Reply to Aldè et al. Comment on "Manchaiah et al. Social Representations of "Tinnitus" and "Health" among Individuals with Tinnitus Seeking Online Psychological Interventions. Audiol. Res. 2023, 13, 207-220".

We would like to thank Dr. Aldè and his colleuage's for their thoughtful comments [...].

Real-life and real-time hearing aid experiences: Insights from self-initiated ecological momentary assessments and natural language analysis.

Introduction: Smartphone technology can provide an effective means to bring real-life and (near-)real-time feedback from hearing aid wearers into the clinic. Ecological Momentary Assessment (EMA) encourages listeners to report on their experiences during or shortly after they take place in order to minimize recall bias, e.g., guided by surveys in a mobile application. Allowing listeners to describe experiences in their own words, further, ensures that answers are independent of predefined jargon or of how survey questions are formulated. Through these means, one can obtain ecologically valid sets of data, for instance during a hearing aid trial, which can support clinicians to assess the needs of their clients, provide directions for fine-tuning, and counselling. At a larger scale, such datasets would facilitate training of machine learning algorithms that could help hearing technology to anticipate user needs. Methods: In this retrospective, exploratory analysis of a clinical data set, we performed a cluster analysis on 8,793 open-text statements, which were collected through self-initiated EMAs, provided by 2,301 hearing aid wearers as part of their hearing care. Our aim was to explore how listeners describe their daily life experiences with hearing technology in (near-)real-time, in their own words, by identifying emerging themes in the reports. We also explored whether identified themes correlated with the nature of the experiences, i.e., self-reported satisfaction ratings indicating a positive or negative experience. Results: Results showed that close to 60% of listeners' reports related to speech intelligibility in challenging situations and sound quality dimensions, and tended to be valued as positive experiences. In comparison, close to 40% of reports related to hearing aid management, and tended to be valued as negative experiences. Discussion: This first report of open-text statements, collected through self-initiated EMAs as part of clinical practice, shows that, while EMA can come with a participant burden, at least a subsample of motivated hearing aid wearers could use these novel tools to provide feedback to inform more responsive, personalized, and family-centered hearing care.

Social Representations of "Tinnitus" and "Health" among Individuals with Tinnitus Seeking Online Psychological Interventions.

(1) Objective: Social representations theory (SRT) is a body of theory within social psychology concerned with how individuals, groups, and communities collectively make sense of socially relevant or problematic issues, ideas, and practices. SRT has been increasingly sued in the area of health and disability. The current study examined the social representations of "tinnitus" and "health" among individuals with tinnitus who are seeking online psychological interventions. (2) Materials/Method: The data were gathered using a free association task about their "tinnitus" and "health" from 399 individuals with tinnitus. The data were analyzed using both qualitative and quantitative analyses methods. (3) Results: The responses resulted in 39 and 30 categories respectively, for "tinnitus" and "health". The most commonly occurring categories for tinnitus included: descriptions of tinnitus (18%), annoying (13.5%), persistent (8%), and distracting (5%). The most commonly occurring categories for health included: content (12%), conditions (8%), active (7%), take control (6%), and overweight (5%). The responses to tinnitus had predominantly negative connotations (i.e., 76.9%) whereas a larger proportion of responses toward their health was related to positive connotations (i.e., 46.4%). These frequently occurring items were also dominant in similarities analysis. Prototypical analysis of tinnitus responses identified categories horrible and bothersome to be key items in the central zone. The categories in central zone of health responses included: content, active, healthy, grateful, and overweight. (4) Conclusions: Individuals with tinnitus have very negative view of their tinnitus impacting their psychological status. Tinnitus management should focus on reducing the negative associations toward their tinnitus and strengthen the positive aspects related to their general health.

Experiential Characteristics among Individuals with Tinnitus Seeking Online Psychological Interventions: A Cluster Analysis.

OBJECTIVE: This study was designed to gain insights regarding patterns of social representations (values, ideas, beliefs) of tinnitus and their relation to demographic and clinical factors. METHOD: A cross-sectional survey design was used including 399 adults seeking help and reporting interest in internet-based cognitive behavior therapy for tinnitus. Data were collected using a free association task and analysis used qualitative (content analysis) and quantitative (cluster analysis and chi-square analysis) using the Iramuteq software. RESULTS: The social representations identified the negative impact of tinnitus and included the way it sounded (descriptions of the way tinnitus sounds (18%), annoyance (13.5%), and persistence (8%)). Four clusters were identified representing four levels of tinnitus severity, namely debilitating tinnitus (24%), distressing tinnitus (10%), annoying tinnitus (46%), and accepting tinnitus (20%). Cluster identity was associated with demographic and clinical variables. DISCUSSION: The identified clusters represented tinnitus severity experience in four stages, ranging from debilitating tinnitus to acceptance of tinnitus. These findings are important for clinical practice where tinnitus descriptions can indicate the stage of the tinnitus experience and which intervention pathway may be most appropriate.

Online Discussions About Tinnitus: What Can We Learn From Natural Language Processing of Reddit Posts?

BACKGROUND: This study was aimed at identifying key topics in online discussions about tinnitus by examining a large data set extracted from Reddit social media using a natural language processing technique. METHOD: A corpus of 113,215 posts about tinnitus was extracted from Reddit's application programming interface. After cleaning the data for duplications and posts without any text information, the sample was reduced to 101,905 posts, which was subjected to cluster analysis using the open-source IRaMuTeQ software to identify main topics based on the co-occurrence of texts. These clusters were named by a panel of tinnitus experts (n = 9) by reading typical text segments within each cluster. RESULTS: The cluster analysis identified 16 unique clusters that belong to two topics, which were named "tinnitus causes and consequences" and "tinnitus management and coping." Based on their characteristics, the clusters were named: tinnitus timeline (10%), tinnitus perception (9.7%), medical triggers and modulators (8.8%), hearing research (8.8%), attention and silence (8.6%), social media posts about tinnitus (7.4%), hearing protection (7.3%), interaction with hearing health care providers (6.7%), mental health and coping (5.8%), music listening (5.7%), hope for a cure (5.6%), interactions with people without tinnitus (5.4%), dietary supplements and alternative therapies (3.2%), sleep (3.9%), dietary effects (1.7%), and writing about tinnitus and being thankful to online community (1.4%). CONCLUSIONS: Despite some limitations, tinnitus posts on Reddit provide rich real-world data to identify various issues and complaints that tinnitus patients and their significant others discuss in online communities. Some of the clusters identified here are novel (e.g., tinnitus timeline, interactions with people without tinnitus) and have not been much discussed in the tinnitus literature. The results suggest that individuals with tinnitus relay on social media for support and highlight the service delivery needs in providing social support through other means (e.g., support groups).

Experiences With Hearing Health Care Services: What Can We Learn From Online Consumer Reviews?

Objective The aim of this study was to examine experiences of hearing health care services as described in online consumer reviews. Design This study used a cross-sectional design. Online consumer reviews about hearing health care services generated from Google.com to an open-ended question "Share details of your own experience at this place" and perceived overall experience (indicated on a 5-point rating scale: "very good" to "very poor") were extracted from 40 different cities across the United States. The open text contributed a text corpus of 9,622 unique consumer reviews. These responses were analyzed with the cluster analysis approach using an open-source automated text analysis software program, IRaMuTeQ, to identify key themes. Association between clusters and consumer experience ratings as well as consumer metadata (percentage of older adults in the city, region) were examined using the chi-square analysis. Results The majority of consumers appeared satisfied with their hearing health care services, with nearly 95% of consumers reporting "very good" and "good" on the global experience scale. The analysis of text responses resulted in seven clusters within two domains. Domain 1 (Clinical Processes) included the three clusters: administration processes, perceived benefits, and device acquisition. Domain 2 (Staff and Service Interactions) included the four clusters: clinician communications, staff professionalism, customer service, and provider satisfaction. Content relating to administration processes was associated with overall rating regarding the hearing health care service experience. Consumer's reviews relating to administration processes mostly described negative experiences, and these participants were more inclined to provide poorer overall experience ratings. In addition, city characteristics (i.e., percentage of older adults, region) had bearing toward what elements of hearing health care services are highlighted more in the consumer reviews. Conclusions Consumers comment on a variety of elements when describing their experiences with hearing health care services. Experiences reported in most clusters were generally positive, although some concerns in the "clinical process" are associated with lower satisfaction. Employing patient-centered strategies and ensuring patients have good experiences in the areas of concern may help improve both patient experience and their satisfaction. Supplemental Material https://doi.org/10.23641/asha.16455924.

Hearing aid acquisition and ownership: what can we learn from online consumer reviews?

OBJECTIVE: To explore the publicised opinions of consumers actively participating in online hearing aid reviews. DESIGN: A retrospective design examining data generated from an online consumer review website (www.HearingTracker.com). Qualitative data (open text responses) were analysed using the open source automated topic modelling software IRaMuTeQ (http://www.iramuteq.org/) to identify themes. Outputs were compared with quantitative data from the consumer reviews (short response questions exploring hearing aid performance and benefit, and some meta-data such as hearing aid brand and years of hearing aid ownership). STUDY SAMPLE: 1378 online consumer hearing aid reviews. RESULTS: Six clusters within two domains were identified. The domain Device Acquisition included three clusters: Finding the right provider, device and price-point; Selecting a hearing aid to suit the hearing loss; Attaining physical fit and device management skills. The domain Device Use included three clusters: Smartphone streaming to hearing aids; Hearing aid adjustment using smartphone; and Hearing in noise. CONCLUSIONS: Although online hearing aid consumers indicate positive performance on multiple-choice questions relating to hearing aid performance and benefit, their online reviews describe a number of barriers limiting their success. Hearing healthcare clinicians must employ a personalised approach to audiological rehabilitation to ensure individual clients' needs are met.

Social representation of hearing aids among people with hearing loss: an exploratory study.

OBJECTIVE: The aim of the current study was to examine the social representation (SR) of hearing aids in people with hearing loss (PHL) in India, the Republic of Korea (ROK), the United Kingdom (UK), and the United States of America (US). DESIGN: The study used a cross-sectional survey design. The data collected by using a free association task were analysed qualitatively (i.e. content analysis) and quantitatively (i.e. chi-square analysis, similarities analysis, prototypical analysis). STUDY SAMPLE: 424 participants with hearing loss. RESULTS: The most commonly reported categories across all countries were "beneficial," "cost and time," and "appearance and design." Approximately 50% of the associations reported were negative. There were variations in terms of the categories that were predominant in the SR of each country. "Others actions and attitude" category was predominantly reported by PHL in India. "Disturbance" and "dissatisfaction" of hearing aids and the "repairs and maintenance of hearing aids" categories were mainly reported from the ROK and the US, respectively. CONCLUSIONS: The current results highlight the main aspects that PHL report spontaneously when they think about hearing aids. The findings will help to further inform public health campaigns and will contribute to develop culturally appropriate media materials regarding hearing aids.

Social Representation of "Hearing Loss" Among People with Hearing Loss: An Exploratory Cross-Cultural Study.

BACKGROUND: Hearing loss can have an effect on the physical, psychosocial, and cognitive wellbeing of an individual. Despite the research on attitudes and stigma associated with hearing loss, people with hearing loss (PHL) continue to delay seeking help. Thus, it is vital to look at alternative theories which have been successfully used in disability research to better understand how PHL perceive hearing loss. PURPOSE: The aim of the current exploratory study was to examine the social representation (SR) of "hearing loss" in PHL in India, Republic of Korea (ROK), United Kingdom (UK), and the United States (US). RESEARCH DESIGN: The study used a cross-sectional survey design. STUDY SAMPLE: In this study, 424 participants were recruited using a consecutive sampling method in four countries (India, Republic of Korea, United Kingdom, and United States). DATA COLLECTION AND ANALYSIS: Data collection was conducted using a questionnaire. Data were analyzed using content analysis, similarities analysis, prototypical analysis, and chi-square analysis. RESULTS: The free associations of the PHL were grouped into 37 categories. The most commonly reported categories were communication difficulties, negative mental state, aging, assessment and management, causes of hearing loss, hearing ability or disability, hearing instruments, and symptoms of hearing loss. Similarities analysis and prototypical analysis highlighted two main negative categories (negative mental state and communication difficulties) which form the central elements of SR of hearing loss. PHL associated hearing loss mainly as a negative phenomenon, but with some positive and neutral aspects. Respondents from ROK reported a greater number of neutral associations compared with other countries. There were cross-cultural similarities and differences in terms of PHL's SR of hearing loss, but there were more similarities than differences. CONCLUSION: The study provides an insight into how PHL collectively view their "hearing loss" and helps to develop our understanding of the influence of culture on the SR of "hearing loss." The results will aid the development of culturally appropriate public education campaigns, marketing material, and appropriate rehabilitation for PHL.

Young Adults' Knowledge and Attitudes Regarding "Music" and "Loud Music" Across Countries: Applications of Social Representations Theory.

Exposure to loud music, especially by young people, has significantly increased in recent years as a result of (a) advancements in technology in terms of personal music players and smart mobile phones, and (b) streaming of music through these devices. The World Health Organization (WHO) estimates that some 1.1 billion teenagers and young adults are at risk of developing hearing loss due to exposure to recreational noise such as music. It is suggested that knowledge and attitude of young adults toward music has bearing upon their music listening habits and thereby influences who is at risk of developing music induced hearing loss. Hence, researchers from various fields have tried to understand the knowledge and attitude of young adults regarding loud music. However, there is some criticism of attitude studies as there is little relation between expressed attitude and behavior. Some recent studies have explored the social representations of music and loud music using the Social Representations Theory (SRT). It has been suggested that social representation is more fundamental than attitude (or in other words social representation informs attitude), hence, it has a better relation to behavior. The current paper: (1) provides an overview of studies on knowledge and attitude of young adults toward loud music, (2) discusses the limitations of attitude theories and introduces SRT, and (3) provides a summary of social representation studies on "music" and "loud music" in young adults from different countries.

Benefits and Shortcomings of Direct-to-Consumer Hearing Devices: Analysis of Large Secondary Data Generated From Amazon Customer Reviews.

Purpose The current study was aimed at understanding the benefits and shortcomings of direct-to-consumer hearing devices (DCHDs) by analyzing the large text corpus of secondary data generated from Amazon customer reviews. Method Secondary data were generated manually by gathering user feedback for 62 different DCHDs (cost range: $9.95-$635) on the Amazon.com website, which included 11,258 unique Amazon-verified customer reviews. The data were analyzed using both quantitative and qualitative analyses methods. Results The cluster analysis of large data corpus resulted in 7 unique clusters, which were labeled as (a) Issues related to fit and comfort (15%), (b) Friends and family recommendations (11.8%), (c) Issues related to sound quality (11.9%), (d) Listening and conversation (16.1%), (e) Positive customer service (12.1%), (f) General usage and customer service (14.7%), and (g) Cost and affordability (17.3%). Exploratory analysis also revealed an association between customer ratings and cost in relation to these clusters (i.e., customer reviews). For example, customer reviews about cheaper DCHDs are related to issues about sound quality, whereas reviews about expensive DCHDs are related to cost and affordability of the device. The qualitative content analysis resulted in 8 main themes, which include (a) intrinsic factors, (b) extrinsic factors, (c) supplemental items, (d) ease of use, (e) interaction with support services, (f) reasons for purchase, (g) experiences, and (h) general information. Conclusions The study using the text mining techniques highlights the benefits and shortcomings of DCHDs that are currently available in the U.S. market. Our findings relate well to the published study results of electroacoustic analysis on similar products, which provide clinicians with knowledge related to DCHDs that they can convey to consumers during clinical consultations. The findings may also be of interest to the hearing instrument industry from the perspective of developing products based on user feedback.

Representation of Hearing Loss and Hearing Aids in the U.S. Newspaper Media: Cross-Sectional Analysis of Secondary Data.

Purpose News media plays an important role in formulating people's knowledge and opinions about various aspects of life, including health. The current study explored how hearing loss and hearing aids are represented in the U.S. newspaper media. Method A cross-sectional study design was selected to analyze publicly available newspaper media data. The data sets were generated from the database, the U.S. Major Dailies by ProQuest, by searching key words for newspapers published during 1990-2017. Cluster analysis (i.e., text pattern analysis) and chi-square tests were performed using Iramuteq software. Results The hearing loss data set had 1,527 texts (i.e., articles). The cluster analysis resulted in 7 clusters, which were named as (1) causes and consequences (26.1%), (2) early identification and diagnosis (9%), (3) health promotion and prevention (22.1%), (4) recreational noise exposure (10.4%), (5) prevalence (14.3%), (6) research and development (12.4%), and (7) cognitive hearing science (5.6%). The hearing aids data set had 2,667 texts. The cluster analysis resulted in 8 clusters, which were named as (1) signal processing (20.2%), (2) insurance (8.9%), (3) prevalence (12.4%), (4) research and development (5.4%), (5) activities and relation (16.2%), (6) features to address background noise (13.8%), (7) innovation (12%), and (8) wireless and connectivity (11.1%). Time series analysis of clusters in both "hearing loss" and "hearing aids" data sets indicated changes in the pattern of information presented in the newspaper media during 1990-2016 (e.g., Cluster 7 focuses on cognitive hearing science in a hearing loss data set emerging only since the year 2012 and growing rapidly). Conclusions The text pattern analysis showed that the U.S. newspaper media focuses on a range of issues when considering hearing loss and hearing aids and that patterns or trends change over time. The study results can be helpful for hearing health care professionals to understand what presuppositions society in general may have as the media has the ability to influence societal perception and opinions.

Patterns in the social representation of "hearing loss" across countries: how do demographic factors influence this representation?

This study aims to understand patterns in the social representation of hearing loss reported by adults across different countries and explore the impact of different demographic factors on response patterns. The study used a cross-sectional survey design. Data were collected using a free association task and analysed using qualitative content analysis, cluster analysis and chi-square analysis. The study sample included 404 adults (18 years and over) in the general population from four countries (India, Iran, Portugal and UK). The cluster analysis included 380 responses out of 404 (94.06%) and resulted in five clusters. The clusters were named: (1) individual aspects; (2) aetiology; (3) the surrounding society; (4) limitations and (5) exposed. Various demographic factors (age, occupation type, education and country) showed an association with different clusters, although country of origin seemed to be associated with most clusters. The study results suggest that how hearing loss is represented in adults in general population varies and is mainly related to country of origin. These findings strengthen the argument about cross-cultural differences in perception of hearing loss, which calls for a need to make necessary accommodations while developing public health strategies about hearing loss.

Representation of Tinnitus in the US Newspaper Media and in Facebook Pages: Cross-Sectional Analysis of Secondary Data.

BACKGROUND: When people with health conditions begin to manage their health issues, one important issue that emerges is the question as to what exactly do they do with the information that they have obtained through various sources (eg, news media, social media, health professionals, friends, and family). The information they gather helps form their opinions and, to some degree, influences their attitudes toward managing their condition. OBJECTIVE: This study aimed to understand how tinnitus is represented in the US newspaper media and in Facebook pages (ie, social media) using text pattern analysis. METHODS: This was a cross-sectional study based upon secondary analyses of publicly available data. The 2 datasets (ie, text corpuses) analyzed in this study were generated from US newspaper media during 1980-2017 (downloaded from the database US Major Dailies by ProQuest) and Facebook pages during 2010-2016. The text corpuses were analyzed using the Iramuteq software using cluster analysis and chi-square tests. RESULTS: The newspaper dataset had 432 articles. The cluster analysis resulted in 5 clusters, which were named as follows: (1) brain stimulation (26.2%), (2) symptoms (13.5%), (3) coping (19.8%), (4) social support (24.2%), and (5) treatment innovation (16.4%). A time series analysis of clusters indicated a change in the pattern of information presented in newspaper media during 1980-2017 (eg, more emphasis on cluster 5, focusing on treatment inventions). The Facebook dataset had 1569 texts. The cluster analysis resulted in 7 clusters, which were named as: (1) diagnosis (21.9%), (2) cause (4.1%), (3) research and development (13.6%), (4) social support (18.8%), (5) challenges (11.1%), (6) symptoms (21.4%), and (7) coping (9.2%). A time series analysis of clusters indicated no change in information presented in Facebook pages on tinnitus during 2011-2016. CONCLUSIONS: The study highlights the specific aspects about tinnitus that the US newspaper media and Facebook pages focus on, as well as how these aspects change over time. These findings can help health care providers better understand the presuppositions that tinnitus patients may have. More importantly, the findings can help public health experts and health communication experts in tailoring health information about tinnitus to promote self-management, as well as assisting in appropriate choices of treatment for those living with tinnitus.

Examination of previously published data to identify patterns in the social representation of "Loud music" in young adults across countries.

PURPOSE: The current study was aimed at understanding the patterns in the social representation of loud music reported by young adults in different countries. MATERIALS AND METHODS: The study included a sample of 534 young adults (18-25 years) from India, Iran, Portugal, United Kingdom, and United States. Participants were recruited using a convince sampling, and data were collected using the free association task. Participants were asked to provide up to five words or phrases that come to mind when thinking about "loud music." The data were first analyzed using the qualitative content analysis. This was followed by quantitative cluster analysis and chi-square analysis. RESULTS: The content analysis suggested 19 main categories of responses related to loud music. The cluster analysis resulted in for main clusters, namely: (1) emotional oriented perception; (2) problem oriented perception; (3) music and enjoyment oriented perception; and (4) positive emotional and recreation-oriented perception. Country of origin was associated with the likelihood of participants being in each of these clusters. CONCLUSION: The current study highlights the differences and similarities in young adults' perception of loud music. These results may have implications to hearing health education to facilitate healthy listening habits.

Examination of Previously Published Data to Identify Patterns in the Social Representation of 'Hearing Aids' Across Countries.

BACKGROUND AND OBJECTIVES: Societal factors seem to exercise a strong influence on hearing aid uptake, use, and satisfaction. In particular, knowledge, perception, and attitude of people will have bearing towards their and others health behavior and decisions. The current study aimed at understanding the perception of hearing aids by adults belonging to the general population in different countries. SUBJECTS AND METHODS: The study employed a crosssectional design. A sample of 404 adults from India, Iran, Portugal, and the United Kingdom were recruited by relying on a convenience sampling. Previously published data was re-analyzed but it was applied for different approach. Free association task was used to collect the data. They were asked to provide up to five words or phrases that come to mind when thinking about "hearing aids." The data was initially analyzed based on qualitative content analysis. This was followed by quantitative cluster analysis and chi square analysis. RESULTS: The content analysis suggested 39 main categories of responses related to hearing aids. The cluster analysis resulted in five main clusters, namely: 1) positive attitude, 2) external factors, 3) hearing aid use and satisfaction, 4) etiology, and 5) benefits and limitations of technology. A few demographic factors (i.e., education, occupation type, country) showed association with different clusters, although country of origin seemed to be associated with most clusters. CONCLUSIONS: The study provides us with unique insights into the perception of hearing aids by the general public, and additionally, the way demographic variables may influence these perceptions.