Value Propositions of Public Adult Hearing Rehabilitation in Denmark.

Objective: To obtain and evaluate detailed descriptions of potential value propositions as seen by adults undergoing hearing rehabilitation with hearing aids. Design: Semi-structured interviews with patients and audiologists, a literature search, and the inclusion of domain knowledge from experts and scientists were used to derive value propositions. A two-alternative forced-choice paradigm and probabilistic choice models were used to investigate hearing aid users' preferences for the value propositions through an online platform. Study sample: Twelve hearing aid users (mean age 70, range 59-70) and eleven clinicians were interviewed. A total of 173 experienced hearing aid users evaluated the value propositions. Results: Twenty-nine value propositions as described by patients, clinicians, and hearing care experts where identified, from which twenty-one value propositions were evaluated. Results of the pair-wise evaluation method show that the value propositions judged to be the most important for the hearing aid users were: "13. To solve the hearing problem you have", "09. Thorough diagnosis of the hearing", and "16. The hearing aid solution is adapted to individual needs", which are related to finding the correct hearing solution and to be considered in the process. The value propositions judged to be least important were: "04 Next of kin and others involved in the process", "26. To be in the same room as the practitioner", and "29. The practitioner's human characteristics", related to the involvement of others in the process and the proximity and personal manner of the practitioners.

Sentence-Based Experience Logging in New Hearing Aid Users.

Purpose The aim of this study was to develop a tool to gain insight into the daily experiences of new hearing aid users and to shed light on aspects of aided performance that may not be unveiled through standard questionnaires. Method The tool is developed based on clinical observations, patient experiences, expert involvement, and existing validated hearing rehabilitation questionnaires. Results An online tool for collecting data related to hearing aid use was developed. The tool is based on 453 prefabricated sentences representing experiences within 13 categories related to hearing aid use. Conclusions The tool has the potential to reflect a wide range of individual experiences with hearing aid use, including auditory and nonauditory aspects. These experiences may hold important knowledge for both the patient and the professional in the hearing rehabilitation process.

Distortion-Product Otoacoustic Emission Measured Below 300 Hz in Normal-Hearing Human Subjects.

Physiological noise levels in the human ear canal often exceed naturally low levels of otoacoustic emissions (OAEs) near the threshold of hearing. Low-frequency noise, and electronic filtering to cope with it, has effectively limited the study of OAE to frequencies above about 500 Hz. Presently, a custom-built low-frequency acoustic probe was put to use in 21 normal-hearing human subjects (of 34 recruited). Distortion-product otoacoustic emission (DPOAE) was measured in the enclosed ear canal volume as the response to two simultaneously presented tones with frequencies f 1 and f 2. The stimulus-frequency ratio f 2/f 1 was varied systematically to find the "optimal" ratio evoking the largest level at 2 f 1-f 2 frequencies 87.9, 176, and 264 Hz. No reference data exist in this frequency region. Results show that DPOAE exists down to at least 87.9 Hz, maintaining the bell-shaped dependence on the f 2/f 1 ratio known from higher frequencies. Toward low frequencies, however, the bell broadens and the optimal ratio increases proportionally to the bandwidth of an auditory filter as defined by the equivalent rectangular bandwidth. The DPOAE phase rotates monotonously as a function of the stimulus ratio, and its slope trend supports the notion of a lack of scaling symmetry in the apex of the cochlea.

Stimulus ratio dependence of low-frequency distortion-product otoacoustic emissions in humans.

Active amplifiers within the cochlea generate, as a by-product of their function, distortion-product otoacoustic emissions (DPOAEs) in response to specific two-tone stimuli. Focus has been on invoking emissions in a mid-frequency range from ∼0.5 to 4 kHz. The present study investigates stimulus parameters of the DPOAE at 2f1-f2 frequencies below 0.5 kHz. Eighteen out of 21 young human adults screened had audiometrically normal hearing for inclusion in the experiment. DPOAEs were measured with pure-tone stimuli in four configurations: f2 fixed around 2.13 kHz, f2 fixed around 0.53 kHz, 2f1-f2 fixed at 1.23 kHz and 0.25 kHz. Eight stimulus ratios, f2/f1, and three stimulus sound pressure levels, L1/L2, were measured in each configuration. Trends in ratio-magnitude responses for the mid-frequency DPOAE agree with those reported in previous literature. DPOAEs are not limited to distortion frequencies >0.5 kHz, but the stimulus ratio invoking the largest DPOAE in the mid-frequency range does not do so in the low-frequency range. Guiding the ratio according to the equivalent rectangular bandwidth of auditory filters maintains the DPOAE level.

Is it necessary to penalize impulsive noise +5 dB due to higher risk of hearing damage?

It is studied whether the +5 dB penalty for impulsiveness established by ISO 1999:1990 accounts for a higher risk of noise-induced hearing loss. A total of 16 normal-hearing human subjects were exposed for 10 min to two types of binaural industrial-recordings: (1) a continuous broad-band noise normalized to L(EX,8 h)=80 dBA and (2) the combination of the previous stimulus with an impulsive noise normalized to L(EX,8 h)=75+5(db penalty)=80 dBA (peak level 117 dBC and repetition rate of 0.5 impacts per second). Distortion product otoacoustic emissions (DPOAEs) were measured in a broad frequency range before and in the following 90 min after the exposure. The group results show that the continuous exposure had a bigger impact on DPOAE levels, with a maximum DPOAE shift of approximately 5 dB in the frequency range of 2-3.15 kHz during the first 10 min of the recovery. No evident DPOAE shift is seen for the impulsive + continuous stimulus. The results indicate that the penalty overestimated the effects on DPOAE levels and support the concept that the risk of hearing loss from low-level impulses may be predicted on an equal-energy basis.

Recovery of distortion-product otoacoustic emissions after a 2-kHz monaural sound-exposure in humans: effects on fine structures.

A better understanding of the vulnerability of the fine structures of distortion-product otoacoustic emissions (DPOAEs) after acoustic overexposure may improve the knowledge about DPOAE generation, cochlear damage, and lead to more efficient diagnostic tools. It is studied whether the DPOAE fine structures of 16 normal-hearing human subjects are systematically affected after a moderate monaural sound-exposure of 10 min to a 2-kHz tone normalized to an exposure level L(EX,8h) of 80 dBA. DPOAEs were measured before and in the following 70 min after the exposure. The experimental protocol allowed measurements with high time and frequency resolution in a 1/3-octave band centered at 3 kHz. On average, DPOAE levels were reduced approximately 5 dB in the entire measured frequency-range. Statistically significant differences in pre- and post-exposure DPOAE levels were observed up to 70 min after the end of the sound exposure. The results show that the effects on fine structures are highly individual and no systematic change was observed.

Overexposure effects of a 1-kHz tone on the distortion product otoacoustic emission in humans.

The effects of overexposure on the properties of distortion product otoacoustic emissions (DPOAEs) are investigated. In total, 39 normal-hearing humans were monaurally exposed to a 1-kHz tone lasting for 3 min at an equivalent threshold sound-pressure level of 105.5 dB. The effects of overexposure were studied in two experiments (1) on the broadband DPOAE and (2) on the DPOAE fine structure, measured using a higher frequency resolution in a narrower frequency range. The obtained DPOAE shifts were compared to temporary threshold shift (TTS) obtained after a similar exposure. Similarities between DPOAE shifts and TTS were found in the affected frequency range and the time course of recovery. The amount of TTS was higher in the early recovery time (1-4-min postexposure), but similar to the DPOAE shift (even in absolute terms) at later recovery times (5-20-min postexposure). The DPOAE fine structure was not systematically changed after the exposure.