions associated with motor, but not language processing, during a silent word-reading condition. Additionally, readers who were less proficient showed no differences in activation between tasks in each of the regions of interest within the cerebellum. We provide evidence that, in typical readers, the cerebellum is functionally specialized for reading tasks that vary in language and articulatory processes. In accordance with prior research, we demonstrate that less-proficient adult readers show decreased functional specialization within the cerebellum during reading tasks. We also show that regions of the cerebellum associated with motor/articulatory processing are different between typical and atypically reading adults. Finally, to our knowledge, this is the first brain-imaging study to specifically examine cerebellar activation during rapid naming tasks and we discuss the implications for these findings with regard to current theoretical models that emphasize the link between reading and speech production.

Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology.

OBJECTIVES: In this article, we explore two manipulations of "meaning response," intended to either "impart" meaning to participants through the manipulation of a few words in the test instructions or to "invite" meaning by making the participant feel involved in the setting of their preferred sound. DESIGN: In experiment 1, 59 adults with normal hearing were randomly assigned to one of the two groups. Group 1 was told "this hearing in noise test (HINT) you are about to do is really hard," while the second group was told "this HINT test is really easy." In experiment 2, 59 normal-hearing adults were randomly assigned to one of two groups. Every participant was played a highly distorted sound file and given 5 mystery sliders on a computer to move as often and as much as they wished until the sound was "best" to them. They were then told we applied their settings to a new file and they needed to rate their sound settings on this new file against either (1) another participant in the study, or (2) an expert audiologist. In fact, we played them the same sound file twice. RESULTS: In experiment 1, those who were told the test was hard performed significantly better than the easy group. In experiment 2, a significant preference was found in the group when comparing "my setting" to "another participant." No significant difference was found in the group comparing "my setting" to the "expert." CONCLUSIONS: Imparting or inviting meaning into the context of audiological outcome measurement can alter outcomes even in the absence of any additional technology or treatment. These findings lend support to a growing body of research about the many nonauditory factors including motivation, effort, and task demands that can impact performance in our clinics and laboratories.

Maturation of bone-conduction transcranial and forehead attenuation using a measure of sound pressure in the ear canal.

OBJECTIVE: Although it is understood that bone-conduction (BC) hearing is different between infants and adults, few studies have attempted to explain why these differences exist. The main objective in this study was to better understand how properties of the developing skull contribute to the maturation of BC sensitivity through an indirect measurement of BC attenuation across the skull. DESIGN: Estimation of transcranial and forehead attenuation of pure-tone BC stimuli was conducted using sound pressure in the ear canal for a transducer placed on the skull ipsi- and contralateral to the probe ear and at the forehead. STUDY SAMPLE: Seventy-six individuals participated in the study, including 59 infants and children (1 month-7 years) and 17 adults. RESULTS: BC attenuation was greatest for young infants, and decreased throughout maturation. Attenuation from the forehead to the ipsilateral temporal bone was also greater compared to the transcranial measures for infants and children older than 10 months. CONCLUSIONS: These results provide evidence that physical maturation of the skull contributes to infant-adult differences in BC attenuation. Clinicians may consider these results, in combination with previous studies using physiological measures, when fitting infants and young children with bone-anchored hearing systems.

DSL prescriptive targets for bone conduction devices: adaptation and comparison to clinical fittings.

OBJECTIVE: To develop an algorithm that prescribes targets for bone conduction frequency response shape, compression, and output limiting, along with a clinical method that ensures accurate transforms between assessment and verification stages of the clinical workflow. DESIGN: Technical report of target generation and validation. STUDY SAMPLE: We recruited 39 adult users of unilateral percutaneous bone conduction hearing aids with a range of unilateral, bilateral, mixed and conductive hearing losses across the sample. RESULTS: The initial algorithm over-prescribed output compared to the user's own settings in the low frequencies, but provided a good match to user settings in the high frequencies. Corrections to the targets were derived and implemented as a low-frequency cut aimed at improving acceptance of the wearer's own voice during device use. CONCLUSIONS: The DSL-BCD prescriptive algorithm is compatible with verification of devices and fine-tuning to target for percutaneous bone conduction hearing devices that can be coupled to a skull simulator. Further study is needed to investigate the appropriateness of this prescriptive algorithm for other input levels, and for other clinical populations including those with single-sided deafness, bilateral devices, children and users of transcutaneous bone conduction hearing aids.

Maturation of Mechanical Impedance of the Skin-Covered Skull: Implications for Soft Band Bone-Anchored Hearing Systems Fitted in Infants and Young Children.

OBJECTIVES: Little is known about the maturational changes in the mechanical properties of the skull and how they might contribute to infant-adult differences in bone conduction hearing sensitivity. The objective of this study was to investigate the mechanical impedance of the skin-covered skull for different skull positions and contact forces for groups of infants, young children, and adults. These findings provide a better understanding of how changes in mechanical impedance might contribute to developmental changes in bone conduction hearing, and might provide insight into how fitting and output verification protocols for bone-anchored hearing systems (BAHS) could be adapted for infants and young children. DESIGN: Seventy-seven individuals participated in the study, including 63 infants and children (ages 1 month to 7 years) and 11 adults. Mechanical impedance magnitude for the forehead and temporal bone was collected for contact forces of 2, 4, and 5.4 N using an impedance head, a BAHS transducer, and a specially designed holding device. Mechanical impedance magnitude was determined across frequency using a stepped sine sweep from 100 to 10,000 Hz, and divided into low- and high-frequency sets for analysis. RESULTS: Mechanical impedance magnitude was lowest for the youngest infants and increased throughout maturation in the low frequencies. For high frequencies, the youngest infants had the highest impedance, but only for a temporal bone placement. Impedance increased with increasing contact force for low frequencies for each age group and for both skull positions. The effect of placement was significant for high frequencies for each contact force and for each age group, except for the youngest infants. CONCLUSIONS: Our findings show that mechanical impedance properties change systematically up to 7 years old. The significant age-related differences in mechanical impedance suggest that infant-adult differences in bone conduction thresholds may be related, at least in part, to properties of the immature skull and overlying skin and tissues. These results have important implications for fitting the soft band BAHS on infants and young children. For example, verification of output force form a BAHS on a coupler designed with adult values may not be appropriate for infants. This may also hold true for transducer calibration when assessing bone conduction hearing thresholds in infants for different skull locations. The results have two additional clinical implications for fitting soft band BAHSs. First, parents should be counseled to maintain sufficient and consistent tightness so that the output from the BAHS does not change as the child moves around during everyday activities. Second, placement of a BAHS on the forehead versus the temporal bone results in changes in mechanical impedance which may contribute to a decrease in signal level at the cochlea as it has been previously demonstrated that bone conduction thresholds are poorer at the forehead compared with a temporal placement.

Which threshold do we trust? A comparison of threshold measurements in adult bone-conduction device users and normal hearing adults.

OBJECTIVES: Advancements in prescriptive formulae for bone-conduction hearing devices (BCDs) have highlighted the importance of measuring in-situ bone-conduction hearing thresholds. In-situ measurements are performed within the BCD manufacturer's software, using the patient's BCD as a transducer. While in-situ testing is a different approach than standard diagnostic bone-conduction testing, both approaches are in fact measuring the same inner ear hearing. Despite this, each approach may result in different thresholds for the same individual. This study aimed to answer the following question: In adults with normal hearing and adults who currently wear a bone-conduction device, are there differences and, if so, how large are these differences when thresholds are measured using different approaches? DESIGN: Bone-conduction hearing thresholds were measured for a group 32 normal hearing participants and a group 15 percutaneous BCD users. The normal hearing participants were tested in two conditions: (1) in-situ, with a BCD worn on a soft-band and (2) with the B71 bone-conduction diagnostic transducer. The BCD users were tested in these two conditions and (3) in-situ with a BCD attached to their abutment. In-situ hearing thresholds were measured with BCDs from two manufacturers. The mean intra-subject differences between these conditions were calculated. RESULTS: For the normal hearing participants, BCD softband thresholds were poorer than the thresholds obtained with the diagnostic transducer across all tested frequencies. The average differences between the BCD softband thresholds and the diagnostic transducer were particularly large in the high frequencies (13 to 35 dB from 3 to 6 kHz). Similar differences were observed for the BCD user participants when comparing their BCD softband thresholds to the diagnostic transducer thresholds. The in-situ percutaneous thresholds were on average better than the diagnostic bone-conduction thresholds, although the differences were not statistically significant. Skin attenuation, calibration differences, and BCD characteristics were contributing factors to these differences. CONCLUSIONS: The intra-subject differences measured in this study confirmed that using different bone-conduction transducers results in the measurement (i.e., recording) of different hearing threshold levels. These results support the necessity for a measurement tool able to measure audibility at threshold independent of the various coupling configurations used in bone-conduction amplification. An effective measurement tool would be required to take into account, or bypass, the factors contributing to the differences measured in this study. Until such a tool is commercially available, clinicians will continue to face uncertainty when fitting and attempting to assess the audibility of passive transcutaneous BCDs.

Technology-limited and patient-derived versus audibility-derived fittings in bone-anchored hearing aid users: a validation study.

OBJECTIVES: Current approaches to fit bone-anchored hearing aid (Baha) rely heavily on patient feedback of "loudness" and "sound quality." Audiologists are limited to this approach for two reasons: (1) the technology in current models of Baha does not allow for much fine-tuning of frequency response or maximum output on an individual basis and (2) there has not been a valid approach to verify the frequency response or maximum output on an individual basis. The objectives of this study are to (1) describe an alternative approach to fit Baha, an "audibility-derived (AD)" fitting, and (2) test whether outcomes improve with this new fitting compared with the current "patient-derived (PD)" fitting. DESIGN: This study used a repeated measures design where each subject experienced both the AD and PD fittings in random order. Subjects were tested on a variety of outcome measures including output levels of aided speech, hearing in noise test (quiet and in noise), consonant recognition in noise, aided loudness, and subjective percentage of words understood. RESULTS: Electromechanical testing revealed significantly higher aided output with the AD fitting, especially in the high frequencies. Subjects performed significantly better in all outcome measures with the AD fitting approach except when testing aided loudness and subjective perception for which the differences were nonsignificant. When the input levels to the Baha were soft, advantages for the AD fitting were emerging on these tests, but they did not reach significance. CONCLUSIONS: This study presents a more objective, fitting approach for Baha that leads to better outcomes in the laboratory. The next steps will be to test these fittings in the real world and to make the approach generally available to clinicians fitting Bahas.

From lollipops to lidocaine: The need for a universal print-to-speech framework.

OBJECTIVE: There is a strong relationship between reading and articulation (Lervåg & Hulme, 2009; Pan et al., 2011). Given the tight coupling of these processes, innovative approaches are needed to understand the intricacies associated with print-speech connections. Here we ran a series of tightly controlled experiments to examine the impact of mouth perturbations on silent reading. METHOD: We altered the mouth, via somatosensory feedback, in several ways: (a) a large lollipop in the mouth (E1), (b) a candy stick (bite bar) held horizontally between the teeth (E2), and (c) lidocaine that served to numb the mouth (E3). Three tasks were completed: (a) picture categorization, (b) "spell" lexical decision (Spell-LDT; "does the letter string spell a real word, yes or no?"), and (c) "sound" lexical decision (Sound-LDT; "does the letter string sound like a real word, yes or no?"). Participants (N = 97; E1 = 27; E2 = 32; E3 = 38) completed each of the tasks two times: once with a somatosensory perturbation (lollipop, bite bar, or lidocaine) and once without. RESULTS: For each experiment, a linear mixed effects analysis was run. Overall, we found that the lollipop (E1) and lidocaine (E3) had some specific effects on word recognition (e.g., for "no" responses), particularly in the Spell-LDT, whereas the bite bar (E2) had no effect on word recognition. The picture categorization task was not impacted by any perturbations. CONCLUSION: These findings provide evidence that sensorimotor information is connected to reading. We discuss how these findings advance our understanding of a print-to-speech framework. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A comparison of three approaches to verifying aided Baha output.

OBJECTIVE: The objective of the present study was to compare three methods of estimating the audibility of aided speech using the Baha. SUBJECTS: 23 Adult Baha users with primarily bilateral conductive hearing loss were recruited from the Bone Conduction Amplification Program at the Institute for Reconstructive Sciences in Medicine in Edmonton, Alberta, Canada. METHODS: A test Baha was set to each subject's preferred listening level. The same Baha was used to assess the audibility of the long-term average speech spectrum (LTASS) for each of the following three approaches: 1) Aided soundfield thresholds, 2) Real Ear SPL, and 3) Real Head Acceleration Level. RESULTS: Significant differences were discovered between the three approaches. Aided soundfield thresholds consistently over-estimated the sensation level of aided speech. The Real Ear SPL approach provided reasonable estimates in the mid-frequencies. However, low- and high-frequency estimates for the Real Ear approach have significant limitations. CONCLUSIONS: The Real Head Acceleration Level appears to be the most accurate method of determining aided audibility with the Baha.

Comparison Of Health Insurance Coverage For Hearing Aids And Other Services In Alberta.

OBJECTIVES: Of the several barriers associated with uptake and adherence to hearing services, cost is the most commonly identified barrier in Canada. This study evaluated health insurance plans for hearing care coverage within Alberta, Canada, and subsequent out-of-pocket expenses that would result if an individual chose to pursue treatment. METHODS: An investigation of eight companies that provide supplementary health coverage in Alberta was conducted. Categories of health service coverage included hearing, vision, speech-language pathology (S-LP), physical therapy related (PT-R; including massage therapy and chiropractic therapy) and alternative medicine related (AM-R; including osteopathy, acupuncture and naturopathy). All coverage amounts were corrected to a four-year term for comparison purposes. RESULTS: For a four-year term, the coverage amounts for hearing services were CAD 300-750; for vision services were CAD 0-900; for S-LP services were CAD 0-2,400; for PT-R services were CAD 1,400-10,200; and for AM-R services were CAD 0-10,200 per four-year term. The expected out-of-pocket expense for vision ranged from CAD 0 to CAD 2,766, whereas for hearing, it ranged from CAD 250 to CAD 11,700. CONCLUSION: A considerable range and discrepancy were reported between hearing care and most paramedical services. In addition, the coverage amounts for hearing care were inconsistent with treatment costs, resulting in considerable out-of-pocket expenses for most consumers. The potential implications of such cost-related barriers on public health are an important consideration as our understanding of the impact of untreated hearing impairment continues to increase.

Consensus statements on the BAHA system: where do we stand at present?

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.

Speech intelligibility of young school-aged children in the presence of real-life classroom noise.

We examined the ability of 40 young children (aged five to eight) to understand speech (monosyllables, spondees, trochees, and trisyllables) when listening in a background of real-life classroom noise. All children had some difficulty understanding speech when the noise was at levels found in many classrooms (i.e., 65 dBA). However, at an intermediate (-6 dB SNR) level, kindergarten and grade 1 children had much more difficulty than did older children. All children performed well in quiet, with results being comparable to or slightly better than those reported in previous studies, suggesting that the task was age appropriate and well understood. These results suggest that the youngest children in the school system, whose classrooms also tend to be among the noisiest, are the most susceptible to the effects of noise.

Are Open-Fit Hearing Aids a Possible Alternative to Bone-Anchored Hearing Devices in Patients with Mild to Severe Hearing Loss? A Preliminary Trial.

Open-fit hearing aids (OFHAs) may be of benefit for some individuals with chronic outer and middle ear conditions for which boneanchored hearing devices (BAHDs) are normally recommended. The purpose of this study was to compare performance between OFHAs and BAHDs. A Starkey Destiny 800 OFHA was fit on eight adult BAHD users and speech perception measures in quiet and in background noise were compared under two different test conditions: i) BAHD only and ii) OFHA only. Equivalent outcome measure performance between these two conditions suggests that the OFHA was able to provide sufficient amplification for mild to moderate degrees of hearing loss (pure-tone averages (PTAs) less than 47 dB HL). The improved speech perception performances and increased loudness ratings observed for several of the participants with moderately-severe to severe degrees of hearing loss (PTAs of 47 dB HL or greater) in the BAHD only condition suggest that the OFHA did not provide sufficient amplification for these individuals. Therefore, OFHAs may be a successful alternative to the BAHD for individuals with no more than a moderate conductive hearing loss who are unable or unwilling to undergo implant surgery or unable to wear conventional hearing aids due to allergies, irritation, or chronic infection associated with the ear being blocked with a shell or earmold.

Listening levels of teenage iPod users: does measurement approach matter?

The main objective of this study was to determine the influence of background noise levels and measurement approach on user-selected listening levels (USLLs) chosen by teenaged MP3 player users. It was hypothesized that the presence of background noise would (i) increase the USLL across all measurement approaches, (ii) result in no significant USLL differences between survey reports, objective lab measures or calibrated self-report field measures, and (iii) cause no interaction effect between level of background noise and measurement approach. There were two independent variables in this study: the level of background noise and measurement approach. The first independent variable, level of background noise, had two levels: quiet and transportation noise. The second independent variable, measurement approach, had three levels: survey, objective in-ear lab measurement and calibrated self-report field measurement. The dependent variable was ear canal A-weighted sound pressure level (dBA SPL). A 2 × 3 repeated-measures ANOVA was used to determine the significance of the main and interaction effects. USLLs increased in the presence of background noise, regardless of the measurement approach used. However, the listening levels estimated by the participants using the survey and self-report field measure were significantly lower than those recorded using in-ear laboratory measurements by 9.6 and 3.3 dBA respectively. In-ear laboratory measures yielded the highest listening levels. Higher listening levels were observed in the presence of background noise for all measurement approaches. It appears that subjects' survey responses underestimate true listening levels in comparison to self-report calibrated field measures, and that both underestimate listening levels measured in the laboratory setting. More research in this area is warranted to determine whether measurement techniques can be refined and adjusted to accurately reflect real-world listening preferences.