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.

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.

The homogeneity with respect to intelligibility of recorded word-recognition materials.

BACKGROUND: In developing the PB-50 word lists, J. P. Egan suggested five developmental principles, two of which were "equal average difficulty" and an "equal range of difficulty" among the lists (page 963). Egan was satisfied that each of the 20 PB-50 lists had equivalent ranges of recognition performances and that the lists produced the same average performances. This was accomplished in preliminary studies that measured the recognition performance of each word and eliminated words that were always or never correct. In preparing for studies of interrupted words, we needed to know the range of difficulty inherent in the speaker specific NU-6 and Maryland CNC materials we planned to use when those words were not interrupted. There were only a few studies in the literature that touched on the range of difficulty characteristic of the word-recognition materials in common usage. The paucity of this information prompted this investigation whose scope broadened to include the CID W-22, Maryland CNC, NU-6, and PB-50 materials spoken by a variety of speakers. PURPOSE: The purpose was to evaluate the homogeneity with respect to intelligibility of the words that comprise several of the common word-recognition materials used in audiologic evaluations. RESEARCH DESIGN: Both retrospective (10) and prospective (3) studies were involved. Data from six of the retrospective studies were from our labs. The prospective studies involved both listeners with normal hearing for pure tones and listeners with sensorineural hearing loss. STUDY SAMPLE: The sample sizes for the 13 data sets ranged from 24 to 1,030, with 24 the typical number for listeners with normal hearing. DATA COLLECTION AND ANALYSIS: The retrospective data were from published studies and archived data from our laboratories. The prospective studies involved presentation of the word-recognition materials to the listeners at a comfortable level. An item analysis was conducted on each data set with descriptive statistics used to characterize the data. Additionally, skewness coefficients were calculated on the distributions of word performances and the interquartile range was used to determine minor and major outliers within each set of 200 words and their component 50-word lists (300 words for the Maryland CNCs). RESULTS: For listeners with normal hearing the majority of performances on the words within a 50-word list were better than the mean performance, which produced negatively skewed distributions with outlier performances in every list. For listeners with sensorineural hearing loss the performances on the words within a 50-word list were evenly distributed above and below the mean performance, which yielded essentially normal distributions with few outliers. There were a few words on which performances were better by the listeners with hearing loss. CONCLUSIONS: Every list of word-recognition materials has a few words on which recognition performances are noticeably poorer than performances on the majority of the remaining words. If the intention of an experiment is to evaluate performance at the word level, then identifying these "outliers" becomes a necessity. Although not evaluated in this report, the implications for 25-word lists are they should be based on recognition-performance data and not compiled arbitrarily.

Validation of a screening test of auditory function using the telephone.

BACKGROUND: Several European countries have demonstrated successful use of telephone screening tests for auditory function. The screening test consists of spoken three-digit sequences presented in a noise background. The speech-to-noise ratios of the stimuli are determined by an adaptive tracking method that converges on the level required to achieve 50% correct recognition. PURPOSE: A version of the three-digit telephone screening protocol for the United States was developed: the US National Hearing Test (NHT). The objective of the current study was to determine the sensitivity and specificity as well as the feasibility of the NHT for use within the Department of Veterans Affairs (VA). Research Design and Study Sample: Using a multisite study design with convenience sampling, we used the NHT to collect data from 693 participants (1379 ears) from three geographical areas of the United States (Florida, Tennessee, and California). DATA COLLECTION AND ANALYSIS: The NHT procedures were as follows: the participants (1) called a toll-free telephone number, (2) entered their assigned ear-specific identification code, (3) listened to 40-sets of digit triplets presented in speech-spectrum background noise, and (4) entered in the numbers that they heard on the telephone key pad. The NHT was performed on each ear, either at home or in a VA clinic. In addition to collecting data from the experimental task, we gathered demographic data and the data from other standard-of-care tests (i.e., audiometric thresholds and speech recognition tests in quiet and in noise). RESULTS: A total of 505 participants completed the NHT at a VA clinic, whereas 188 completed the test at home. Although the ear-specific NHT and mean pure-tone threshold all correlated significantly (p < 0.001), there were more modest correlations in the low- and high-frequency ranges with the highest correlation seen with the 2000 Hz mean pure-tone threshold. When the NHT 50% point or threshold was compared with the three-frequency PTA at 500, 1000, and 2000 Hz, the sensitivity was 0.87 and specificity was 0.54. When comparing the NHT with the four-frequency PTA at 500, 1000, 2000, and 4000 Hz, the sensitivity was 0.81 and specificity increased to 0.65. The NHT also correlated strongly with other speech-in-noise measures. CONCLUSIONS: The NHT was found to correlate with other audiometric measures, including pure-tone thresholds and speech recognition tests in noise, at sufficiently high correlation values to support its use as a screening test of auditory function.

A treatise on the thresholds of interoctave frequencies: 1500, 3000, and 6000 Hz.

BACKGROUND: For the past 50+ years, audiologists have been taught to measure the pure-tone thresholds at the interoctave frequencies when the thresholds at adjacent octave frequencies differ by 20 dB or more. Although this so-called 20 dB rule is logical when enhanced audiometric resolution is required, the origin of the rule is elusive, and a thorough literature search failed to find supporting scientific data. PURPOSE: This study purposed to examine whether a 20 dB difference between thresholds at adjacent octave frequencies is the critical value for whether the threshold of the interoctave frequency should be measured. Along this same line of questioning is whether interoctave thresholds can be predicted from the thresholds of the adjacent or bounding octave frequencies instead of measured, thereby saving valuable time. RESEARCH DESIGN: Retrospective, descriptive, correlational, and cross-sectional. STUDY SAMPLE: Audiograms from over a million veterans provided the data, which were archived at the Department of Veterans Affairs, Denver Acquisition and Logistics Center. DATA COLLECTION AND ANALYSIS: Data from the left and right ears were independently evaluated. For each ear three interoctave frequencies (1500, 3000, and 6000 Hz) were studied. For inclusion, thresholds at the interoctave frequency and the two bounding octave frequencies had to be measurable, which produced unequal numbers of participants in each of the six conditions (2 ears by 3 interoctave frequencies). Age tags were maintained with each of the six conditions. RESULTS: Three areas of analyses were considered. First, relations among the octave-frequency thresholds were examined. About 62% of the 1000-2000 Hz threshold differences were ≥20 dB, whereas about 74% of the 4000-8000 Hz threshold differences were <20 dB. About half of the threshold differences between 2000 and 4000 Hz were <20 dB and half were >20 dB. There was an inverse relation between frequency and the percent of negative slopes between octave-frequency thresholds, ranging from 89% at 1500 Hz to 54% at 6000 Hz. The majority of octave-frequency pairs demonstrated poorer thresholds for the higher frequency of the pair. Second, interoctave frequency thresholds were evaluated using the median metric. As the interoctave frequency increased from 1500 to 6000 Hz, the percent of thresholds at the interoctave frequencies that were not equal to the median threshold increased from ∼9.5% (1500 Hz) to 15.6% (3000 Hz) to 28.2% (6000 Hz). Bivariate plots of the interoctave thresholds and the mean octave-frequency thresholds produced 0.85-0.91 R² values and 0.79-0.92 dB/dB slopes. Third, the predictability of the interoctave thresholds from the mean thresholds of the bounding octave frequencies was evaluated. As expected, as the disparity between octave-frequency thresholds increased, the predictability of the interoctave threshold decreased; for example, using a ±5 dB criterion at 1500 Hz, 53% of the thresholds were ±5 dB when the octave thresholds differed by ≥20 dB, whereas 77% were ±5 dB when the octave thresholds differed by <20 dB. CONCLUSIONS: The current findings support the 20 dB rule for testing interoctave frequency thresholds and suggest the rule could be increased to 25 dB or more with little adverse effect.

Learning to listen again: the role of compliance in auditory training for adults with hearing loss.

PURPOSE: To examine the role of compliance in the outcomes of computer-based auditory training with the Listening and Communication Enhancement (LACE) program in Veterans using hearing aids. METHOD: The authors examined available LACE training data for 5 tasks (i.e., speech-in-babble, time compression, competing speaker, auditory memory, missing word) from 50 hearing-aid users who participated in a larger, randomized controlled trial designed to examine the efficacy of LACE training. The goals were to determine: (a) whether there were changes in performance over 20 training sessions on trained tasks (i.e., on-task outcomes); and (b) whether compliance, defined as completing all 20 sessions, vs. noncompliance, defined as completing less than 20 sessions, influenced performance on parallel untrained tasks (i.e., off-task outcomes). RESULTS: The majority, 84% of participants, completed 20 sessions, with maximum outcome occurring with at least 10 sessions of training for some tasks and up to 20 sessions of training for others. Comparison of baseline to posttest performance revealed statistically significant improvements for 4 of 7 off-task outcome measures for the compliant group, with at least small (0.2 < d < 0.3) Cohen's d effect sizes for 3 of the 4. There were no statistically significant improvements observed for the noncompliant group. CONCLUSION: The high level of compliance in the present study may be attributable to use of systematized verbal and written instructions with telephone follow-up. Compliance, as expected, appears important for optimizing the outcomes of auditory training. Methods to improve compliance in clinical populations need to be developed, and compliance data are important to report in future studies of auditory training.

Characteristics of the audiometric 4,000 Hz notch (744,553 veterans) and the 3,000, 4,000, and 6,000 Hz notches (539,932 veterans).

The purpose of this study was to examine the prevalence and characteristics of audiograms that are notched (1) at 4,000 Hz and (2) at 3,000, 4,000, and/or 6,000 Hz. Bilateral audiograms from 1,000,001 veterans were obtained from Department of Veterans Affairs archives; after "cleaning" algorithms were applied, 744,553 participants (mean age = 63.5 yr) were included in the 4,000 Hz notch analysis (group 1) and 539,932 participants (mean age = 62.2 yr) were included in the 3,000, 4,000, and/or 6,000 Hz notch analysis (group 2). A notch was defined when the threshold at the notch frequency (3,000, 4,000, or 6,000 Hz) minus the 2,000 Hz threshold and the threshold at the notch frequency minus the 8,000 Hz threshold both were greater than or equal to 10 dB. In group 1, 77.1% did not have a notch at 4,000 Hz. In group 2, 65.3% did not have a notch at 3,000, 4,000, or 6,000 Hz; 12.4% had bilateral notches, 11.7% had left ear notches, and 10.7% had right ear notches. The notches were about twice as deep on the low-frequency side of the notch than on the high-frequency side. The mean left ear and right ear notch depths were about the same (23 dB), with mode notch depths in the 15.0 to 17.5 dB range.

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.

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.

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.

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).

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.

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.

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.

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.

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.