Adults who report difficulty hearing speech in noise: an exploration of experiences, impacts and coping strategies.

Objective: Listening difficulties in noise are common, even in those with clinically normal hearing. There is a suggestion that subjective assessment of hearing difficulties may be more closely associated with listening effort and fatigue rather than objective measures of hearing and/or speech perception. The aim of this study was to better understand these perceptual deficits and experiences of this population.Design: An exploratory survey was distributed to participants with self-reported listening-in-noise difficulties. The primary aim of the survey was to gather information about challenging listening environments, its impact, and preferred rehabilitation strategies. Secondly, responses were compared to their performance on behavioural tasks.Study sample: Fifty adults aged 33-55 (22 females, with normal or near-normal hearing thresholds), completed the survey, and 45 of these performed behavioural tasks.Results: Background noise with conversational content was the most common source of hearing difficulties. Participants expended higher concentration and attention when communicating in noise, and correlations with previously published behavioural data was reported. Social impacts varied, few had sought treatment, and respondents preferred training over devices.Conclusions: Insights gained may provide clinicians and researchers with an understanding of the situations, impacts and non-auditory factors associated with listening-in-noise difficulties, and preferred rehabilitation for these clients.

Developing Sound Skills for Reading: Teaching Phonological Awareness to Preschoolers With Hearing Loss.

This study evaluated the effectiveness of intervention for developing deaf and hard-of-hearing (DHH) preschoolers' phonological awareness (PA) skills. Thirty children (mean age 57 months) with aided, bilateral hearing loss (and who primarily communicated using spoken English) were recruited in the year prior to commencing formal schooling. The study used an experimental design with participants assigned to one of two intervention conditions-vocabulary instruction, or explicit PA instruction. Both intervention programs were based around items drawn from a common word set and presented over six short weekly sessions by a researcher using a computer tablet. Overall, participants showed greater knowledge of word items used in interventions and improved performance on rhyme-based PA skills following intervention. However, the PA group showed significantly greater improvement than the vocabulary group for both overall PA performance and for consonant-vowel-consonant blending. DHH children's order of PA skill development was also examined, with comparison to that shown for children without hearing loss. The results provide early encouraging evidence about the potential benefit of explicit PA instruction for this population.

Changing beliefs about leisure noise: using health promotion models to investigate young people's engagement with, and attitudes towards, hearing health.

OBJECTIVE: To investigate factors influencing young people's motivation to reduce their leisure noise exposure, and protect their hearing health. DESIGN: Questionnaires were conducted online to investigate young people's hearing health attitudes and behaviour. Items were developed using an integrated health promotion approach. The stage of change model was used to group participants in relation to their engagement with noise reduction behaviour. The health belief model was used to compare each group's perceptions of susceptibility and severity of hearing loss, as well as the benefits and barriers to noise reduction. STUDY SAMPLE: Results are presented for 1196 young Australians aged between 18 and 35 years. RESULTS: Participants' engagement with noise reduction behaviour was used to assign them to stage of change groupings: Maintenance (11%), Action (28%), Contemplation (14%), or Pre-contemplation (43%). Each group's responses to health belief model items highlighted key differences across the different stages of engagement. CONCLUSIONS: Future hearing health promotion may benefit from tailoring intervention activities to best suit the stage of change of individuals. Different information may be useful at each stage to best support and motivate young people to look after their hearing health.

Estimating young Australian adults' risk of hearing damage from selected leisure activities.

OBJECTIVE: Several previous studies have attempted to estimate the risk of noise-induced hearing loss from loud leisure noise. Some of these studies may have overestimated the risk because they used noise estimates taken from the higher end of reported levels. The aim of the present study was to provide a realistic estimate of the number of young Australian adults who may be at risk of hearing damage and eventual hearing loss from leisure-noise exposure. DESIGN: Average noise levels at five high-noise leisure activities, (1) nightclubs; (2) pubs, bars, and registered clubs; (3) fitness classes; (4) live sporting events; (5) concerts and live music venues, were calculated using 108 measurements taken from a large database of leisure noise measurements. In addition, an online survey was administered to a convenience sample of 1000 young adults aged 18 to 35 years, who reported the time spent at these leisure activities and the frequency with which they undertook the activities. They also answered questions about tinnitus and their perceived risk of hearing damage. Although the survey data cannot be considered representative of the population of young Australian adults, it was weighted to this population in respect of age, gender, education, and location. The survey data and the average noise levels were used to estimate each individual's annual noise exposure, and in turn, estimate those at risk of hearing damage from leisure-noise exposure. RESULTS: For the majority of participants (n = 868), the accumulated leisure noise level was within the acceptable workplace limit. However, 132 participants or 14.1% (population weighted) were exposed to an annual noise dose greater than the acceptable workplace noise limit. By far, the main source of high-risk leisure noise was from nightclubs. Those with more leisure-noise exposure experienced more tinnitus and perceived themselves to be more at risk than those with lower noise exposures. CONCLUSIONS: It is recommended that nightclub operators reduce noise levels, display warnings, and provide earplugs for patrons and employees. Health promoters should focus their attention on those young adults who are most at risk and provide them with targeted practical advice about reducing their leisure-noise exposure and avoiding hearing loss.

When expectation meets experience: parents' recollections of and experiences with a child diagnosed with hearing loss soon after birth.

OBJECTIVE: To examine parents' recollections of and their experiences with bringing up a child diagnosed with hearing loss at a very young age. DESIGN: Based on the analysis of informal parent discussion groups, four open-ended questions were formulated to solicit information about parents' expectations following diagnosis, as well as experiences and challenges when raising a child with a hearing loss. STUDY SAMPLE: Forty parents of children, aged between three to five years, who were diagnosed with hearing loss before the age of three years. RESULTS: Parents' responses revealed strong support for early intervention, high expectations for their child's development, and desire for information tailored to individual needs. Parents also reported anxiety relating to their perceptions of the significance of consistent device usage on their child's development. Further concerns arose from their observations of the difficulties experienced by their child in real-world environments despite consistent device usage, and their perception of their child's language delay despite early intervention. CONCLUSIONS: The findings point to a need to support parents to form realistic expectations based on current knowledge. Implications for clinicians to provide improved management of children with hearing loss are discussed.

Leisure noise exposure: participation trends, symptoms of hearing damage, and perception of risk.

OBJECTIVE: Leisure activities that emit high noise levels have the potential to expose participants to excessive noise exposure, which can result in hearing damage. This study investigated young people's participation in high-noise leisure activities and the relationship between their leisure noise exposure, symptoms of hearing damage, and perception of risk. DESIGN: Participants completed an online survey relating to participation in selected high-noise leisure activities, symptoms of hearing damage, and beliefs about the risk posed by these activities. STUDY SAMPLE: One thousand 18- to 35-year-old Australian adults completed the survey. RESULTS: Annual noise exposure from the five leisure activities ranged from 0-6.77 times the acceptable noise exposure, with nightclubs posing the greatest risk. Those who attended one noisy activity were more likely to attend others, in particular nightclubs, pubs, and live music events. Noise exposure was correlated with early warning signs of hearing damage and perceived risk of damage. CONCLUSIONS: Active young adults who engage in noisy activities are showing early signs of hearing damage. Furthermore, they perceive the risk associated with their activities. The challenge for researchers and hearing health practitioners is to convert self-perceived risk into positive hearing health behaviours for long-term hearing health.

Noise with attitude: influences on young people's decisions to protect their hearing.

OBJECTIVE: To investigate young people's experiences and attitudes towards hearing health and their participation in noise reduction behaviours, to better understand how education and prevention messages may be better targeted. DESIGN: An online survey was used to investigate participants' own hearing health, their engagement with noise reduction behaviour, and their beliefs about hearing health and the risk posed by leisure activities. STUDY SAMPLE: Results are presented for 1000 Australian young adults (18-35 years). RESULTS: Most participants reported current good hearing health, although over a fifth showed possible early warning signs of damage. Approximately half of participants took steps to reduce their noise exposure. However, preventative action was not related to hearing loss symptomology, or perceived personal risk of noise-related damage. Participants' engagement with hearing health was related to beliefs about the risk posed by leisure noise, hearing health awareness, and the importance of hearing. CONCLUSIONS: There is a need to further educate young people about the risks posed to hearing by leisure activity participation and factors that may assist improve hearing health. It is important that hearing health messages move past the traditional emphasis on knowledge, and move towards the use of more personalized motivators of noise reduction behaviour.

The objective-subjective assessment of noise: young adults can estimate loudness of events and lifestyle noise.

OBJECTIVE: The aim of the study was to establish whether individuals can subjectively estimate: (1) the loudness of events with respect to the objectively measured noise level; and (2) the overall loudness of their daily noise exposure level. DESIGN: Participants wore personal noise exposure meters for up to five days. During this time, participants kept diaries of daily events and estimated the loudness of these events and their overall noise exposure using 1-to-10 rating scales. STUDY SAMPLE: A group of 45 volunteers aged between 18 and 35 years participated in the study. RESULTS: 86% of participants' subjective estimates were significantly correlated with the objective noise measurements. Multiple regression showed that age, overall lifestyle noise, and diary quality were predictors of the strength of correlation observed. In addition participants' subjective estimates of their overall noise exposure were significantly correlated with their actual average daily noise exposure. CONCLUSIONS: Results suggest that individuals can make a reasonable estimate of the loudness of events they experience and the overall level of noise they experience. These results may have significant influence for those interested in producing effective hearing health awareness programs in that individuals may be capable of assessing their own degree of hazard exposure.

Music to whose ears? The effect of social norms on young people's risk perceptions of hearing damage resulting from their music listening behavior.

Professional and community concerns about the potentially dangerous noise levels for common leisure activities has led to increased interest on providing hearing health information to participants. However, noise reduction programmes aimed at leisure activities (such as music listening) face a unique difficulty. The noise source that is earmarked for reduction by hearing health professionals is often the same one that is viewed as pleasurable by participants. Furthermore, these activities often exist within a social setting, with additional peer influences that may influence behavior. The current study aimed to gain a better understanding of social-based factors that may influence an individual's motivation to engage in positive hearing health behaviors. Four hundred and eighty-four participants completed questionnaires examining their perceptions of the hearing risk associated with listening to music listening and asking for estimates of their own and their peer's music listening behaviors. Participants were generally aware of the potential risk posed by listening to personal stereo players (PSPs) and the volumes likely to be most dangerous. Approximately one in five participants reported using listening volumes at levels perceived to be dangerous, an incidence rate in keeping with other studies measuring actual PSP use. However, participants showed less awareness of peers' behavior, consistently overestimating the volumes at which they believed their friends listened. Misperceptions of social norms relating to listening behavior may decrease individuals' perceptions of susceptibility to hearing damage. The consequences of hearing health promotion are discussed, along with suggestions relating to the development of new programs.

Medical practitioners' attitudes to hearing rehabilitation for older adults.

OBJECTIVE: Medical practitioners have the potential to play a significant role in older adults' help seeking behaviour in relation to hearing rehabilitation. The current study aimed to look at attitudinal factors that influence practitioners' decisions to discuss hearing difficulties with older patients and refer them for hearing rehabilitation. DESIGN: A questionnaire based on constructs from the Health Belief Model was used to examine factors that may influence practitioners' referral decisions. STUDY SAMPLE: One hundred and ten practitioners' attitudes to hearing rehabilitation were examined. RESULTS: The results indicated that practitioners have a high level of awareness about their older patients' susceptibility to hearing loss, and a good understanding of the severity of the associated impacts on older adults' lives. Although practitioners acknowledged the theoretical benefits of hearing rehabilitation, many appear less certain about the potential for actual benefit for their older adults. Barriers to referral include negative perceptions about how older patients prioritise hearing, and patients' ability to afford and adapt to the use of hearing aids. CONCLUSIONS: Additional research and education targeted at these area may be beneficial for medical practitioners to increase referral behaviour and improve discussions about hearing rehabilitation with their older patients.

Evaluation of the NAL-NL1 and the DSL v.4.1 prescriptions for children: Paired-comparison intelligibility judgments and functional performance ratings.

This paper reports intelligibility judgments and real-life functional performance of 48 children in a double-blind, cross-over trial comparing the NAL-NL1 and the DSL v.4.1 prescriptions. Intelligibility judgments were obtained by using a paired-comparisons procedure with audiovisual stimuli. Functional performance of children during two eight-week periods, each with hearing aids adjusted to one prescription, was assessed by parents and teachers (PEACH and TEACH) and by children's self reports (SELF). Consistently across reports, performance was significantly better in quiet than in noise. On average, better performance in noise (a higher Noise subscale score) was associated with NAL-NL1 than with DSL v.4.1, both for the PEACH and the SELF. This difference was significant for the SELF in Australia. Intelligibility judgments revealed preferences that were equally split between prescriptions in both countries, on average. In the Australian sample, intelligibility judgments agreed with the questionnaire ratings and with parents' ratings. An increase in preference for NAL was significantly associated with lesser hearing loss. The effect was not significant in the Canadian sample.

Hearing protection for clubbers is music to their ears.

ISSUE ADDRESSED: while it is difficult to promote the use of hearing protectors in noisy workplaces and leisure settings, some nightclub attendees choose to wear earplugs when exposed to loud music. This qualitative study investigated the perceptions of clubbers about the advantages and disadvantages of earplug use in nightclubs. Such first-hand information could potentially be used to educate non-wearers about the features of different earplug types, the experience of wearing earplugs and their relative merits. METHODS: structured telephone interviews were conducted with 20 regular clubbers who wear different types of earplugs at nightclubs. Participants were asked about their experience of wearing earplugs and, in particular, what they perceive to be the advantages and disadvantages of earplugs. RESULTS: participants' responses revealed that cheaper foam earplugs are considered less satisfactory than more expensive earplugs, which are relatively discreet and comfortable, facilitate communication with others, create minimal music distortion and, in some cases, improve music sound quality. In terms of effectiveness, all types of earplugs were considered beneficial in reducing the after-effects of loud music and providing hearing protection. CONCLUSIONS: the perceived advantages of earplugs, which are often not recognised by non-earplug wearers, should be communicated in order to encourage the use of earplugs among clubbers.

Discovering the Unmet Needs of People With Difficulties Understanding Speech in Noise and a Normal or Near-Normal Audiogram.

Purpose A proportion of people with a normal audiogram or mild hearing loss (NA-MHL) experience greater-than-expected difficulty hearing speech in noise. This preliminary exploratory study employed a design thinking approach to better understand the clinical pathway and treatment options experienced by this population. Method Exploratory survey data were analyzed from 233 people with NA-MHL who had consulted a clinician and 47 clinicians. Qualitative analysis was performed on interview data from 21 people with NA-MHL and seven clinicians. Results Results revealed that noisy environments, such as restaurants, were where many people experienced listening difficulties. Most people with NA-MHL were not offered a treatment option at their audiology appointment, and their satisfaction with the appointment was diverse. Many clients reported frustration at being told that their hearing was "normal." Data from clinicians showed that there is no standard test protocol for this population, and most felt that they did not have adequate training or resources to help NA-MHL clients. Conclusion This study discusses the research needs regarding the experience of those with NA-MHL, their help-seeking behaviors, and treatment options. Understanding these needs is the first step to designing projects to improve the quality of life of this population.

Time to Listen: Most Regular Patrons of Music Venues Prefer Lower Volumes.

High sound levels are a feature of nightclubs and live music venues, and therefore pose a risk to patrons' hearing. As a result, these venues are often a focus area for hearing health promotion, and particular emphasis is placed on motivating patrons to take steps to reduce their noise exposure. In the current study, we approached this issue from a different angle. We asked whether sound levels in music venues accurately reflect the preferences of regular patrons, and examined their attitudes and preferences toward sound levels and protective listening behaviors. The study examined results from 993 regular patrons of nightclubs and live music venues, collected as part of an Australian online hearing health survey. Participants were asked about their participation at the two target venues, experiences of hearing difficulties, and risk perceptions. They were also asked about their preferences in relation to typical venue sound levels and beliefs about other attendees' preferences. Results showed that while participants generally rated their hearing as good, the majority had experienced hearing difficulties following sound exposure at music venues. The majority of regular patrons were dissatisfied with current sound levels, with around three-quarters of participants reporting preferences below the levels typically experienced at music venues. Participants were generally aware of the risk posed by high sound levels and those who regarded themselves to be at greater risk from attending music venues were more likely to prefer lower sound levels. These findings have important consequences for the development of hearing health initiatives within entertainment venues. Rather than motivating patrons to change their behavior, encouraging venues to meet their patrons' needs and preferences may be a more successful strategy. Venue operators may find that this approach has a positive impact not only on the hearing health of patrons, but also on the economic health of their venue. Ultimately, reducing the hearing risk in music venues may best be achieved not by telling people what to do, but by listening to what they actually want.

Personal Listening Devices in Australia: Patterns of Use and Levels of Risk.

Personal listening devices (PLDs) have the potential to increase the risk of noise-induced hearing loss (NIHL) for users. The present study aimed to investigate the nature and extent of the risk posed, by describing the user profile of a PLD population, identifying listening habits of that population, and examining whether PLD risk status is associated with hearing damage. A sample of 4,185 Australian PLD users completed an online survey about listening behaviors and hearing health. Listeners were characterized as low, high, or very high-risk based on daily noise dose estimates calculated from self-reported listening volume and durations. Listening patterns and hearing difficulties were examined in relation to risk status. Results indicated differences in listening volumes and durations with respect to age, with higher listening volumes reported for environments with greater background noise. Fifteen percent of participants' usage was classified as posing a potential risk to hearing, with a significantly greater proportion of younger people in higher-risk categories. Forty-one percent of participants reported feeling they have a hearing loss, with ∼20% reporting difficulties with speech in noise. For 18- to 35-year-olds, higher-risk status was associated with a greater proportion of self-reported hearing difficulties, including perceived poorer speech perception. These results have implications for hearing health promotion activities and suggest that messages should focus on either volume levels or durations depending on the particular activity in which the PLD is used. In addition, the results underline the importance of placing PLD exposure in the context of individuals' wider noise exposure. Although PLD use alone is not placing the majority of users at risk, it may be increasing the likelihood that individuals' cumulative noise exposure will exceed safe levels.

Hearing protection devices: Use at work predicts use at play.

Use of hearing protection devices (HPDs) at work is widespread and well researched, but less is known about HPD use in high-noise leisure activities. We investigated HPD use of 8,144 Australians in leisure settings. An online survey asked questions about HPD use at work and leisure and examined whether age, gender, HPD use at work, and tinnitus predicted HPD use in leisure activities. Leisure-based HPD use was most common during high-risk work-related activities. Use of HPDs at work was the most significant predictor of leisure-based use, with workplace users up to 5 times more likely to use HPDs at leisure. Men were significantly more likely than women to use HPDs in 10/20 leisure activities, and those with tinnitus were more likely than those without to use HPDs in 8/20 activities. Older participants were more likely to use HPDs at nightclubs and concerts, but younger participants were more likely to use HPDs playing e-games and musical instruments.

Providing earplugs to young adults at risk encourages protective behaviour in music venues.

For some young people, nightclubs and other music venues are a major source of noise exposure, arising from a combination of very high noise levels; relatively long attendance duration; and frequent, sustained participation over several years. Responsibility for hearing protection is largely left to individuals, many of whom choose not to wear earplugs. In order to encourage earplug use in these settings, a new approach is needed. The aim of the study was to examine whether presentation of hearing health information would result in increased use of earplugs, or whether provision of earplugs alone would be sufficient to change behaviour. A total of 51 regular patrons of music venues were allocated to either a low-information (lo-info) or high-information (hi-info) group. Both groups completed a survey about their current noise exposure, earplug usage and perceived risk of hearing damage. Both groups were also provided with one-size-fits-all filtered music earplugs. The hi-info group was also provided with audio-visual and written information about the risks of excessive noise exposure. After 4 weeks, and again after an additional 12 weeks, participants were asked about their recent earplug usage, intention to use earplugs in the future, and perceived risk of hearing damage. The results showed that after 4 weeks, the hi-info group's perceived personal risk of hearing damage was significantly higher than that of the lo-info group. After 16 weeks, these differences were no longer evident; however, at both 4 and 16 weeks, both the lo- and hi-info groups were using the earplugs equally often; and both groups intended to use earplugs significantly more often in the future. This suggests that the information was unnecessary to motivate behavioural change. Rather, the simple act of providing access to earplugs appears to have effectively encouraged young at-risk adults to increase their earplug use.