Test-retest reliability of the Hearing Handicap Inventory for the Elderly.

The Hearing Handicap Inventory for the Elderly (HHIE) is a self-assessment tool, composed of emotional and social/situational subscales and designed to measure the perceived effects of hearing impairment in the noninstitutionalized elderly. Previous study has indicated that the HHIE has a high internal consistency, as well as high split-half reliability. The present study was undertaken to examine test-retest reliability associated with the HHIE, as the latter information is prerequisite to the application of the HHIE as a measure of change in perception of handicap which may result from audiologic intervention. Forty-seven noninstitutionalized elderly individuals with sensorineural hearing loss were sampled, using two measurement techniques: face-to-face (N = 20) and paper-and-pencil (N = 27) administration. Test-retest reliability was high for both the face-to-face and paper-and-pencil administration, suggesting that the HHIE has potential as a measure of change resulting from rehabilitation.

The relationship of continuous (C) and interrupted (I) tones at threshold and most comfortable loudness (MCL) in hearing-impaired ears.

Differences in the Bekesy tracking levels of continuous (C) and interrupted (I) tones at both threshold and most comfortable loudness (MCL) were determined in a large clinical sample of persons with hearing loss. Results indicate small but significant C-I differences not only at the two levels separately but also in the tracking of C and I tones at threshold relative to MCL, regardless of frequency or hearing loss severity. Such results may have implications for both diagnostic and rehabilitative audiology.

Audiometric correlates of the Hearing Handicap Inventory for the elderly.

The self-assessment of hearing handicap has received considerable attention in recent years. The Hearing Handicap Inventory for the Elderly (HHIE) is a self-assessment technique designed to quantify the emotional and social effects of self-perceived hearing impairment in the noninstitutionalized elderly. The purpose of the present study was to examine the audiometric correlates of hearing handicap as measured by the HHIE. One hundred elderly subjects received complete audiometric evaluations as well as the HHIE. The results indicated that pure-tone sensitivity in the better ear was most highly correlated with the HHIE (r = .61) and that word recognition accounted for no more than 20% of the variance in HHIE scores. These results are similar to those reported for younger subjects and for other handicap assessment techniques. The results also indicated that there is considerable individual variability in the emotional and social response to hearing impairment, especially in individuals with mild (26-40 dB PTA in better ear) hearing impairment. The variability in response to impairment coupled with the fact that audiometric measures explain less than 50% of the variance in hearing handicap suggest that hearing handicap in the elderly will be measured more appropriately via a self-report format rather than as an inference from audiometric data.

Audiologic correlates of hearing handicap in the elderly.

This investigation was conducted to determine the relationship between self-assessed hearing handicap and audiometric measures in a large sample of noninstitutionalized elderly individuals. Eighty subjects underwent a complete audiological evaluation and responded to the Hearing Measurement Scale (HMS). Each of the correlations between measures of sensitivity and the HMS score was statistically significant. The speech discrimination scores showed a somewhat lower correlation with the HMS score than did pure-tone measures. The implications of the above findings are discussed.

Effect of a pretest listening exposure on the ascending-descending gap at most comfortable loudness levels.

The effect of approach mode (ascending versus descending, A-D) on comfortable loudness was determined for a 1000 Hz pure tone using Békésy audiometry. Two groups (experimental and control) of 10 normal-hearing young adult subjects measured their most comfortable loudness (MCL) levels pre- and post-treatment. The experimental group received a treatment of a listening exposure to a 70 dB intensity range before the test. The results demonstrated a statistically significant change of the A-D gap in the experimental group while the A-D gap for the control group remained essentially unchanged. It is proposed that MCL is underestimated in the ascending approach and overestimated on the descending testing, which results in the A-D gap. In addition, the results demonstrate the importance of the procedures used in research and clinic of the MCL.

Hearing impairment and social isolation in the elderly.

This investigation was conducted to determine the relationship between hearing impairment and social isolation in a sample of community-based individuals over age 65. Each subject reported first noting a hearing loss after age 53. In all cases the hearing loss was insidious in onset and of unknown etiology. All subjects underwent a complete audiological evaluation. This included pure-tone testing, speech discrimination testing, and self-assessed hearing handicap. Further, responses were obtained to scales which measured quantitatively the degree of subjective and objective social isolation. Each of the correlations between the Objective and Subjective Social Isolation Scale scores and the audiologic variables was statistically significant. The audiologic measures were more strongly correlated with the subjective than with the objective isolation measures. The Hearing Measurement Scale (HMS) score explained the greatest and the W-22 score the smallest proportion of the variance in each of the isolation scale scores.

The hearing handicap inventory for the elderly: a new tool.

This report describes the development and standardization of the Hearing Handicap Inventory for the Elderly (HHIE). This self-assessment tool is designed to assess the effects of hearing impairment on the emotional and social adjustment of elderly people. The inventory is comprised of two subscales: a 13-item subscale explores the emotional consequences of hearing impairment; a 12-item subscale explores both social and situational effects. The inventory was administered to 100 elderly subjects (mean age = 75 years) with hearing threshold levels in the better ear ranging from normal to severe. The reliability of the HHIE was evaluated by assessing its internal consistency through the computation of Chronbach's alpha. Alpha values ranged from 0.88 (social/situational subscale) to 0.95 for the entire inventory. Split-half reliabilities were equally high. The validity of the HHIE was not directly evaluated. Certain aspects of the data, however, support the construct validity of the instrument, while analysis of the questions themselves appears to attest to its content validity. Possible uses of the inventory were described and suggestions were made regarding future research on the instrument. The reliability and validity of the HHIE as well as its brevity, simplicity, and ease of administration and interpretation all recommend its use in assessing hearing handicap in the elderly.

Hearing impairment associated with chronic renal failure.

The auditory sensitivity of 67 patients with chronic end-stage renal failure was assessed. In order to determine the incidence of hearing loss and to describe the impairment and possible contributing factors, one group of 39 patients was assessed prior to treatment by hemodialysis. Twelve of these subjects were then followed for 1 year as they are treated by hemodialysis. The remaining 27 patients, not treated by hemodialysis, were also retested in one year. A second group of 28 patients who ad been receiving hemodialysis over periods of 1 1/2, 3, and 6 years was also evaluated. A high incidence of high-frequency impairment was obtained which could not be attributed to age, noise exposure, ototoxicity, or hereditary. An association between this high-frequency impairment and both the renal disease and its treatment was suggested. Clinically significant sensorineural hearing loss did not appear associated with non-genetic kidney disease.

Effects of conductive hearing loss: fact or fiction.

This paper reviews the empirical evidence implicating conductive hearing impairment as a causal agent in learning disability, language dysfunction, and central auditory problems. From this review one can conclude that there are few, if any, valid data linking conductive hearing impairment to any of these problems. Suggestions for improving research in this area conclude the article.

Central auditory dysfunction among chronic alcoholics.

The relationship between chronic alcoholism and auditory processing problems was examined using a central auditory test battery. Fifteen carefully selected alcoholic subjects and 15 age-matched nonalcoholic control subjects were evaluated using pure-tone thresholds, spondee thresholds, speech discrimination, acoustic reflex thresholds, performance-intensity function, Staggered Spondaic Word (SSW) test, Synthetic Sentence Identification (SSI), and temporal summation. Significant differences between the groups were obtained for acoustic reflex measurement, SSW, and SSI. A significant subject-related interaction was obtained for temporal summation measurement. Approximately half of the alcoholics yielded results consistent with brainstem pathologic features.

The effect of psychophysical method on the loudness of continuous and interrupted pure tones.

Using the Bekesy tracking method for loudness judgement tasks such as most comfortable loudness (MCL) and recalled loudness (RL) measurements, normal listeners have tracked continuous (C) tones at lesser intensities than interrupted (I) tones. The resulting continuous/interrupted (C/I) separations have ranged up to 22 dB. Explanations of the unexpected C/I separations have not been in agreement. The purpose of this study was to investigate whether psychophysical method has a significant effect on the C/I separation. Subjects were six normal-hearing adults, each of whom participated in three practice and ten test sessions of one hour each. Thirty-six experimental conditions were presented. The test signals were C tones, 200/200 msec I tones and 200/800 msec I tones, all at 1 kHz. The reference intensities wer 20, 50 and 80 dB SPL. The four methods were Bekesy tracking method (BTM), method of adjustment (MAdj), method of limits (ML) and method of constant stimuli difference (MCSD). Mean values for Point of Subjective Equality and C/I separation were calculated. C/I separations obtained with the BTM were significantly larger than C/I separations obtained with any other psychophysical method. These results demonstrate that C/I separations obtained during suprathreshold Bekesy tracking tasks by normal hearers are largely caused by the measurement method itself rather than by differences in C and I tone loudness. Time order errors could explain the BTM effect.

The contribution of the acoustic reflex to the ascending-descending most comfortable loudness gap.

The contribution of the acoustic reflex (AR) contraction to the ascending-descending (A-D) gap was explored. 15 normal listeners traced ascending and descending most comfortable loudness (MCL) levels for continuous (C) and interrupted (I) tones at 250, 1000 and 4000 Hz. Reflex thresholds were obtained for each subject at the test frequencies. No evidence was found to implicate the AR as the causative agent in the A-D gap. Two important trends emerged: (1) an ordering of MCL conditions occurred which was consistent across frequencies and (2) there was a consistent difference between AR level and MCL for a given stimulus condition which was constant across frequencies. The findings suggest that a predictive relationship may exist between AR and pure-tone MCL.

Evaluation of a clinical method for measuring comfortable loudness for speech.

The reliability of a clinical method for measuring most comfortable loudness for speech was evaluated on 100 subjects with sensorineural hearing loss. The method uses spondaic words as the test stimuli. The test-retest reliability was determined for an ascending and descending approach mode for all 100 subjects as well as for subgroups categorized on the basis of severity of hearing loss and pure-tone configuration. Results indicated that reliability was not affected by approach mode, hearing loss severity, or pure-tone configuration. Test-retest differences were not significant and test-retest correlations were high (r = 0.73 to 0.93) across all subgroup categories. Clinical reliability was demonstrated by the high percentages (85 to 92%) of subjects who had test-retest differences no greater +/-5 dB. The procedure is rapid, uses no special equipment, is easily performed, and is reliable. Thus, it is recommended as the preferred clinical procedure.

Effects of instructional set on the comfortable loudness range.

Ten normal-hearing young adult subjects measured their Comfortable Loudness Ranges (CLRs) using two instructional sets. The first instructional set (range tracking) was similar to the Bekesy Comfortable Loudness tracking method described by Jerger and Jerger (1974). The second instructional set (limit tracking) required the subjects to perform separate trackings of each limit (upper and lower) of their CLRs. Results demonstrated a 34.4 dB difference between CLRs for the two instructional sets. The range tracking method yielded the narrowest CLR. Both instructional sets yielded similar upper limits of the CLR. The results of the present investigation demonstrate the importance of instructions employed in research and clinical measurements of the CLR.

Relationships between comfortable loudness levels for speech and speech discrimination in sensorineural hearing loss.

The primary purpose of this study was to investigate the relationship between the sensation level selected as most comfortable for loudness and intelligibility, and the sensation level at which maximum speech discrimination is obtained. An articulation function was generated at five sensation levels for 45 subjects with sensorineural hearing loss. Speech discrimination scores were also obtained at sensation levels corresponding to most comfortable loudness levels for loudness and intelligibility. Results indicated that most comfortable loudness, at least under the conditions of the present study, does not appear to be the level at which maximum speech discrimination is obtained. Therefore, the use of comfortable loudness as a single sensation level for testing a subject's maximum discrimination is not recommended at this time.

Effects of stimulus presentation and instructions on pure-tone thresholds and false-alarm responses.

The effects of three instructional sets (conventional Carhart-Jerger, strict, and lax) and of two stimulus presentation methods (continuous tones, pulsed tones) on pure-tone thresholds and false-alarm responses were determined for 20 male subjects. False alarms were tallied during hearing measurement periods and during 30-second time-out periods totaling nine minutes of time-out per subject. Results showed that 50% of the subjects made false-alarm responses to some extent at 250, 1000, and 4000 Hz. Instructions and stimulus mode, along with frequency, affected the number of false alarms, but thresholds under the experimental conditions were unchanged. It is suggested that a method for assessing and controlling false alarms is an important clinical consideration.