Effectiveness and costs of a low-threshold hearing screening programme (HörGeist) for individuals with intellectual disabilities: protocol for a screening study.

INTRODUCTION: Individuals with intellectual disabilities (ID) often suffer from hearing loss, in most cases undiagnosed or inappropriately treated. The implementation of a programme of systematic hearing screening, diagnostics, therapy initiation or allocation and long-term monitoring within the living environments of individuals with ID (nurseries, schools, workshops, homes), therefore, seems beneficial. METHODS AND ANALYSIS: The study aims to assess the effectiveness and costs of a low-threshold screening programme for individuals with ID. Within this programme 1050 individuals with ID of all ages will undergo hearing screening and an immediate reference diagnosis in their living environment (outreach cohort). The recruitment of participants in the outreach group will take place within 158 institutions, for example, schools, kindergartens and places of living or work. If an individual fails the screening assessment, subsequent full audiometric diagnostics will follow and, if hearing loss is confirmed, initiation of therapy or referral to and monitoring of such therapy. A control cohort of 141 participants will receive an invitation from their health insurance provider via their family for the same procedure but within a clinic (clinical cohort). A second screening measurement will be performed with both cohorts 1 year later and the previous therapy outcome will be checked. It is hypothesised that this programme leads to a relevant reduction in the number of untreated or inadequately treated cases of hearing loss and strengthens the communication skills of the newly or better-treated individuals. Secondary outcomes include the age-dependent prevalence of hearing loss in individuals with ID, the costs associated with this programme, cost of illness before-and-after enrolment and modelling of the programme's cost-effectiveness compared with regular care. ETHICS AND DISSEMINATION: The study has been approved by the Institutional Ethics Review Board of the Medical Association of Westphalia-Lippe and the University of Münster (No. 2020-843 f-S). Participants or guardians will provide written informed consent. Findings will be disseminated through presentations, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: DRKS00024804.

Middle Ear Implant Usage Restores Subjective Listening Effort toward Normal in Complex Acoustic Scenes.

INTRODUCTION: The amount of listening effort needed to understand speech in every-day life is an important outcome measure of the effectiveness of a hearing device. The main goal of this study was to assess subjective listening effort in patients implanted with an active middle ear implant Vibrant Soundbridge (VSB) with and without using their speech processor in complex acoustic scenarios. METHODS: Ten VSB users were measured using the adaptive categorical listening effort scaling (ACALES) method in four different acoustic scenarios, realized using a multichannel loudspeaker array. The four acoustic scenarios included both spatially simple and complex speech and noise arrangements that realistically simulated challenging every-day listening situations. Signal-to-noise ratios (SNRs) were adaptively varied during the measurement. Twelve normal-hearing (NH) listeners performed the same experiment as a control group. RESULTS: Listening effort was significantly reduced in all tested acoustic scenarios when participants used their VSB. When using the VSB, SNRs corresponding to mild-to-moderate listening effort were found not to be statistically different from SNRs found in the NH control group. SNRs corresponding to extreme listening effort of VSB users approached NH values, indicating partial restoration of listening effort. DISCUSSION AND CONCLUSIONS: Usage of the middle ear implant VSB was found to restore subjective listening effort to normal at high SNRs completely, and at lower SNRs partially. The remaining gap at low SNRs may be due to lower effectiveness of signal processing at high noise levels or due to the microphone location effect.

[Influence of directional microphones on listening effort in middle ear implant users]. / Einfluss von Richtmikrofonie auf die Höranstrengung bei Mittelohrimplantatträgern.

BACKGROUND AND OBJECTIVE: Besides speech intelligibility, subjective listening effort is an important outcome for the success of hearing devices and their signal processing. The aim of the present study was to determine subjective listening effort for speech in a noisy background in patients with the active middle ear implant Vibrant Soundbridge (VSB) for omnidirectional and directional microphone settings, with and without occlusion of the contralateral ear. MATERIAL AND METHODS: A total of 15 patients using a VSB were measured using the adaptive categorical listening effort scaling (ACALES) method in a ring of loudspeakers placed in an anechoic room. Different background noises from different directions and simultaneously presented sentences from the Oldenburg sentence test were combined in four different realistic acoustic scenes. RESULTS: The directional microphone program reduced median subjective listening effort only numerically compared to the omnidirectional microphone program in acoustic scenarios with diffuse noise and with low signal-to-noise ratios; however, this difference failed to reach statistical significance. When occluding the ear contralateral to the VSB, all investigated listening effort categories were measured at significantly higher signal-to-noise ratios than with access to both ears. CONCLUSION: Due to missing statistical significance in reduction of listening effort, this study delivered no recommendation for or against usage of the directional microphone program; however, reduced listening effort was shown for binaural listening in comparison to monaural listening. Therefore, patients should be encouraged to always listen with both ears for best results.