[Automatic hearing screening for better monitoring of hearing health using the example of the German armed forces]. / Automatisiertes Hörscreening zur verbesserten Überwachung der Hörgesundheit am Beispiel der Bundeswehr.

In the present study, the concept of a systematic automated screening of temporary soldiers was evaluated based on the example of the ENT Department of the Bundeswehr Central Hospital Koblenz. From 2014 to 2017, anonymized data of 169 individuals were collected from the setting of the Bundeswehr Central Hospital. Included in the data are results from measurements with automated pure-tone audiometry (APTA; e.g., [3]), from measurements with the digit triple test for determination of the speech discrimination threshold in noise (e.g., [20]), and from interviews with questionnaires (Hearing-Dependent Daily Activities [HDDA], e.g., [14]; HearCom questionnaire, e.g., [15]). There was an initial publication from this project evaluating the questionnaires in terms of their suitability for detecting hearing loss [14]. In the following (from March 2015), only the HDDA, which was described as more sensitive, was used for measurements at the hearing screening measurement station. A complete run with the three procedures took approximately 22 min. Approximately 17% of the examined participants had abnormal findings in at least one of the procedures at the screening station. The results of the respective methods taken together detect more than any method alone and can be assumed to be complementary. Deviations between APTA with level monitor and manual tone audiometry were within the measurement accuracy. In the range between 1 and 4 kHz, hearing thresholds are somewhat underestimated with APTA. The threshold for the HDDA questionnaire with an HDDA sum ≥ 19 was confirmed. Automated hearing screening offers a good opportunity to check hearing ability on a regular basis in a standardized and reliable manner, while keeping personnel requirements low.

Conformities and gaps of clinical audiological data with the international classification of functioning disability and health core sets for hearing loss.

OBJECTIVE: The International Classification of Functioning Disability and Health (ICF) is a classification of health and health-related domains created by the World Health Organization and can be used as a standard to evaluate the health and disability of individuals. The ICF Core Set for Hearing Loss (CSHL) refers to the ICF categories found to be relative to Hearing Loss (HL) and the consequences of it on daily life. This study aimed to adapt the content of a database gathered in Hörzentrum Oldenburg gGmbH that included HL medical assessments and audiological data to the ICF. DESIGN: ICF linking rules were applied to these assessment methods including medical interviews, ear examinations, pure-tone audiometry, Adaptive Categorical Loudness Scaling, and speech intelligibility test. STUDY SAMPLE: 1316 subjects. RESULTS: In total, 44% of the brief and 18% of the comprehensive CSHL categories were addressed. The hearing functions were broadly evaluated. "Activities and Participation" and "Environmental Factors" were poorly examined (17% and 12% of the comprehensive CSHL categories, respectively). CONCLUSIONS: The HL correlation with day-to-day activities limitation, performance restriction, and environmental conditions were poorly addressed. This study showed the essence of incorporating these methodologies with approaches that assess the daily-life challenges caused by HL in rehabilitation.

Vehicle noise: comparison of loudness ratings in the field and the laboratory.

Objective: Distorted loudness perception is one of the main complaints of hearing aid users. Measuring loudness perception in the clinic as experienced in everyday listening situations is important for loudness-based hearing aid fitting. Little research has been done comparing loudness perception in the field and in the laboratory.Design: Participants rated the loudness in the field and in the laboratory of 36 driving actions. The field measurements were recorded with a 360° camera and a tetrahedral microphone. The recorded stimuli, which are openly accessible, were presented in three conditions in the laboratory: 360° video recordings with a head-mounted display, video recordings with a desktop monitor and audio-only.Study samples: Thirteen normal-hearing participants and 18 hearing-impaired participants with hearing aids.Results: The driving actions were rated as louder in the laboratory than in the field for the condition with a desktop monitor and for the audio-only condition. The less realistic a laboratory condition was, the more likely it was for a participant to rate a driving action as louder. The field-laboratory loudness differences were bigger for louder sounds.Conclusion: The results of this experiment indicate the importance of increasing realism and immersion when measuring loudness in the clinic.

The development of a Self-Rated ICF-based questionnaire (HEAR-COMMAND Tool) to evaluate Hearing, Communication, and Conversation disability: Multinational experts' and patients' perspectives.

Objective: An instrument that facilitates the advancement of hearing healthcare delivery from a biomedical model to a biopsychosocial one that underpins the International Classification of Functioning, Disability, and Health framework (ICF) brief and comprehensive Core Sets for Hearing Loss (CSHL) is currently unavailable. The objective is to describe the process of developing and validating a new questionnaire named the HEAR-COMMAND Tool created by transferring the ICF CSHL into a theory-supported, practically manageable concept. Design: A team from Germany, the USA, the Netherlands, and Egypt collaborated on development. The following ICF domains were considered; "Body Functions" (BF), "Activities and Participation" (AP), and "Environmental Factors" (EF). The development yielded English, German, and Arabic versions. A pilot validation study with a total of 109 respondents across three countries, Germany, Egypt, and the USA was conducted to revise the item terminology according to the feedback provided by the respondents. Results: The questionnaire included a total of 120 items. Ninety items were designed to collect information on the functioning and 30 items inquiring about demographic information, hearing status, and Personal Factors. Except for the "Body Structures" (BS) domain, all the categories of the brief ICF CSHL were covered (a total of 85% of the categories). Moreover, the items covered 44% of the comprehensive ICF CSHL categories including 73% of BF, 55% of AP, and 27% of EF domains. Overall, the terminology of 24 ICF-based items was revised based on the qualitative analysis of the respondents' feedback to further clarify the items that were found tod be unclear or misleading. The tool highlighted the broad connection of HL with bodily health and contextual factors. Conclusions: The HEAR-COMMAND Tool was developed based on the ICF CSHL and from multinational experts' and patients' perspectives with the aim to improve the execution of audiological services, treatment, and rehabilitation for adult patients with HL. Additional validation of the tool is ongoing. The next step would be to pair the tool with BS categories since it was excluded from the tool and determine its effectiveness in guiding hearing health care practitioners to holistically classify categories influencing hearing, communication, and conversation disability.

Individual Hearing Aid Benefit in Real Life Evaluated Using Ecological Momentary Assessment.

Ecological momentary assessment (EMA) was used in 24 adults with mild-to-moderate hearing loss who were seeking first hearing-aid (HA) fitting or HA renewal. At two stages in the aural rehabilitation process, just before HA fitting and after an average 3-month HA adjustment period, the participants used a smartphone-based EMA system for 3 to 4 days. A questionnaire app allowed for the description of the environmental context as well as assessments of various hearing-related dimensions and of well-being. In total, 2,042 surveys were collected. The main objectives of the analysis were threefold: First, describing the "auditory reality" of future and experienced HA users; second, examining the effects of HA fitting for individual participants, as well as for the subgroup of first-time HA-users; and third, reviewing whether the EMA data collected in the unaided condition predicted who ultimately decided for or against permanent HA use. The participants reported hearing-related disabilities across the full range of daily listening tasks, but communication events took the largest share. The effect of the HA intervention was small in experienced HA users. Generally, much larger changes and larger interindividual differences were observed in first-time compared with experienced HA users in all hearing-related dimensions. Changes were not correlated with hearing loss or with the duration of the HA adjustment period. EMA data collected in the unaided condition did not predict the cancelation of HA fitting. The study showed that EMA is feasible in a general population of HA candidates for establishing individual and multidimensional profiles of real-life hearing experiences.

The Virtual Reality Lab: Realization and Application of Virtual Sound Environments.

To assess perception with and performance of modern and future hearing devices with advanced adaptive signal processing capabilities, novel evaluation methods are required that go beyond already established methods. These novel methods will simulate to a certain extent the complexity and variability of acoustic conditions and acoustic communication styles in real life. This article discusses the current state and the perspectives of virtual reality technology use in the lab for designing complex audiovisual communication environments for hearing assessment and hearing device design and evaluation. In an effort to increase the ecological validity of lab experiments, that is, to increase the degree to which lab data reflect real-life hearing-related function, and to support the development of improved hearing-related procedures and interventions, this virtual reality lab marks a transition from conventional (audio-only) lab experiments to the field. The first part of the article introduces and discusses the notion of the communication loop as a theoretical basis for understanding the factors that are relevant for acoustic communication in real life. From this, requirements are derived that allow an assessment of the extent to which a virtual reality lab reflects these factors, and which may be used as a proxy for ecological validity. The most important factor of real-life communication identified is a closed communication loop among the actively behaving participants. The second part of the article gives an overview of the current developments towards a virtual reality lab at Oldenburg University that aims at interactive and reproducible testing of subjects with and without hearing devices in challenging communication conditions. The extent to which the virtual reality lab in its current state meets the requirements defined in the first part is discussed, along with its limitations and potential further developments. Finally, data are presented from a qualitative study that compared subject behavior and performance in two audiovisual environments presented in the virtual reality lab-a street and a cafeteria-with the corresponding field environments. The results show similarities and differences in subject behavior and performance between the lab and the field, indicating that the virtual reality lab in its current state marks a step towards more ecological validity in lab-based hearing and hearing device research, but requires further development towards higher levels of ecological validity.

Influence of working memory and attention on sound-quality ratings.

This study investigated the potential influence of cognitive factors on subjective sound-quality ratings. To this end, 34 older subjects (ages 61-79) with near-normal hearing thresholds rated the perceived sound quality of speech and music stimuli that had been distorted by linear filtering, non-linear processing, and multiband dynamic compression. In addition, all subjects performed the Reading Span Test (RST) to assess working memory capacity (WMC), and the test d2-R (a visual test of letter and symbol identification) was used to assess the subjects' selective and sustained attention. The quality-rating scores, which reflected the susceptibility to signal distortions, were characterized by large interindividual variances. Linear mixed modelling with age, high-frequency pure tone threshold, RST, and d2-R results as independent variables showed that individual speech-quality ratings were significantly related to age and attention. Music-quality ratings were significantly related to WMC. Taking these factors into account might lead to improved sound-quality prediction models. Future studies should, however, address the question of whether these effects are due to procedural mechanisms or actually do show that cognitive abilities mediate sensitivity to sound-quality modifications.

What Keeps Older Adults With Hearing Impairment From Adopting Hearing Aids?

The aim of this study was to compare elderly individuals who are hearing impaired but inexperienced in using hearing aids (hearing aid non-users; HA-NU) with their aided counterparts (hearing aid users; HA-U) across various auditory and non-auditory measures in order to identify differences that might be associated with the low hearing aid uptake rate. We have drawn data of 72 HA-NU and 139 HA-U with a mild-to-moderate hearing loss, and matched these two groups on the degree of hearing impairment, age, and sex. First, HA-NU and HA-U were compared across 65 auditory, cognitive, health-specific, and socioeconomic test measures as well as measures assessing technology commitment. Second, a logistic regression approach was performed to identify relevant predictors for using hearing aids. Finally, we conducted a sensitivity analysis for the matching approach. Group comparisons indicated that HA-NU perceive their hearing problem as less severe than their aided counterparts. Furthermore, HA-NU showed worse technology commitment and lower socioeconomic status than HA-U. The logistic regression revealed self-reported hearing performance, technology commitment, and the socioeconomic and health status as the most important predictors for using hearing aids.

Development and psychometric properties of the sound preference and hearing habits questionnaire (SP-HHQ).

OBJECTIVE: The aim of the study was, based on the individualisation of hearing aids (HA) and pre-sets for audio devices, to develop a questionnaire to determine the basis for profiling sound preferences and hearing habits to gather additional information usable for HA fitting and adjustment tools for audio-devices. METHODS: We developed a questionnaire consisting of 46 items. A postal survey was conducted with N = 622 users with a mean age of 66 years (47.9% aided with HA, 45.7% female). RESULTS: Seven factors were identified by means of Explanatory and Confirmatory Factor Analyses: F1: 'Annoyance/distraction by background noise', F2: 'Importance of sound quality', F3: 'Noise Sensitivity', F4: 'Avoidance of unpredictable sounds', F5: 'Openness towards loud/new sounds', F6: 'Preferences for warm sounds', and F7: 'Details of environmental sounds/music'. Only the first of these factors was related to the audiogram of the user. No difference with any of the factors could be observed with HA use/non-use. In contrast, gender effects were found with female respondents preferring warm sounds and being more sensitive to noise. CONCLUSIONS: The sound preference and hearing habits questionnaire (SP-HHQ) is a usable tool for profiling the users with respect to sound preferences relevant for HA fitting and pre-sets for audio devices.

Assessment of hearing aid algorithms using a master hearing aid: the influence of hearing aid experience on the relationship between speech recognition and cognitive capacity.

OBJECTIVES: Model-based hearing aid development considers the assessment of speech recognition using a master hearing aid (MHA). It is known that aided speech recognition in noise is related to cognitive factors such as working memory capacity (WMC). This relationship might be mediated by hearing aid experience (HAE). The aim of this study was to examine the relationship of WMC and speech recognition with a MHA for listeners with different HAE. DESIGN: Using the MHA, unaided and aided 80% speech recognition thresholds in noise were determined. Individual WMC capacity was assed using the Verbal Learning and Memory Test (VLMT) and the Reading Span Test (RST). STUDY SAMPLE: Forty-nine hearing aid users with mild to moderate sensorineural hearing loss divided into three groups differing in HAE. RESULTS: Whereas unaided speech recognition did not show a significant relationship with WMC, a significant correlation could be observed between WMC and aided speech recognition. However, this only applied to listeners with HAE of up to approximately three years, and a consistent weakening of the correlation could be observed with more experience. CONCLUSIONS: Speech recognition scores obtained in acute experiments with an MHA are less influenced by individual cognitive capacity when experienced HA users are taken into account.

Relation Between Listening Effort and Speech Intelligibility in Noise.

PURPOSE: Subjective ratings of listening effort might be applicable to estimate hearing difficulties at positive signal-to-noise ratios (SNRs) at which speech intelligibility scores are near 100%. Hence, ratings of listening effort were compared with speech intelligibility scores at different SNRs, and the benefit of hearing aids was evaluated. METHOD: Two groups of listeners, 1 with normal hearing and 1 with hearing impairment, performed adaptive speech intelligibility and adaptive listening effort tests (Adaptive Categorical Listening Effort Scaling; Krueger, Schulte, Brand, & Holube, 2017) with sentences of the Oldenburg Sentence Test (Wagener, Brand, & Kollmeier, 1999a, 1999b; Wagener, Kühnel, & Kollmeier, 1999) in 4 different maskers. Model functions were fitted to the data to estimate the speech reception threshold and listening effort ratings for extreme effort and no effort. RESULTS: Listeners with hearing impairment showed higher rated listening effort compared with listeners with normal hearing. For listeners with hearing impairment, the rating extreme effort, which corresponds to negative SNRs, was more correlated to the speech reception threshold than the rating no effort, which corresponds to positive SNRs. A benefit of hearing aids on speech intelligibility was only verifiable at negative SNRs, whereas the effect on listening effort showed high individual differences mainly at positive SNRs. CONCLUSION: The adaptive procedure for rating subjective listening effort yields information beyond using speech intelligibility to estimate hearing difficulties and to evaluate hearing aids.

Auditory and Non-Auditory Contributions for Unaided Speech Recognition in Noise as a Function of Hearing Aid Use.

Differences in understanding speech in noise among hearing-impaired individuals cannot be explained entirely by hearing thresholds alone, suggesting the contribution of other factors beyond standard auditory ones as derived from the audiogram. This paper reports two analyses addressing individual differences in the explanation of unaided speech-in-noise performance among n = 438 elderly hearing-impaired listeners (mean = 71.1 ± 5.8 years). The main analysis was designed to identify clinically relevant auditory and non-auditory measures for speech-in-noise prediction using auditory (audiogram, categorical loudness scaling) and cognitive tests (verbal-intelligence test, screening test of dementia), as well as questionnaires assessing various self-reported measures (health status, socio-economic status, and subjective hearing problems). Using stepwise linear regression analysis, 62% of the variance in unaided speech-in-noise performance was explained, with measures Pure-tone average (PTA), Age, and Verbal intelligence emerging as the three most important predictors. In the complementary analysis, those individuals with the same hearing loss profile were separated into hearing aid users (HAU) and non-users (NU), and were then compared regarding potential differences in the test measures and in explaining unaided speech-in-noise recognition. The groupwise comparisons revealed significant differences in auditory measures and self-reported subjective hearing problems, while no differences in the cognitive domain were found. Furthermore, groupwise regression analyses revealed that Verbal intelligence had a predictive value in both groups, whereas Age and PTA only emerged significant in the group of hearing aid NU.

Development of a German reading span test with dual task design for application in cognitive hearing research.

OBJECTIVE: To report the development of a standardized German version of a reading span test (RST) with a dual task design. Special attention was paid to psycholinguistic control of the test items and time-sensitive scoring. We aim to establish our RST version to use for determining an individual's working memory in the framework of hearing research in German contexts. DESIGN: RST stimuli were controlled and pretested for psycholinguistic factors. The RST task was to read sentences, quickly determine their plausibility, and later recall certain words to determine a listener's individual reading span. RST results were correlated with outcomes of additional sentence-in-noise tests measured in an aided and an unaided listening condition, each at two reception thresholds. STUDY SAMPLE: Item plausibility was pre-determined by 28 native German participants. An additional 62 listeners (45-86 years, M = 69.8) with mild-to-moderate hearing loss were tested for speech intelligibility and reading span in a multicenter study. RESULTS: The reading span test significantly correlated with speech intelligibility at both speech reception thresholds in the aided listening condition. CONCLUSION: Our German RST is standardized with respect to psycholinguistic construction principles of the stimuli, and is a cognitive correlate of intelligibility in a German matrix speech-in-noise test.

Intention to use hearing aids: a survey based on the theory of planned behavior.

OBJECTIVE: To determine the intention to use hearing aids (HAs) by applying the theory of planned behavior (TPB). DESIGN: The TPB is a widely used decision-making model based on three constructs hypothesized to influence the intention to perform a specific behavior; namely, "attitude toward the behavior", "subjective norm", and "behavioral control". The survey was based on a TPB-specific questionnaire addressing factors relevant to HA provision. STUDY SAMPLE: Data from 204 individuals reporting hearing problems were analyzed. Different subgroups were established according to the stage of their hearing help-seeking. RESULTS: The TPB models' outcome depended on the subgroup. The intention of those participants who had recognized their hearing problems but had not yet consulted an ear, nose, and throat specialist was largely dominated by the "subjective norm" construct, whereas those who had already consulted an ear, nose, and throat specialist or had already tried out HAs were significantly influenced by all constructs. The intention of participants who already owned HAs was clearly less affected by the "subjective norm" construct but was largely dominated by their "attitude toward HAs". CONCLUSION: The intention to use HAs can be modeled on the basis of the constructs "attitude toward the behavior", "subjective norm", and "behavioral control". Individual contribution of the constructs to the model depends on the patient's stage of hearing help-seeking. The results speak well for counseling strategies that explicitly consider the individual trajectory of hearing help-seeking.

Audio reproduction for personal ambient home assistance: concepts and evaluations for normal-hearing and hearing-impaired persons.

Within the Lower Saxony Research Network Design of Environments for Ageing (GAL), a personal activity and household assistant (PAHA), an ambient reminder system, has been developed. One of its central output modality to interact with the user is sound. The study presented here evaluated three different system technologies for sound reproduction using up to five loudspeakers, including the "phantom source" concept. Moreover, a technology for hearing loss compensation for the mostly older users of the PAHA was implemented and evaluated. Evaluation experiments with 21 normal hearing and hearing impaired test subjects were carried out. The results show that after direct comparison of the sound presentation concepts, the presentation by the single TV speaker was most preferred, whereas the phantom source concept got the highest acceptance ratings as far as the general concept is concerned. The localization accuracy of the phantom source concept was good as long as the exact listening position was known to the algorithm and speech stimuli were used. Most subjects preferred the original signals over the pre-processed, dynamic-compressed signals, although processed speech was often described as being clearer.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies--outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL).

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human-machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific "GAL technology", providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL's highly inter- and multidisciplinary aspects, with respect to research into GAL's application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

Multimodal activity monitoring for home rehabilitation of geriatric fracture patients--feasibility and acceptance of sensor systems in the GAL-NATARS study.

BACKGROUND: Demographic change will lead to a diminishing care workforce faced with rising numbers of older persons in need of care, suggesting meaningful use of health-enabling technologies, and home monitoring in particular, to contribute to supporting both the carers and the persons in need. OBJECTIVES: We present and discuss the GAL-NATARS study design along with first results regarding technical feasibility of long-term home monitoring and acceptance of different sensor modalities. METHODS: Fourteen geriatric participants with mobility-impairing fractures were recruited in three geriatric clinics. Following inpatient geriatric rehabilitation, their homes were equipped with ambient sensor components for three months. Additionally, a wearable accelerometer was employed. Technical feasibility was assessed by system and component downtimes, technology acceptance by face-to-face interviews. RESULTS: The overall system downtime was 6%, effected by two single events, but not by software failures. Technology acceptance was rated very high by all participants at the end of the monitoring periods, and no interference with their social lives was reported. DISCUSSION AND CONCLUSIONS: Home-monitoring technologies were well-accepted by our participants. The information content of the data still needs to be evaluated with regard to clinical outcome parameters as well as the effect on the quality of life before recommending large-scale implementations.

Use of self-assessment inventories in hearing-aid provision: German versions of ECHO and SADL.

OBJECTIVE: This study presents German versions of the ECHO (expected consequences of hearing aid ownership) and SADL (satisfaction with amplification in daily life) self-assessment inventories ( Cox et al, 1999 , 2000 ). STUDY SAMPLE: The questionnaires were administered to a group of 290 hearing-aid candidates (ECHO) and 462 experienced hearing-aid users (SADL) recruited at different audiological centres in Germany. DESIGN: The psychometric properties of the German versions and the original questionnaires were similar as confirmed by factor analysis and internal consistency analysis. RESULTS: When comparing outcomes for the ECHO and SADL inventories from the two study groups it was found that satisfaction outperformed expectations. In addition, the relationships of the questionnaire subscales with personality traits as measured with the Big Five inventory were examined. Certain weak though statistically significant correlations were found revealing that personality in hearing-impaired persons does not greatly affect ECHO and SADL outcomes. In contrast, ECHO subscale scores were clearly associated with the motivation to use amplification and might thus help to detect non-adherents. CONCLUSION: These findings, along with the fact that pre-fitting expectations can be directly compared to post-fitting satisfaction, makes the application of the ECHO and SADL inventories highly valuable in rehabilitative audiology.

A system for the model based emergency detection and communication for the telerehabilitation training of cardiopulmonary patients.

Cardiopulmonary diseases affect millions of people and cause high costs in health care systems worldwide. Patients should perform regular endurance exercises to stabilize their health state and prevent further impairment. However, patients are often uncertain about the level of intensity they should exercise in their current condition. The cost of continuous monitoring for these training sessions in clinics is high and additionally requires the patient to travel to a clinic for each single session. Performing the rehabilitation training at home can raise compliance and reduce costs. To ensure safe telerehabilitation training and to enable patients to control their performance and health state, detection of abnormal events during training is a critical prerequisite. Therefore, we created a model that predicts the heart rate of cardiopulmonary patients and that can be used to detect and avoid abnormal health states. To enable external feedback and an immediate reaction in case of a critical situation, the patient should have the possibility to configure the system to communicate warnings and emergency events to clinical and non-clinical actors. To fulfill this task, we coupled a personal health record (PHR) with a new component that extends the classic home emergency systems. The PHR is also used for a training schedule definition that makes use of the predictive HR model. We used statistical methods to evaluate the prediction model and found that our prediction error of 3.2 heart beats per minute is precise enough to enable a detection of critical states. The concept for the communication of alerts was evaluated through focus group interviews with domain experts who judged that it fulfills the needs of potential users.

Indication criteria for cochlear implants and hearing aids: impact of audiological and non-audiological findings.

Owing to technological progress and a growing body of clinical experience, indication criteria for cochlear implants (CI) are being extended to less severe hearing impairments. It is, therefore, worth reconsidering these indication criteria by introducing novel testing procedures. The diagnostic evidence collected will be evaluated. The investigation includes postlingually deafened adults seeking a CI. Prior to surgery, speech perception tests [Freiburg Speech Test and Oldenburg sentence (OLSA) test] were performed unaided and aided using the Oldenburg Master Hearing Aid (MHA) system. Linguistic skills were assessed with the visual Text Reception Threshold (TRT) test, and general state of health, socio-economic status (SES) and subjective hearing were evaluated through questionnaires. After surgery, the speech tests were repeated aided with a CI. To date, 97 complete data sets are available for evaluation. Statistical analyses showed significant correlations between postsurgical speech reception threshold (SRT) measured with the adaptive OLSA test and pre-surgical data such as the TRT test (r=-0.29), SES (r=-0.22) and (if available) aided SRT (r=0.53). The results suggest that new measures and setups such as the TRT test, SES and speech perception with the MHA provide valuable extra information regarding indication for CI.