Reliability and validity of the Finnish version of the prosthesis evaluation questionnaire.

BACKGROUND: Thus far there have been no specific patient-reported outcome instrument in Finnish for health-related quality of life (HRQoL) assessment after major lower extremity amputation and successful prosthesis fitting. METHODS: The prosthesis evaluation questionnaire (PEQ) was translated and cross-culturally adapted into Finnish. Participants completed a questionnaire package including the Finnish version of the PEQ and the 15 D HRQoL instrument. Scales (n = 10) were tested for internal consistency, floor-ceiling effect, and reproducibility for which participants completed the PEQ twice within a 2-week interval. Validity was tested by estimating the correlation between the 15 D index and the scales. The authors included 122 participants who had completed the questionnaire on two separate occasions in the final analysis. RESULTS: Mean scale scores of the 10 scales varied from 52 to 83. Cronbach's alphas ranged from 0.67 to 0.96. The total score showed no floor-ceiling effect. Reproducibility of the scales was good (intraclass correlation coefficient, 0.78-0.87; coefficient of repeatability, 19-36). Significant correlations were observed between the 15 D index and the scales for ambulation, social burden, usefulness, and well-being. CONCLUSIONS: This study provided evidence of the reliability and validity of the Finnish version of the PEQ in assessing the HRQoL among major lower extremity amputated patients who have been fitted with prosthesis. Implications for rehabilitation Measurement of quality of life during rehabilitation can provide important information on patients' well-being. The prosthesis evaluation questionnaire (PEQ) is a valid instrument for assessing health-related quality of life (HRQoL) after major lower extremity amputation. This study provided evidence of the reliability and validity of the Finnish version of the PEQ for assessing HRQoL among patient who have undergone major lower extremity amputation.

[Ocular prosthetics. Fitting, daily use and complications]. / Augenprothetische Versorgung. Anpassung, Handhabung und Komplikationen.

BACKGROUND: Ocular prosthetics make a decisive contribution to the functional, esthetic and psychosomatic rehabilitation of patients after ocular extirpation. OBJECTIVES: This article provides an overview of the fitting, daily care and complications of ocular prosthetics. METHODS: The study comprised a PubMed literature review and own clinical results. RESULTS: Ocular prosthetics made from cryolite glass or perspex can be manufactured and fitted 5-8 weeks after removal of the eye. During this period a conformer is placed within the conjunctival sac in order to prevent scar formation and shrinking of the socket. Artificial eyes can be worn continuously, only interrupted by a short but regular cleaning procedure. Artificial tears and lid hygiene improve the comfort of wearing. Glass prostheses have to be renewed every 1-2 years, while perspex prostheses need to be polished once a year. Complications, such as giant papillary conjunctivitis or blepharoconjunctivitis sicca are facilitated by poor fit, increased age and inappropriate care of the prosthetic device. In the case of socket shrinkage or anophthalmic socket syndrome, surgical interventions are needed to re-enable the use of an artificial eye. CONCLUSION: Adequate fitting, daily care of ocular prosthetics and therapeutic management of associated complications are mandatory for a durable functional, esthetic and psychosomatic rehabilitation after ocular extirpation.

Comparison of eSRTs and comfort levels in users of Digisonic SP cochlear implants.

OBJECTIVE: This project proposes to assess the relation between the electrical stapedius reflex threshold (eSRT) and comfort levels in users of the Digisonic SP cochlear implant. METHODS: Cross-sectional study, where eSRTs are compared to the comfort current levels at 2 weeks and at 1-year post-fitting in a group of 11 adults getting a significant improvement in open set speech recognition from a Digisonic SP cochlear implant. RESULTS: The linear relation between eSRTs and comfort levels results in Pearson correlation coefficients of 0.65 (P < 0.01; at 2 weeks) to 0.60 (P < 0.05; at 1 year). The comfort levels can be predicted from the eSRTs for the Digisonic SP device from the model equation C level = 19.12 + 0.41*eSRT within a clinically acceptable margin of error. DISCUSSION: Reflex thresholds could be obtained in most participants, and in most channels of the Digisonic implant. The equation model appears as a quite reliable predictor of comfort levels for users of this device.

Psychometric properties of a revised Danish translation of the international outcome inventory for hearing aids (IOI-HA).

OBJECTIVE: The original Danish translation of the international outcome inventory for hearing aids (IOI-HA) proved problematic as the wording of item 5 was not semantically clear, rendering the questionnaire internally inconsistent. The objective of this study was to examine data collected with a revised Danish translation of the IOI-HA in order to: (1) evaluate the effect of the revision, and (2) to examine if the psychometric properties of the revised translation of the IOI-HA are equivalent to those of previously validated translations. DESIGN: Psychometric properties were evaluated performing inter-item correlation analysis, principal component analysis, and item-total correlation. STUDY SAMPLE: Three hundred forty-one adult hearing-impaired participants-all of whom were voluntary hearing aid testers attached to the Global Audiology Group in GN ReSound A/S on a non-payment basis - were mailed a revised Danish IOI-HA questionnaire. RESULTS: Statistical analysis revealed good internal consistency along with a clear division of items into two distinct factors. CONCLUSIONS: The revised Danish translation of the IOI-HA proves internally consistent. Furthermore, it possesses psychometric properties equivalent to those reported in several corresponding studies of other translations. Data obtained from it can therefore validly be considered comparable to data obtained from previously validated translations of the IOI-HA.

Influence of adjustments to amputation and artificial limb on quality of life in patients following lower limb amputation.

The objectives of this study are to investigate the relationship between adjustments to amputation and artificial limb, and quality of life (QoL), and to analyse the influence of sociodemographic, medical and amputation-related factors on this relationship. Patients with unilateral and noncongenital lower limb amputation who were using artificial limb were interviewed (n=368) using structured questionnaires. The Trinity Amputation and Prosthesis Experience Scales (TAPES) were used to assess adjustments to amputation and artificial limb and the MOS Short-Form Health Survey (SF-36) was used to assess the physical (PCS) and mental (MCS) component summary of QoL. Absence of comorbidity and residual stump pain, being employed, young age, less functional restriction, being more adjusted to limitation, increased social adjustment and less restriction in athletic activity were related to better PCS scores. Absence of comorbidity and phantom limb pain, nonuse of assistive device, being more adjusted to limitation, increased social adjustment and being less functionally restricted were related to higher MCS scores. Comorbidity had a modifying effect on both PCS and MCS scores. In addition, age, being employed and residual stump pain had a modifying influence on PCS, whereas assistive device use and phantom limb pain had a modifying influence on MCS. Our findings show that TAPES subscales have a modifying effect on the associations between several background (sociodemographic and amputation characteristics) and QoL (PCS and MCS). This indicates that adjustments to amputation and artificial limb are the key determinants of QoL in individuals following lower limb amputation.

Older people's views on what they need to successfully adjust to life with a hearing aid.

This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit.

The effects of hearing aid use on listening effort and mental fatigue associated with sustained speech processing demands.

OBJECTIVES: To maintain optimal understanding, persons with sensorineural hearing loss (SNHL) often report a need for increased attention, concentration, and "listening effort" compared with persons without hearing loss. It is generally assumed that this increased effort is related to subjective reports of mental fatigue in persons with hearing loss. Although the benefits of hearing aids for improving intelligibility are well documented, their impact on listening effort and mental fatigue are less clear. This study used subjective and objective measures to examine the effects of hearing aid use and advanced hearing aid features on listening effort and mental fatigue in adults with SNHL. DESIGN: Sixteen adults (aged 47-69 years) with mild to severe sloping SNHL participated. A dual-task paradigm assessed word recognition, word recall, and visual reaction times (RTs) to objectively quantify listening effort and fatigue. Mental fatigue was operationally defined as a decrement in performance over the duration of the experiment (approximately 1 hr). Participants were fitted with study hearing aids and tested unaided and in two aided conditions (omnidirectional and with directional processing and digital noise reduction active). Subjective ratings of listening effort experienced during the day and ratings of fatigue and attentiveness immediately before and after the dual-task were also obtained. RESULTS: Word recall was better and dual-task RTs were significantly faster in the aided compared with unaided conditions, suggesting a decrease in listening effort when listening aided. Word recognition and recall in unaided and aided conditions remained relatively stable over the duration of the dual-task, suggesting these processes were resistant to mental fatigue. In contrast, dual-task RTs systematically increased over the duration of the speech task when listening unaided, consistent with development of mental fatigue. However, dual-task RTs remained stable over time in both aided conditions suggesting that hearing aid use reduced susceptibility to mental fatigue. Subjective ratings of fatigue and attentiveness also increased significantly after completion of the dual-task; however, no differences between unaided and aided subjective ratings were observed. Correlation analyses between subjective and objective measures of listening effort and mental fatigue showed no strong or consistent relationship. Likewise, subject variables such as age and degree of hearing loss showed no strong or consistent relationship to either subjective or objective measures of listening effort or mental fatigue. CONCLUSIONS: Results from subjective and select objective measures suggest sustained speech-processing demands can lead to mental fatigue in persons with hearing loss. It is important to note that the use of clinically fit hearing aids may reduce listening effort and susceptibility to mental fatigue associated with sustained speech-processing demands. The present study design did not reveal additional benefits, in terms of reduced listening effort or fatigue, from use of directional processing and digital noise-reduction algorithms. However, experimental design limitations suggest further work in this area is needed. Finally, subjective and objective measures of listening effort and mental fatigue due to sustained speech-processing demands, were not strongly associated, suggesting that these measures may assess different aspects of listening effort and mental fatigue.

Identifying successful outcomes and important factors to consider in upper limb amputation rehabilitation: an international web-based Delphi survey.

PURPOSE: To identify and gain agreement on successful outcomes of and important factors to consider in rehabilitation following upper limb absence (ULA). METHOD: Fifty-three participants consisting of multi-disciplinary rehabilitation professionals, and individuals with ULA were invited to complete a three-round modified Delphi iterative survey. Following three Delphi questionnaire rounds, participants clarified the definitions of success in three areas (prosthesis use, activities and participation and self-image). In addition, participants identified and agreed the important factors to consider in rehabilitation after ULA. RESULTS: Results showed that participants reached agreement (having a SD <1) over the three rounds on 78 out of 81 rated items. Of these, 54 rated items were "accepted" as important by panel members (mean score of 4 on a five-point Likert scale). Twenty-four items were rejected. Only three rated items had not reached agreement by the third round. CONCLUSIONS: Clarification of successful outcomes and factors that should be taken into consideration in a patient's rehabilitation allows a clearer evaluation of what should be the focus of rehabilitation. The findings from the Delphi study can help form the basis for a screening tool for clinicians to be able to identify areas of concern and subsequent treatment for a patient in their care. Implications for Rehabilitation To date, there has been no definitive guidance on which outcomes should be assessed in amputation rehabilitation. This study identified the seven core domains of importance regarding the rehabilitation of individuals with ULA and created a starting point for developing a new portfolio of research that aims to address all relevant aspects of patients' rehabilitation. This study reached a consensus and enabled an insight into what defines successful prosthesis use, self-image and activities and participation, and provided evidence that the current definition of prosthesis use in the literature does not sufficiently capture what RPs and individuals with ULA consider important, such as specific use of the prosthesis, as often as an individual wishes, while using it as intended. This study provided RPs and individuals with ULA an opportunity to communicate their opinions and knowledge anonymously regarding the important areas to consider in rehabilitation.

External breast prostheses in post-mastectomy care: women's qualitative accounts.

A good-quality external breast prosthesis and prosthesis-fitting service is an integral part of the recovery process post-mastectomy. However, this is an area of care that has minimal information or research available. The aim of this research was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. To ascertain women's own personal and subjective experiences, five focus groups with 47 women recruited through national cancer advocacy/support organizations and four Follow-up Breast Clinics throughout Ireland were conducted. As a result, five main themes emerged: (1) The fitting experience--Fitting? (2) Post-mastectomy products--Having? (3) Cost--Affording? (4) Information--Knowing? and (5) Adaptation--Accepting? The emerging themes pinpointed the impact of the fitting experience, fitting environment and the qualities of a prosthesis fitter on a woman's experience in obtaining a first or replacement breast prosthesis; the importance of the physical characteristics of the prosthesis and mastectomy bras; cost, affordability and entitlements; a lack of and perceived difficulty in getting information; and the myriad of personal and social impacts of a breast prosthesis for the woman. These findings are integral for the development of standards of practice in the fitting and supply of external breast prostheses in post-mastectomy care.

A survey of UK practitioner attitudes to the fitting of rigid gas permeable lenses.

PURPOSE: Rigid gas permeable (GP) contact lenses may provide the safest option for lens wear, but prescribing rates are in decline. This study investigated the effect of practitioner attitudes on GP lens prescribing. METHODS: A questionnaire was developed using a focus group and a pilot study. Questions addressed clinical time spent fitting GP lenses, specialist equipment requirements and perceived safety and comfort. With ethical approval, the questionnaire was sent to 1000 randomly selected UK registered eye care practitioners (ECPs). RESULTS: In general, ECPs enjoy the challenge of fitting GPs, although fitting takes longer than soft lens fitting. There is a difference in attitude between longer qualified and more recently qualified ECPs. Longer qualified ECPs more frequently reported enjoyment of the fitting challenges, recommended GP lenses to patients and were less likely to believe that GP lenses were becoming obsolete. ECPs are in strong agreement on the ocular health advantages of fitting GPs. They do not feel specialist equipment is generally needed, although some reported a topographer to be advantageous. The large majority of ECPs do not have access to the specialist equipment they perceive to be normally associated with GP fitting (radiuscope, V-gauge). They believe that initial fitting discomfort of GP fitting is a major drawback to their fitting, and while they feel this greatly improves with adaptation, they do not feel it reaches soft lens wear comfort. A total of 30.3% of ECPs feel it is clinically acceptable to use topical anaesthetic during GP fitting, but only 1.4% of ECPs regularly do so. CONCLUSIONS: ECPs are aware of the benefits that GP lenses provide in terms of ocular health. They find GPs take longer to fit, but they enjoyed the challenge of fitting, which suggests that they are not lacking in clinical skill, nor any specialist equipment. However, they are unhappy with initial patient comfort, and are not yet prepared to use topical anaesthetics during initial fitting. As a consequence, ECPs believe that GP lenses are becoming obsolete. Negative practitioner attitudes toward various aspects of GP fitting may mean fewer recommendations to patients and reduced GP prescribing.

Experiences in the provision, fitting and supply of external breast prostheses: findings from a national survey.

A good-quality external breast prosthesis and prosthesis-fitting service is integral to recovery post-mastectomy. However, this area of care has minimal information or research available. The aim of this study was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. Three national surveys were undertaken with women (n = 527), breast care nurses (BCNs) (n = 32) and retail prosthesis fitters (n = 12). The findings identified the importance of the prosthesis for shape, appearance to self, appearance to others, sense of well-being, self-confidence and femininity. Dissatisfaction with weight, comfort and movement of the prosthesis was identified. Cost and travel distance were found to influence the replacement of the prosthesis. Dissatisfaction emerged with the display and choice of products, and brochure availability at the prosthesis fitting. Women preferred to be fitted for the first silicone prosthesis by a BCN in a hospital setting whereas for the replacement prosthesis they preferred a trained fitter at a specialized prosthesis supplier. BCNs and retail fitters identified the need for service guidelines and increased availability of professional development opportunities in prosthesis-fitting. These findings contributed to the development of standards of care for breast prosthesis-fitting services to benefit women and to provide guidelines for those providing the service.

Perfil biopsicossocial de portadores de anoftalmia no sul de Minas Gerais - Brasil / Biopsychosocial profile of patients with anophthalmia in the south of Minas Gerais - Brazil

OBJETIVO: Avaliar o perfil biopsicossocial de portadores de anoftalmia, com ênfase no impacto psicológico e funcional da perda ocular e na reintegração social dessa população. MÉTODOS: Realizou-se estudo transversal com 84 pacientes (50 do gênero masculino e 34 do feminino), reabilitados ou em processo de reabilitação com próteses oculares, avaliados por meio de questionário que contemplava dimensões como: etiologia da perda ocular, grau de adaptação à prótese e impacto nas atividades profissionais, sociais e escolares. RESULTADOS: O olho direito foi afetado em 45,2 por cento dos pacientes, o olho esquerdo em 51,2 por cento, e os demais apresentavam anoftalmia bilateral. Relataram dificuldade, atual ou já superada, de adaptação à visão monocular 47,5 por cento dos participantes. No gênero masculino as principais causas da anoftalmia foram os traumatismos oculares por acidentes (54 por cento), e no feminino, as doenças adquiridas (38,2 por cento). Na população estudada, a perda ocular ocorreu, em média, aos 20,5 ± 18,4 anos, e o tempo decorrido até a primeira reabilitação protética foi de 8,6 ± 13,1 anos. A maioria dos pacientes (66,1 por cento) relatou satisfação e boa adaptação à prótese ocular. Sentimentos de tristeza, vergonha e timidez foram freqüentemente relatados. CONCLUSÃO: Pacientes com anoftalmia freqüentemente apresentam transtornos psíquicos e/ou funcionais que dificultam sua readaptação ao meio social, profissional e familiar, o que é agravado por fatores econômicos e pela carência de serviços públicos que ofereçam tratamento reabilitador. A realização de campanhas de esclarecimento à população também pode ser útil para a prevenção das causas que levam à perda ocular.

PURPOSE: To evaluate the biopsychosocial profile of patients with anophthalmia, with emphasis on the psychological and functional impact of eye loss and the social reintegration of this population. METHODS: Prospective analyses of 84 patients (50 males and 34 females), rehabilitated or in the rehabilitation process with ocular prostheses were interviewed by means of a questionnaire with dimensions involving the etiology of the ocular defect, degree of adaptation to the ocular prosthesis, and impact on professional, family and social activities. RESULT: The right eye was affected in 45.2 percent of the patients, the left eye in 51.2 percent, and the rest of the patients had bilateral anophthalmia. Difficulty in adapting to monocular vision was reported by 47.6 percent of the patients. The main causes of anophthalmia in males were eye injuries due to accidents (54 percent), and, in females, acquired diseases (38.2 percent). For the total studied population, the eye loss occurred at a mean of 20.5 ± 18.41 years, and the elapsed time until the first rehabilitation with ocular prosthesis was of 8.6 ± 13.10 years. Most patients (66.1 percent) reported satisfaction and good adaptation to the prosthesis. Feelings of sadness, shame and shyness were frequently reported. CONCLUSION: Anophtalmic patients often exhibit psychic and/or functional disorders which hinder their social, professional and family readaptation, and this is aggravated by both economic factors and lack of public services that provide rehabilitative treatment. Public information campaigns could also be useful to prevent causes that lead to ocular loss.

Factors related to patients' general satisfaction with removable partial dentures: a stepwise multiple regression analysis.

This study aimed to analyze factors related to patients' general satisfaction with removable partial dentures (RPDs), such as esthetics, retention, speech, chewing, and comfort. A total of 103 patients with Kennedy Class I RPDs (34 to 82 years old; mean age: 63; 35 men, 68 women) assessed their satisfaction with dentures. Stepwise multiple regression analysis was used to evaluate the relationship among the factors. Significant correlations were found between general satisfaction and each of the individual components (P < .05). The patients' assessment of esthetics explained almost 50% of general satisfaction in both arches (P < .05). Esthetics, chewing, and speech had significant effects on the patients' general satisfaction with dentures.

[Biopsychosocial profile of patients with anophthalmia in the south of Minas Gerais - Brazil]. / Perfil biopsicossocial de portadores de anoftalmia no sul de Minas Gerais - Brasil.

PURPOSE: To evaluate the biopsychosocial profile of patients with anophthalmia, with emphasis on the psychological and functional impact of eye loss and the social reintegration of this population. METHODS: Prospective analyses of 84 patients (50 males and 34 females), rehabilitated or in the rehabilitation process with ocular prostheses were interviewed by means of a questionnaire with dimensions involving the etiology of the ocular defect, degree of adaptation to the ocular prosthesis, and impact on professional, family and social activities. RESULT: The right eye was affected in 45.2% of the patients, the left eye in 51.2%, and the rest of the patients had bilateral anophthalmia. Difficulty in adapting to monocular vision was reported by 47.6% of the patients. The main causes of anophthalmia in males were eye injuries due to accidents (54%), and, in females, acquired diseases (38.2%). For the total studied population, the eye loss occurred at a mean of 20.5 +/- 18.41 years, and the elapsed time until the first rehabilitation with ocular prosthesis was of 8.6 +/- 13.10 years. Most patients (66.1%) reported satisfaction and good adaptation to the prosthesis. Feelings of sadness, shame and shyness were frequently reported. CONCLUSION: Anophtalmic patients often exhibit psychic and/or functional disorders which hinder their social, professional and family readaptation, and this is aggravated by both economic factors and lack of public services that provide rehabilitative treatment. Public information campaigns could also be useful to prevent causes that lead to ocular loss.

Processo de adaptação de próteses auditivas em usuários atendidos em uma instituição pública federal - parte I: resultados e implicações com o uso da amplificação / Hearing aids fitting process in users that are seen in a federal public institution: part I -results and implications with the amplification device

A adaptação de próteses auditivas abrange vários aspectos a serem analisados, desde o fornecimento da mesma até os resultados da protetização, o que possibilitaria uma melhoria do planejamento das ações em Atenção à Saúde Auditiva. OBJETIVOS: Verificar as dificuldades relacionadas ao uso e manuseio de pilhas e moldes auriculares e as características da amplificação, e discutir os aspectos envolvidos no processo de adaptação das próteses auditivas, orientação e acompanhamento deste grupo de estudo. MATERIAL E MÉTODO: 31 indivíduos, de 12 a 77 anos de idade, portadores de perdas auditivas bilaterais simétricas, neurossensoriais ou mistas, de graus moderado a moderadamente severo e usuários de próteses digitais ou analógicas programáveis. Foi realizada uma entrevista com tópicos relacionados ao uso e manuseio das pilhas, moldes e próteses auditivas, assim como sobre as características da amplificação. RESULTADOS: Dos indivíduos entrevistados 12,90 por cento, 58,06 por cento e 67,74 por cento apresentaram dificuldades relacionadas às pilhas, aos moldes ou cápsulas auriculares, e às características da amplificação, respectivamente. CONCLUSÃO: A maioria dos usuários apresentou algum tipo de queixa relacionado ao funcionamento das próteses auditivas e os resultados da intervenção estão diretamente relacionados às expectativas, necessidades de comunicação e preocupações financeiras do usuário e ao suporte fornecido por sua rede municipal de saúde.

Hearing aid fitting involves numerous issues that must be investigated - from the device supply all the way to results achieved with it in order to improve its results in planning Auditory Health Care. AIMS: to verify difficulties related to device use, batteries and ear molds handling, the very characteristics of sound amplification, and to discuss factors that impact audiological rehabilitation in this group of patients. MATERIALS AND METHODS: 31 individuals, from 12 to 77 years age, with bilaterally symmetrical hearing losses, sensorineural or mixed, from moderate to moderately severe degrees and hearing aid users of digital or hybrid hearing aids. We carried out an interview approaching topics related to device use, battery handling, ear molds and hearing aids, as well as sound amplification characteristics. RESULTS: 12.90 percent, 58.06 percent and 67.74 percent of the interviewees presented difficulties related to battery, ear molds or capsules and amplification characteristics, respectively. CONCLUSION: the majority of the individuals presented some kind of complaint related to hearing aids characteristics, and difficulties related to users' expectations, communication skills and monetary cost and the Municipal Health Care Network, which all interfered in the audiological rehabilitation.

Hearing aids fitting process in users that are seen in a federal public institution: part I--results and implications with the amplification device.

UNLABELLED: Hearing aid fitting involves numerous issues that must be investigated - from the device supply all the way to results achieved with it in order to improve its results in planning Auditory Health Care. AIMS: to verify difficulties related to device use, batteries and ear molds handling, the very characteristics of sound amplification, and to discuss factors that impact audiological rehabilitation in this group of patients. MATERIALS AND METHODS: 31 individuals, from 12 to 77 years age, with bilaterally symmetrical hearing losses, sensorineural or mixed, from moderate to moderately severe degrees and hearing aid users of digital or hybrid hearing aids. We carried out an interview approaching topics related to device use, battery handling, ear molds and hearing aids, as well as sound amplification characteristics. RESULTS: 12.90%, 58.06% and 67.74% of the interviewees presented difficulties related to battery, ear molds or capsules and amplification characteristics, respectively. CONCLUSION: the majority of the individuals presented some kind of complaint related to hearing aids characteristics, and difficulties related to users' expectations, communication skills and monetary cost and the Municipal Health Care Network, which all interfered in the audiological rehabilitation.

Experience with the SOUNDTEC implantable hearing aid.

OBJECTIVE: To assess the efficacy, morbidity, and patient satisfaction of the SOUNDTEC semi-implantable hearing aid. STUDY DESIGN: Retrospective case review. SETTING: Two tertiary referral centers (the Silverstein Institute and the Atkins Institute). PATIENTS: Sixty-four (four bilateral placements) patients with bilateral moderately severe sensorineural hearing loss: 47 patients had previously worn hearing aids. INTERVENTIONS: After separating the incudostapedial joint, a magnet encased in a titanium canister with a ring was introduced onto the stapes neck. Gelfoam or adipose tissue was used to stabilize the magnet. After 3 months, the external processor was fitted. MAIN OUTCOME MEASURES: At 1 month, audiometric testing was performed and functional gain was assessed. Patient acceptance and implant performance were measured by a visual analogue questionnaire. RESULTS: The device produced an average functional gain of 26 dB. Fifty-five percent of patients complained of magnet movement; this was eliminated in 80% of Silverstein Institute patients when the external processor was worn and fat was used to stabilize the magnet. CONCLUSION: The SOUNDTEC direct device is well tolerated in the majority of patients, with a significant increase in functional gain. Magnet instability and noise were the most frequent complaints and improved with processor placement and anchoring the magnet with fat. This electromagnetic semi-implantable hearing aid confers greater functional gain over conventional hearing aids and reduces occlusion effect and feedback.

Benefits from hearing aids in relation to the interaction between the user and the environment.

It is becoming increasingly recognized that, in addition to the influence of audiometric variables and associated psychoacoustic abilities, the benefits from and candidature for various signal-processing schemes in hearing aids are strongly influenced by listeners' characteristics (such as motivations, expectations, and personality), and also the auditory environments in which those listeners are required to function (i.e. their auditory ecology). We will report elsewhere an experiment on a group of 50 listeners in a within-subject, randomized, blind, crossover design of five different hearing aid rationales, of which two contained linear amplification and three contained non-linear amplification which differed only in release-time constant. This article reports the interaction between the audiometric and cognitive characteristics of listeners, and the test conditions under which speech identification procedures are conducted (presentation level, signal-to-noise ratio, and temporal characteristics of interfering noise). The analyses show significant interactions between hearing impairment and cognitive ability, and the extent to which, when tested unaided, listeners can derive advantage from temporal structure in a background noise. The analysis then addresses the benefits of amplification (defined as the difference between performance in the amplified and unaided conditions) and shows significant interactions between cognitive ability, the temporal characteristics of interfering noise, and the time constants of non-linear amplification rationales. The direction of the interaction is that listeners with greater cognitive ability derive greater benefit from temporal structure in background noise when listening via fast time constants, one of whose effects is to facilitate 'listening in the gaps'.