International Outcome Inventory for Hearing Aids: Data From a Large Swedish Quality Register Database.

PURPOSE: The purpose of this study was to analyze a database of completed International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires obtained from over 100,000 clients fitted with new hearing aids in Sweden during the period of 2012-2016. Mean IOI-HA total scores were correlated with degree of hearing loss, unilateral versus bilateral fitting, first-time versus return clients, gender, and variation among dispensing clinics. The correlations with expectations, service quality, and technical functioning of the hearing aids were also analyzed. METHOD: Questionnaires containing the 7 IOI-HA items as well as questions concerning some additional issues were mailed to clients 3-6 months after fitting of new hearing aids. The questionnaires were returned to and analyzed by an independent research institute. RESULTS: More than 100 dispensing clinics nationwide take part in this project. A response rate of 52.6% resulted in 106,631 data sets after excluding incomplete questionnaires. Forty-six percent of the responders were women, and 54% were men. The largest difference in mean score (0.66) was found for the IOI-HA item "use" between return clients and first-time users. Women reported significantly higher (better) scores for the item "impact on others" compared with men. The bilaterally fitted subgroup reported significantly higher scores for all 7 items compared with the unilaterally fitted subgroup. Experienced users produced higher scores on benefit and satisfaction items, whereas first-time users gave higher scores for residual problems. No correlation was found between mean IOI-HA total score and average hearing threshold level (pure-tone average [PTA]). Mean IOI-HA total scores were found to correlate significantly with perceived service quality of the dispensing center and with the technical functionality of the hearing aids. CONCLUSIONS: When comparing mean IOI-HA total scores from different studies or between groups, differences with regard to hearing aid experience, gender, and unilateral versus bilateral fitting have to be considered. No correlation was found between mean IOI-HA total score and degree of hearing loss in terms of PTA. Thus, PTA is not a reliable predictor of benefit and satisfaction of hearing aid provision as represented by the IOI-HA items. Identification of a specific lower fence in PTA for hearing aid candidacy is therefore to be avoided. Large differences were found in mean IOI-HA total scores related to different dispensing centers.

International Collegium of Rehabilitative Audiology (ICRA) recommendations for the construction of multilingual speech tests. ICRA Working Group on Multilingual Speech Tests.

OBJECTIVE: To provide guidelines for the development of two types of closed-set speech-perception tests that can be applied and interpreted in the same way across languages. The guidelines cover the digit triplet and the matrix sentence tests that are most commonly used to test speech recognition in noise. They were developed by a working group on Multilingual Speech Tests of the International Collegium of Rehabilitative Audiology (ICRA). DESIGN: The recommendations are based on reviews of existing evaluations of the digit triplet and matrix tests as well as on the research experience of members of the ICRA Working Group. They represent the results of a consensus process. RESULTS: The resulting recommendations deal with: Test design and word selection; Talker characteristics; Audio recording and stimulus preparation; Masking noise; Test administration; and Test validation. CONCLUSIONS: By following these guidelines for the development of any new test of this kind, clinicians and researchers working in any language will be able to perform tests whose results can be compared and combined in cross-language studies.

Dynamic relation between working memory capacity and speech recognition in noise during the first 6 months of hearing aid use.

The present study aimed to investigate the changing relationship between aided speech recognition and cognitive function during the first 6 months of hearing aid use. Twenty-seven first-time hearing aid users with symmetrical mild to moderate sensorineural hearing loss were recruited. Aided speech recognition thresholds in noise were obtained in the hearing aid fitting session as well as at 3 and 6 months postfitting. Cognitive abilities were assessed using a reading span test, which is a measure of working memory capacity, and a cognitive test battery. Results showed a significant correlation between reading span and speech reception threshold during the hearing aid fitting session. This relation was significantly weakened over the first 6 months of hearing aid use. Multiple regression analysis showed that reading span was the main predictor of speech recognition thresholds in noise when hearing aids were first fitted, but that the pure-tone average hearing threshold was the main predictor 6 months later. One way of explaining the results is that working memory capacity plays a more important role in speech recognition in noise initially rather than after 6 months of use. We propose that new hearing aid users engage working memory capacity to recognize unfamiliar processed speech signals because the phonological form of these signals cannot be automatically matched to phonological representations in long-term memory. As familiarization proceeds, the mismatch effect is alleviated, and the engagement of working memory capacity is reduced.

Sounds perceived as annoying by hearing-aid users in their daily soundscape.

BACKGROUND: The noises in modern soundscapes continue to increase and are a major origin for annoyance. For a hearing-impaired person, a hearing aid is often beneficial, but noise and annoying sounds can result in non-use of the hearing aid, temporary or permanently. OBJECTIVE: The purpose of this study was to identify annoying sounds in a daily soundscape for hearing-aid users. DESIGN: A diary was used to collect data where the participants answered four questions per day about annoying sounds in the daily soundscape over a two-week period. STUDY SAMPLE: Sixty adult hearing-aid users. RESULTS: Of the 60 participants 91% experienced annoying sounds daily when using hearing aids. The annoying sound mentioned by most users, was verbal human sounds, followed by other daily sound sources categorized into 17 groups such as TV/radio, vehicles, and machine tools. When the hearing-aid users were grouped in relation to age, hearing loss, gender, hearing-aid experience, and type of signal processing used in their hearing aids, small and only few significant differences were found when comparing their experience of annoying sounds. CONCLUSIONS: The results indicate that hearing-aid users often experience annoying sounds and improved clinical fitting routines may reduce the problem.

Audiometric screening of a population with intellectual disability.

OBJECTIVE: Evaluation of pure-tone audiometry (PTA) in hearing screening of a population with mild to profound intellectual disability (ID). DESIGN: PTA was performed at six frequencies at the screening level 20 dB HL. Referral criteria were threshold levels ≥ 25 dB HL at two or more frequencies for one ear or both. STUDY SAMPLE: 1478 participants aged 7-91 years were included. RESULTS: 1470 (99.5%) people cooperated in screening of which 1325 (90%) could be tested on both ears at all six frequencies. A majority, 987 (66.8%), performed ordinary PTA, 234 (15.8%) conditioned play audiometry, and 249 (16.9%) behavioural observation audiometry. Six hundred and sixty-nine (45%) passed and 809 (55%) failed according to referral criteria. Of those failing, 441 (54.5%) accepted referral to clinical evaluation. CONCLUSIONS: PTA with slight modifications is applicable for screening of a population with mild to profound intellectual disability. The most challenging and time-consuming activity is to introduce the test procedure in a way that reduces anxiety and establishes trust.

Hearing loss is negatively related to episodic and semantic long-term memory but not to short-term memory.

PURPOSE: To test the relationship between degree of hearing loss and different memory systems in hearing aid users. METHOD: Structural equation modeling (SEM) was used to study the relationship between auditory and visual acuity and different cognitive and memory functions in an age-hetereogenous subsample of 160 hearing aid users without dementia, drawn from the Swedish prospective cohort aging study known as Betula (L.-G. Nilsson et al., 1997). RESULTS: Hearing loss was selectively and negatively related to episodic and semantic long-term memory (LTM) but not short-term memory (STM) performance. This held true for both ears, even when age was accounted for. Visual acuity alone, or in combination with auditory acuity, did not contribute to any acceptable SEM solution. CONCLUSIONS: The overall relationships between hearing loss and memory systems were predicted by the ease of language understanding model (J. Rönnberg, 2003), but the exact mechanisms of episodic memory decline in hearing aid users (i.e., mismatch/disuse, attentional resources, or information degradation) remain open for further experiments. The hearing aid industry should strive to design signal processing algorithms that are cognition friendly.

The emergence of cognitive hearing science.

Cognitive Hearing Science or Auditory Cognitive Science is an emerging field of interdisciplinary research concerning the interactions between hearing and cognition. It follows a trend over the last half century for interdisciplinary fields to develop, beginning with Neuroscience, then Cognitive Science, then Cognitive Neuroscience, and then Cognitive Vision Science. A common theme is that an interdisciplinary approach is necessary to understand complex human behaviors, to develop technologies incorporating knowledge of these behaviors, and to find solutions for individuals with impairments that undermine typical behaviors. Accordingly, researchers in traditional academic disciplines, such as Psychology, Physiology, Linguistics, Philosophy, Anthropology, and Sociology benefit from collaborations with each other, and with researchers in Computer Science and Engineering working on the design of technologies, and with health professionals working with individuals who have impairments. The factors that triggered the emergence of Cognitive Hearing Science include the maturation of the component disciplines of Hearing Science and Cognitive Science, new opportunities to use complex digital signal-processing to design technologies suited to performance in challenging everyday environments, and increasing social imperatives to help people whose communication problems span hearing and cognition. Cognitive Hearing Science is illustrated in research on three general topics: (1) language processing in challenging listening conditions; (2) use of auditory communication technologies or the visual modality to boost performance; (3) changes in performance with development, aging, and rehabilitative training. Future directions for modeling and the translation of research into practice are suggested.

The design of a project to assess bilateral versus unilateral hearing aid fitting.

Binaural hearing provides advantages over monaural in several ways, particularly in difficult listening situations. For a person with bilateral hearing loss, the bilateral fitting of hearing aids thus seems like a natural choice. However, surprisingly few studies have been reported in which the additional benefit of bilateral versus unilateral hearing aid use has been investigated based on real-life experiences. Therefore, a project has been designed to address this issue and to find tools to identify people for whom the drawbacks would outweigh the advantages of bilateral fitting. A project following this design is likely to provide reliable evidence concerning differences in benefit between unilateral and bilateral fitting of hearing aids by evaluating correlations between entrance data and outcome measures and final preferences.

On the sneeze-reflex and its control.

Experiments in cats have shown that sneezing can be induced using low intensity electrical current. This study focusses on answering the question whether the sneezing-reflex can also be induced in man through electrical stimulation, whether it is reproducible, and if the response can be abolished pharmacologically? Three healthy males were tested using intranasal stimulation in different parts of the nose using a current from an electric pulse generator. Using currents in the range 2-11 mA, it was possible to induce and reproduce sneezing in the anterior portion of the nose corresponding to the distribution area of the anterior ethmoidal nerve. In one tested subject, local anaesthetics applied to the mucous membranes of the nose abolished the sneezing. Sneeze reflex-reduction may be one way to reduce viral contamination between subjects. Further research could include pharmacological investigations to identify a sneeze-inhibiting substance with small risks for side effects that can be added to common cold nasal sprays.

Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database.

CONCLUSION: The first results from 300 patients in a Swedish national database for sudden sensorineural hearing loss (SSNHL) demonstrate that corticosteroids or 'no treatment at all' are the treatment options in use today. No significant difference in outcome was seen between treated and non-treated patients. Since spontaneous recovery might be the cause, a placebo-controlled randomized study is required before a positive effect of corticosteroids can be asserted. OBJECTIVES: To investigate the treatment policy for SSNHL in Sweden, the effect on outcome, and which variables are of value in predicting the outcome. PATIENTS AND METHODS: A national database was developed in Sweden which gathers data from patients with SSNHL. A form is used for data collection covering background, current disease, examinations, and treatment. Audiograms at the onset of SSNHL and after 3 months are analyzed. RESULTS: Of 300 patients, 208 were considered to have idiopathic SSNHL; 50% were treated with corticosteroids, 44% did not receive any treatment. The treated patients had the same outcome as the non-treated patients. The time interval from onset of SSNHL to start of treatment was of importance for the outcome irrespective of type of audiogram or results from laboratory tests. Higher age and heredity for hearing loss gave a significantly lower chance of improvement.

A survey of public health policy on bilateral fittings and comparison with market trends: the evidence-base required to frame policy.

This report presents a review of the situation in a number of countries with respect to public health policy for funding of hearing aid services in general and support to bilateral fittings in particular. The data show considerable variations among the countries studied in number of hearing aids fitted per 1000 inhabitants, differing by a factor of 6 between the extremes. Also the percentage of bilateral fittings differs with an average estimated to be of the order of 50%. For hearing-impaired children, bilateral fittings are given full financial support in most countries studied. The data presented indicate the need for a reliable, scientifically valid evidence-base regarding bilateral hearing aid fitting.

A Swedish version of the Hearing In Noise Test (HINT) for measurement of speech recognition.

A Swedish Hearing In Noise Test (HINT), consisting of everyday sentences to be used in an adaptive procedure to estimate the speech recognition thresholds in noise and quiet, has been developed. The material consists of 250 sentences, with a length of five to nine syllables, normalized for naturalness, difficulty and reliability. The sentences were recorded with a female speaker. From the sentences, 25 phonemically balanced lists were created. All lists fluctuate less than 1 dB of the overall mean. The standard deviation of the test-retest difference is 0.94 dB when testing with one list, and decreases to 0.68 dB and 0.56 dB for two and three lists, respectively. The average speech recognition thresholds in noise for the Swedish sentences were -3.0 dB signal/noise ratio (SD=1.1 dB). The present study has resulted in a well-defined and internationally comparable set of sentences, which can be used in Swedish audiological rehabilitation and research to measure speech recognition in noise and quiet.

[Local overpressure treatment reduces vestibular symptoms in patients with Menière's disease--secondary publication. A clinically randomised multicenter double-blind placebo-controlled study]. / Lokal overtryksbehandling reducerer vestibulaere symptomer hos patienter med Menières sygdom--sekundaerpublikation. Et klinisk randomiseret multicenter-dobbeltblindet placebokontrolleret studie.

This investigation was performed to evaluate the efficacy of a new device, the Méniètt, in the treatment of Ménière's disease. The device delivers pressure pulses to the middle ear through a ventilating tube in the tympanic membrane. These pressure changes are conveyed to the inner ear, reducing the endolymphatic hydrops. The device is significantly effective in reducing the vestibular symptoms, as compared with the placebo device. Local overpressure treatment is a novel treatment that is non-invasive, non-destructive and safe. It should be offered to patients before more invasive surgical modalities are suggested.

Speech understanding in quiet and noise, with and without hearing aids.

Speech recognition and cognitive functions important for speech understanding were evaluated by objective measures and by scores of perceived effort, with and without hearing aids. The tests were performed in silence, and with background conditions of speech spectrum random noise and ordinary speech. One young and one elderly group of twelve hearing-impaired subjects each participated. Hearing aid use improved speech recognition in silence (7 dB) and in the condition with speech as background (2.5 dB S/N), but did not change the perceived effort scores. In the cognitive tests no hearing aid benefit was seen in objective measures, while there was an effect of hearing aid use in scores of perceived effort, subjects reported less effort. There were no age effects on hearing aid benefit. In conclusion, hearing aid use may result in reduced effort in listening tasks that is not associated with improvement in objective scores.

Cognitive performance and perceived effort in speech processing tasks: effects of different noise backgrounds in normal-hearing and hearing-impaired subjects.

Cognitive tests of speech understanding were administered (presented as text, or in auditory or audiovisual modality) and perceived effort was rated. This was done in four background conditions: in silence, and in three types of noise (S/N=+10 dB) varying in temporal structure and meaningfulness. Four groups of 12 subjects each (young/elderly with normal hearing and young/elderly with hearing impairment) participated. The presence of noise had a negative effect on accuracy and speed of performance in the speech processing tasks, and resulted in higher scores of perceived effort, even when the stimuli were presented as text. Differences in performance between noise conditions existed. In the subjective scores, the noise with temporal variations, but without meaningful content, was the most disruptive of the three noise conditions. In the objective scores the hearing-impaired subjects showed poorer results in noise with temporal variations. The elderly subjects were more distracted by noise with temporal variations, and especially by noise with meaningful content. In noise, all subjects, particularly those with impaired hearing, were more dependent upon visual cues than in the quiet condition.

Local overpressure treatment reduces vestibular symptoms in patients with Meniere's disease: a clinical, randomized, multicenter, double-blind, placebo-controlled study.

OBJECTIVES: To evaluate the efficacy of a new device, the Meniett, in the treatment of Meniere's disease. The device delivers pressure pulses to the middle ear through a ventilating tube in the tympanic membrane at a frequency of 6 Hz for 0.6 second. After rising to a pressure level of 1.2 kPa, the pressure oscillates between 0.4 and 1.2 kPa. It is believed that the pressure changes are conveyed to the inner ear, inducing a transport of fluids via the pressure outlets and thus reducing the endolymphatic hydrops. STUDY DESIGN: A clinical, randomized, multicenter, double-blind, placebo-controlled study. A total of 40 patients were included that had active Meniere's disease according to American Academy of Otolaryngology-Head and Neck Surgery criteria, aged between 20 and 65 years, with a history of at least eight attacks during the past year. After insertion of the ventilation tube, the patients should have had attacks of vertigo for 2 months before entering the study. OUTCOME MEASURES: Primary study endpoints were change in frequency of vertigo, change of functionality profile, and change in patient perception of vertigo (visual analogue scale); secondary endpoints were perception of tinnitus, aural pressure, and hearing, as well as an audiologic evaluation of hearing before and after the treatment period. RESULTS: The functionality level improved statistically significantly in the active group compared with the placebo group (p=0.0014), as did the visual analogue scale evaluation of vertigo (p=0.005). There was a trend toward a reduction of the frequency of vertiginous attacks that was not significant (p=0.090). With regard to the secondary endpoints, there was no statistical difference between active and placebo groups. CONCLUSION: Local overpressure treatment is a novel treatment that is noninvasive, nondestructive, and safe. It significantly reduces vestibular symptoms in patients with Meniere's disease. The Meniett was cleared by the Food and Drug Administration in 2000.

Otoacoustic emissions and tympanometry in a general adult population in Sweden.

The present study concerns a general adult population in Sweden, not exposed to hazardous occupational noise. Tympanometry and spontaneous (SOAE), transient evoked (TEOAE) and distortion-product (DPOAE) otoacoustic emissions were investigated in 493 randomly selected men and women aged from 20 to 79 years. Effects of gender, age, ear side and middle ear state were determined, with and without adjusting for hearing threshold level. No statistically significant effects on middle ear pressure or compliance were present. For TEOAEs and DPOAEs, the effect of gender and age was statistically significant (p < 0.01), with larger signal levels for female subjects and young subjects, even after adjusting for hearing threshold level. No effect of middle ear pressure on otoacoustic emissions was present, but high middle ear compliance was associated with low emission levels (p < 0.01). Reference data for middle ear compliance and pressure and prevalence data on SOAEs, TEOAEs and DPOAEs for male and female subjects in different age groups were determined. Mean signal levels of TEOAEs and DPOAEs are presented.