The Acceptable Noise Level and the Pure-Tone Audiogram

PURPOSE

The vast majority of previous studies suggest that there is no relationship between the acceptable noise level (ANL) and pure-tone hearing thresholds reported as the average pure-tone hearing thresholds (pure-tone average). This study aims to explore (a) the relationship between hearing thresholds at individual frequencies and the ANL and (b) a measure of the slope of the audiogram and ANL.

METHOD

Sixty-three Danish adult hearing aid users participated. Assessments were pure-tone audiogram and 3 different versions of the ANL test made monaurally at 2 different sessions.

RESULTS

The findings show that low-frequency hearing thresholds and the slope of the audiogram are significantly related to all versions of the ANL.

CONCLUSION

It is possible that previous studies have failed to discover a relationship between ANL and hearing thresholds due to the use of the broad 4-frequency pure-tone average. This has implications for our understanding of the ANL test.

Long-term measurements using home audiometry with Békésy's technique

OBJECTIVE

To examine the efficacy of fixed-frequency Békésy's home audiometry to assess hearing fluctuation and treatment outcomes in patients with subjectively fluctuating hearing loss.

DESIGN

SMAPH, a software audiometry program for Windows, was installed and calibrated on laptop computers. Békésy's audiometry was carried out daily in the patients' homes, using sound-attenuating earphones.

STUDY SAMPLE

Seventeen patients with previously or currently subjectively fluctuating hearing loss. Five patients received of treatment for their conditions during the measurement period.

RESULTS

Measurement periods ranged from 6 to 60 days. Varying degrees of compliance were seen, some patients measuring less than 50% of the days, others measuring every day. Based on their long-term measurements the patients were classified into three groups: patients with stable recordings, with fluctuating low-frequency hearing loss, or with fluctuating high-frequency hearing loss. In the patients with stable recordings, significant test-retest differences were seen below 10 dB at frequencies 0.125-8 kHz.

CONCLUSIONS

Home audiometry with Békésy's technique can be used to evaluate disease activity and to monitor hearing results after therapy.

Measuring motivation using the transtheoretical (stages of change) model: A follow-up study of people who failed an online hearing screening

OBJECTIVE

Acceptance and readiness to seek professional help have shown to be important factors for favourable audiological rehabilitation outcomes. Theories from health psychology such as the transtheoretical (stages-of-change) model could help understand behavioural change in people with hearing impairment. In recent studies, the University of Rhode Island change assessment (URICA) has been found to have good predictive validity.

DESIGN

In a previous study, 224 Swedish adults who had failed an online hearing screening completed URICA and two other measures of stages of change. This follow-up aimed to: (1) determine prevalence of help-seeking at a hearing clinic and hearing aid uptake, and (2) explore the predictive validity of the stages of change measures by a follow-up on the 224 participants who had failed a hearing screening 18 months previously.

STUDY SAMPLE

A total of 122 people (54%) completed the follow-up online questionnaire, including the three measures and questions regarding experience with hearing help-seeking and hearing aid uptake.

RESULTS

Since failing the online hearing screening, 61% of participants had sought help. A good predictive validity for a one-item measure of stages of change was reported.

CONCLUSIONS

The Staging algorithm was the stages of change measure with the best ability to predict help-seeking 18 months later.

Occupational stress among Swedish audiologists in clinical practice: Reasons for being stressed

OBJECTIVE

The present study reports on the application of a Swedish translation of the audiologist occupational stress questionnaire (AOSQ) on audiologists working in Sweden. The relations between AOSQ scores and perceived effort, perceived rewards, coping strategies at work, demographic variables such as salary, education length, practise length, and practice type were tested.

DESIGN

A cross-sectional e-mail survey using the AOSQ, effort-reward imbalance questionnaire, and demographic questions.

STUDY SAMPLE

Four-hundred and four Swedish licensed audiologists working with clients.

RESULTS

The Swedish AOSQ translation demonstrated high inter-item correlations and high internal consistency. Several stress factors were identified: time spent at work, accountability, leadership at the workplace, paperwork and practice demands, equipment and clinical protocols, own health concerns, and job control. The outcome on the complete AOSQ questionnaire was related to perceived effort, perceived rewards, coping strategies at work, and age.

CONCLUSIONS

The Swedish AOSQ translation seems to provide a valid measure of occupational stress among audiologists.

The initial evaluation of an Internet-based support system for audiologists and first-time hearing aid clients

OBJECTIVES

Audiologists provide professional contact and support between appointments to clients with hearing impairment using telephone and e-mail, but more advanced and flexible technological platforms are also possible. The present study aimed to evaluate the clinical application of an Internet-based support system for audiologists and their first-time hearing aid clients.

DESIGN

An Internet-based support system developed by Månsson et al. (2013) for psychologists and their clients was adapted for audiologic purposes. Three audiologic clinics in Sweden tested the support system with their clients.

STUDY SAMPLE

Twenty-three clients managed by four audiologists used and evaluated the support system. In addition, five of the clients and all four audiologists were interviewed and their responses were analyzed using content analysis.

RESULTS

The clients and the audiologists reported positive experiences and overall satisfaction but audiologists reported that the support system did not address the needs of all clients. More positive experiences and greater satisfaction with the support system were associated with reductions on self-reported consequences of hearing loss and positive hearing aids outcomes.

CONCLUSIONS

An Internet-based support system can be used in audiologic rehabilitation. Both audiologists and clients recognized the system's potential value to offer an online support to the provision of audiologic services.

Are children with stronger cognitive capacity more or less disturbed by classroom noise and dysphonic teachers?

PURPOSE

This study aimed to explore if dysphonic voice quality affects children's performance on a language comprehension test, the Test for Reception of Grammar-2 (TROG-2), performed in simultaneous background noise (non-semantic babble). A further aim was to investigate the role of Working Memory Capacity (WMC) and Executive Functioning (EF) in coping with the voice against a background of babble conditions.

METHOD

Ninety-three mainstreamed 8 year old children with typical language development were tested for WMC and EF. Two groups of children (n = 47/46) were formed and presented with recordings of TROG-2 instructions read by one female speaker: one group was presented with recordings with induced dysphonic voice quality, the other with recordings of typical voice. Both groups listened to the voice recordings in competing babble noise at a Signal-to-Noise Ratio of + 10 dB.

RESULT

Significant differences were found for the interaction between cognitive capacity and the TROG-2 results in relation to the voice conditions. In the dysphonic voice condition, children with better WMC results scored higher at the easier comprehension tasks. In the typical voice condition, children with better WMC and EF results scored higher on the more difficult tasks. Seventeen per cent of the variance for the TROG-2 results was explained by the WMC and EF results. There was no overall effect on the children's performance depending of voice condition.

CONCLUSION

The effect of the speaker's voice quality on children's performance varies depending on the prevalence of background babble noise and on the task demands. The dysphonic voice and babble noise seem to demand allocation of cognitive capacities at the cost of language comprehension.

Parental comparison of the prosodic and paralinguistic ability of children with cochlear implants and their normal hearing siblings

The everyday communication of children is commonly observed by their parents. This paper examines the responses of parents (n=18) who had both a Cochlear Implant (CI) and a Normal Hearing (NH) child. Through an online questionnaire, parents rated the ability of their children on a gamut of speech communication competencies encountered in everyday settings. Comparative parental ratings of the CI children were significantly poorer than those of their NH siblings in speaker recognition, happy and sad emotion, and question versus statement identification. Parents also reported that they changed the vocal effort and the enunciation of their speech when they addressed their CI child and that their CI child consistently responded when their name was called in normal, but not in noisy backgrounds. Demographic factors were not found to be linked to the parental impressions.

The Process of Developing an Internet-Based Support System for Audiologists and First-Time Hearing Aid Clients

BACKGROUND

In audiologic practice, complementary information sources and access to the clinician between appointments improve information retention and facilitate adjustment behaviors. An Internet-based support system is a novel way to support information sharing and clinician access.

PURPOSE

This research forum article describes the process of developing an Internet-based support system for audiologists and their first-time hearing aid clients.

METHOD

The iterative development process, including revisions by 4 research audiologists and 4 clinical audiologists, is described. The final system is exemplified.

CONCLUSION

An Internet-based support system was successfully developed for audiologic practice.

On the interaction of speakers' voice quality, ambient noise and task complexity with children's listening comprehension and cognition

Suboptimal listening conditions interfere with listeners’ on-line comprehension. A degraded source signal, noise that interferes with sound transmission, and/or listeners’ cognitive or linguistic limitations are examples of adverse listening conditions. Few studies have explored the interaction of these factors in pediatric populations. Yet, they represent an increasing challenge in educational settings. We will in the following report on our research and address the effect of adverse listening conditions pertaining to speakers’ voices, background noise, and children’s cognitive capacity on listening comprehension. Results from our studies clearly indicate that children risk underachieving both in formal assessments and in noisy class-rooms when an examiner or teacher speaks with a hoarse (dysphonic) voice. This seems particularly true when task complexity is low or when a child is approaching her/his limits of mastering a comprehension task.

Audio spectrum analysis of umbilical artery Doppler ultrasound signals applied to a clinical material

Analysis of umbilical artery flow velocity waveforms characterized by pulsatility index (PI) is used to evaluate fetoplacental circulation in high-risk pregnancies. However, an experienced sonographer may be able to further differentiate between various timbres of Doppler audio signals. Recently, we have developed a method for objective audio signal characterization; the method has been tested in an animal model. In the present pilot study, the method was for the first time applied to human pregnancies. Doppler umbilical artery velocimetry was performed in 13 preterm fetuses before and after two doses of 12 mg betamethasone. The auditory measure defined by the frequency band where the spectral energy had dropped 15 dB from its maximum level (MAXpeak-15 dB ), increased two days after betamethasone administration (p = 0.001) parallel with a less pronounced decrease in PI (p = 0.04). The new auditory parameter MAXpeak-15 dB reflected the changes more sensitively than the PI did.

Does the acceptable noise level (ANL) predict hearing-aid use?

OBJECTIVE

It has been suggested that individuals have an inherent acceptance of noise in the presence of speech, and that different acceptance of noise results in different hearing-aid (HA) use. The acceptable noise level (ANL) has been proposed for measurement of this property. It has been claimed that the ANL magnitude can predict hearing-aid use patterns. Many papers have been published reporting on different aspects of ANL, but none have challenged the predictive power of ANL. The purpose of this study was to discuss whether ANL can predict HA use and how more reliable ANL results can be obtained.

DESIGN

Relevant literature regarding the ANL was found on Medline, Embase, and Google Scholar. Additional information was found as references in the included papers and through personal contacts, for instance when attending audiology conferences.

STUDY SAMPLE

Forty-five papers published in peer reviewed journals as well as a number of papers from trade journals, posters and oral presentations from audiology conventions.

CONCLUSIONS

An inherent acceptance of noise in the presence of speech may exist, but no method for precise measurement of ANL is available. The ANL model for prediction of HA use has yet to be proven valid.

The acceptable noise level: the effect of repeated measurements

OBJECTIVE

This study explores if increasing number of repetitions might improve the precision of the acceptable noise level (ANL) test.

DESIGN

We measured twelve ANL repetitions, i.e. four complete ANL tests (4 × 3 repetitions), at one session using diotic presentation and a non-semantic ANL version.

STUDY SAMPLE

Thirty-two normal-hearing adults.

RESULTS

Small order and fatigue effects were seen. We used the coefficient of repeatability (CR) to assess the repeatability; CRs ranged between 3.9 and 7.6 dB for the four ANL tests. Using the twelve ANL repetitions we removed the variability of the ANL across subjects by normalizing the data to the individual mean ANL for the twelve repetitions. The mean normalized ANL across the subjects rapidly approached the ANL normalized to the individual mean for the 12 repetitions (0 dB), and after three repetitions the SD seemed to be stable at about 3 dB.

CONCLUSIONS

The findings suggest that both order and fatigue affect the ANL. The findings also suggest that it may be more accurate to speak of an acceptable noise range than ANL. These findings have large implications for how we understand acceptable noise and it would explain a large part of the variability seen among normal-hearing and perhaps hearing-impaired subjects.

Frequency discrimination in ears with and without contralateral cochlear dead regions

OBJECTIVE

The purpose of this study was to test the ability to discriminate low-frequency pure-tone stimuli for ears with and without contralateral dead regions, in subjects with bilateral high-frequency hearing loss; we examined associations between hearing loss characteristics and frequency discrimination of low-frequency stimuli in subjects with high-frequency hearing loss.

DESIGN

Cochlear dead regions were diagnosed using the TEN-HL test. A frequency discrimination test utilizing an adaptive three-alternative forced choice method provided difference limens for reference frequencies 0.25 kHz and 0.5 kHz.

STUDY SAMPLE

Among 105 subjects with bilateral high-frequency hearing loss, unilateral dead regions were found in 15 subjects. These, and an additional 15 matched control subjects without dead regions, were included in the study.

RESULTS

Ears with dead regions performed best at the frequency discrimination test. Ears with a contralateral dead region performed significantly better than ears without a contralateral dead region at 0.5 kHz, the reference frequency closest to the mean audiogram cut-off, while the opposite result was obtained at 0.25 kHz.

CONCLUSIONS

Results may be seen as sign of a contralateral effect of unilateral dead regions on the discrimination of stimuli with frequencies well below the audiogram cut-off in adult subjects with bilateral high-frequency hearing loss.

Operator auditory perception and spectral quantification of umbilical artery Doppler ultrasound signals

OBJECTIVE

An experienced sonographer can by listening to the Doppler audio signals perceive various timbres that distinguish different types of umbilical artery flow despite an unchanged pulsatility index (PI). Our aim was to develop an objective measure of the Doppler audio signals recorded from fetoplacental circulation in a sheep model.

METHODS

Various degrees of pathological flow velocity waveforms in the umbilical artery, similar to those in human complicated pregnancies, were induced by microsphere embolization of the placental bed (embolization model, 7 lamb fetuses, 370 Doppler recordings) or by fetal hemodilution (anemia model, 4 lamb fetuses, 184 recordings). A subjective 11-step operator auditory scale (OAS) was related to conventional Doppler parameters, PI and time average mean velocity (TAM), and to sound frequency analysis of Doppler signals (sound frequency with the maximum energy content [MAXpeak] and frequency band at maximum level minus 15 dB [MAXpeak-15 dB] over several heart cycles).

RESULTS

WE FOUND A NEGATIVE CORRELATION BETWEEN THE OAS AND PI: median Rho -0.73 (range -0.35- -0.94) and -0.68 (range -0.57- -0.78) in the two lamb models, respectively. There was a positive correlation between OAS and TAM in both models: median Rho 0.80 (range 0.58-0.95) and 0.90 (range 0.78-0.95), respectively. A strong correlation was found between TAM and the results of sound spectrum analysis; in the embolization model the median r was 0.91 (range 0.88-0.97) for MAXpeak and 0.91 (range 0.82-0.98) for MAXpeak-15 dB. In the anemia model, the corresponding values were 0.92 (range 0.78-0.96) and 0.96 (range 0.89-0.98), respectively.

CONCLUSION

Audio-spectrum analysis reflects the subjective perception of Doppler sound signals in the umbilical artery and has a strong correlation to TAM-velocity. This information might be of importance for clinical management of complicated pregnancies as an addition to conventional Doppler parameters.

Psychosocial work environment among Swedish audiologists

OBJECTIVE

The study examined the self-reported psychosocial work environment for audiologists working in three practice types (public, completely private, and private but publicly funded).

DESIGN

A cross-sectional e-mail survey using the demand-control-support questionnaire, a short version of the effort-reward imbalance (ERI) questionnaire, and descriptive data.

STUDY SAMPLE

Five-hundred Swedish licensed audiologists.

RESULTS

Overall, the results indicate differences in psychosocial work environment pertaining to the practice types. These differences are small and the type explains few percent of the variability accounted in the measures of psychosocial work environment. Social support seems important for the psychosocial work environment and is considered a reward in itself. Using the demand-control model, 29% of the audiologists reported working in a high-stress psychosocial work environment. Using the ERI-ratio to estimate the imbalance between effort and reward it was shown that that 86% of the participants experienced an unfavorable work situation where the rewards do not correspond to the efforts made.

CONCLUSIONS

The organizational framework has minor effect on self-reported psychosocial work environment for Swedish licensed audiologists. The percentage of unfavorable ERI-ratios seen in Swedish audiologists seems conspicuously high compared to other working populations in general, but also compared to other health service workers.

Acceptable noise level (ANL) with Danish and non-semantic speech materials in adult hearing-aid users

OBJECTIVE

The acceptable noise level (ANL) test is used for quantification of the amount of background noise subjects accept when listening to speech. This study investigates Danish hearing-aid users' ANL performance using Danish and non-semantic speech signals, the repeatability of ANL, and the association between ANL and outcome of the international outcome inventory for hearing aids (IOI-HA).

DESIGN

ANL was measured in three conditions in both ears at two test sessions. Subjects completed the IOI-HA and the ANL questionnaire.

STUDY SAMPLE

Sixty-three Danish hearing-aid users; fifty-seven subjects were full time users and 6 were part time/non users of hearing aids according to the ANL questionnaire.

RESULTS

ANLs were similar to results with American English speech material. The coefficient of repeatability (CR) was 6.5-8.8 dB. IOI-HA scores were not associated to ANL.

CONCLUSIONS

Danish and non-semantic ANL versions yield results similar to the American English version. The magnitude of the CR indicates that ANL with Danish and non-semantic speech materials is not suitable for prediction of individual patterns of future hearing-aid use or evaluation of individual benefit from hearing-aid features. The ANL with Danish and non-semantic speech materials is not related to IOI-HA outcome.