The clinical use of Arthur Boothroyd (AB) word lists in Australia: exploring evidence-based practice

Accuracy and Consistency of Confidence Limits for Monosyllable Identification Scores Derived Using Simulation, the Harrell-Davis Estimator, and Nonlinear Quantile Regression

BACKGROUND

Audiological diagnosis and rehabilitation often involve the assessment of whether the maximum speech identification score (PBmax) is poorer than expected from the pure-tone average (PTA) threshold. This requires the estimation of the lower boundary of the PBmax values expected for a given PTA (one-tailed 95% confidence limit, CL). This study compares the accuracy and consistency of three methods for estimating the 95% CL.

METHOD

The 95% CL values were estimated using a simulation method, the Harrell-Davis (HD) estimator, and non-linear quantile regression (nQR); the latter two are both distribution-free methods. The first two methods require the formation of sub-groups with different PTAs. Accuracy and consistency in the estimation of the 95% CL were assessed by applying each method to many random samples of 50% of the available data and using the fitted parameters to predict the data for the remaining 50%.

STUDY SAMPLE

A total of 642 participants aged 17 to 84 years with sensorineural hearing loss were recruited from audiology clinics. Pure-tone audiograms were obtained and PBmax scores were measured using monosyllables at 40 dB above the speech recognition threshold or at the most comfortable level.

RESULTS

For the simulation method, 6.7 to 8.2% of the PBmax values fell below the 95% CL for both ears, exceeding the target value of 5%. For the HD and nQR methods, the PBmax values fell below the estimated 95% CL for approximately 5% of the ears, indicating good accuracy. Consistency, estimated from the standard deviation of the deviations from the target value of 5%, was similar for all the methods.

CONCLUSIONS

The nQR method is recommended because it has good accuracy and consistency, and it does not require the formation of arbitrary PTA sub-groups.

Factors Affecting the Use of Speech Testing in Adult Audiology

OBJECTIVE

The aim of this study was to evaluate hearing health care professionals' (HHPs) speech testing practices in routine adult audiology services and better understand the facilitators and barriers to speech testing provision.

DESIGN

A cross-sectional questionnaire study was conducted.

STUDY SAMPLE

A sample (N = 306) of HHPs from the public (64%) and private (36%) sectors in the United Kingdom completed the survey.

RESULTS

In the United Kingdom, speech testing practice varied significantly between health sectors. Speech testing was carried out during the audiology assessment by 73.4% of private sector HHPs and 20.4% of those from the public sector. During the hearing aid intervention stage, speech testing was carried out by 56.5% and 26.5% of HHPs from the private and public sectors, respectively. Recognized benefits of speech testing included (a) providing patients with relatable assessment information, (b) guiding hearing aid fitting, and (c) supporting a diagnostic test battery. A lack of clinical time was a key barrier to uptake.

CONCLUSIONS

Use of speech testing varies in adult audiology. Results from this study found that the percentage of U.K. HHPs making use of speech tests was low compared to that of other countries. HHPs recognized different benefits of speech testing in audiology practice, but the barriers limiting uptake were often driven by factors derived from decision makers rather than clinical rationale. Privately funded HHPs used speech tests more frequently than those working in the public sector where time and resources are under greater pressure and governed by guidance that does not include a recommendation for speech testing. Therefore, the inclusion of speech testing in national clinical guidelines could increase the consistency of use and facilitate the comparison of practice trends across centers.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044457.

Clinical validation of the Russian Matrix test - effect of hearing loss, age, and noise level

OBJECTIVE

To validate the Russian matrix sentence test (RUMatrix) for the assessment of speech recognition in quiet and in noise in clinical praxis. The effect of hearing impairment, age, and masking-noise level on speech recognition was examined.

DESIGN

All participants underwent pure tone audiometry, a monosyllabic speech test in quiet, and speech recognition measurements with RUMatrix in quiet (SRT_Q) and in noise (SRT_N).

STUDY SAMPLE

One hundred and forty-two listeners divided into four groups: 1. Young normal-hearing listeners, 2. Older normal-hearing listeners, 3. Young hearing-impaired listeners, and 4. Older hearing-impaired listeners.

RESULTS

Significant differences between groups of listeners were found in the SRT_Q and SRT_N. A strong correlation between hearing threshold and SRT_Q (R²=0.88, p < 0.001) indicates a strong link between speech recognition in quiet and audibility. The pure-tone average explained less variance in SRT_N (R²=0.67, p < 0.001), pointing out an additional influence of suprathreshold distortion. A high test sensitivity of 0.99 was found for SRT_N and SRT_Q. The monosyllabic test had a low sensitivity (0.21), indicating that the test is not suitable for separating normal-hearing and hearing-impaired listeners.

CONCLUSIONS

RuMatrix is a reliable speech recognition assessment tool with a high sensitivity and validity for the main aspects of hearing impairment.

Does person-centred care improve outcomes for musicians fitted with hearing protectors?

Objective: To reduce the risk of hearing injury, musicians are often recommended custom-made musicians' hearing protectors (MHP). Studies report benefits of use however, many still report challenges leading to relatively low uptake and inconsistent usage. Person-centred approaches to health have been shown to improve patient outcomes, and these principles may be translatable to musicians' hearing care. The aim was to investigate if use of, and satisfaction with, MHP is influenced by the treatment delivered to musicians by audiologists.Design: Participants were randomly allocated to one of four conditions that varied in extent of person-centred care.Study sample: Forty-two musicians with an interest in purchasing MHP were recruited.Results: Satisfaction with MHP was high overall and users reported a reduction in incidence of tinnitus. Participants reported few issues related to sound quality, however insertion difficulty was the main problem reported. Only one musician self-identified the need for alterations to their MHP.Conclusions: Adoption of person-centred approaches to MHP was not found to increase likelihood of use, however, satisfaction was high across all conditions. Most often, the need for MHP alterations were clinician-identified during fitting appointments or follow-up contact, underscoring the importance of including these components when providing audiological services to musicians.