Psychometric evaluation of hearing specific self-report measures and their associations with psychosocial and demographic variables

Factors in the Effective Use of Hearing Aids among Subjects with Age-Related Hearing Loss: A Systematic Review

Objectives: Investigate factors contributing to the effective management of age-related hearing loss (ARHL) rehabilitation. Methods: A systematic review was conducted following PRISMA guidelines. The protocol was registered in PROSPERO (CRD42022374811). Articles were identified through systematic searches in the Scopus, PubMed, Web of Science, and Cochrane databases in May 2024. Only articles published between January 2005 and May 2024 were included. Studies were assessed for eligibility by two independent researchers and evaluated using the Crowe Critical Appraisal Tool v1.4 (CCAT). Results: Of the 278 articles identified, 54 were included. Three factors explain effective HA use. First, hearing aid signal processing, with directional microphones and noise reduction, improves user comfort and understanding regarding noise. Second, there is hearing aid fitting, with the NAL prescription rules as the gold standard, and bilateral, high-level HA performance for spatial localization and noise comprehension. Third, there is a patient-centered approach, using patient-related outcome measures (PROMs), questionnaires, counseling, and regular follow-up to involve patients in their therapeutic rehabilitation. Conclusions: Reaching a consensus on acoustic parameters is challenging due to variability in audiological results. Involving patients in their rehabilitation, addressing their needs and expectations, and offering individualized care are crucial.

Psychometric properties of the Swedish version of the international outcome inventory - alternative interventions (IOI-AI) - ear surgery (IOI-AIop)

OBJECTIVE

The aims of this study were to adapt the Swedish version of the International Outcome Inventory for Hearing Aids (IOI-HA) to the International Outcome Inventory for Alternative Interventions (IOI-AI) in the context of ear surgery (IOI-AIop) and to test the psychometric properties.

DESIGN

The validated Swedish questionnaire IOI-HA was adapted to the IOI-AIop by omitting the question about hearing aid use and changing the term "hearing aid" to "surgery" in the remaining items. The validity, component structure and reliability of the IOI-AIop were assessed.

STUDY SAMPLE

Subjects diagnosed with otosclerosis and undergoing stapedotomy were included in the study (n = 162).

RESULTS

High mean scores were noted for all items. Ceiling effects were noted, most pronounced for the satisfaction item. Principal component analysis (PCA) yielded a two-component structure explaining 77.5% of the variance. The test-retest reliability measured by intra class correlation coefficient was >0.9, and the internal consistency coefficient measured by Cronbach's alfa was >0.8.

CONCLUSION

The IOI-AIop showed good psychometric properties. However, ceiling effects were observed. The two-component solution was in line with previous factor analyses of the IOI-HA and the IOI-AI. The comprehensive IOI-AIop is recommended as a useful tool to evaluate patient perspectives after ear surgery.

Validity of the Italian adaptation of the Hearing Handicap Inventory for the Elderly (HHIE-It)

Objective

The aim of this study was to assess the validity and reliability of the Italian translation of the Hearing Handicap Inventory for the Elderly (HHIE).

Methods

A sample of 275 adults, aged > 65 years, filled out the Italian version of the HHIE (HHIE-It) together with the MOS 36-Item Short Form Health Survey (SF-36). Seventy-one participants answered the questionnaire a second time after six weeks. The internal consistency, test-retest reliability, construct and criterion validity were evaluated.

Results

Cronbach's alpha was 0.94 and suggested a high internal consistency. There was also a significant intraclass correlation coefficient (ICC) between test and retest scores. In addition, Pearson's correlation coefficient between the two scores was high and significant. High and significant correlation coefficients were also found between the HHIE-It score and the pure tone average threshold of the better ear and between the HHIE-It and the subscales Role-emotional, Social Functioning and Vitality of the SF-36. These latter results indicate good construct and criterion validity, respectively.

Conclusions

The HHIE-It maintained the reliability and validity of the English version suggesting its utility for both clinical and research purposes.

A randomised, controlled trial of clinically implementing online hearing support

Objective: The research-oriented objective of this study was to document the effectiveness of online support for hearing aid (HA) users compared with traditional support.Design: This study is a randomised controlled trial with parallel group design. The research-oriented objectives were evaluated using the Hearing Handicap Inventory for the Elderly (HHIE) and the Communication Strategies Scale (CSS) at baseline and immediately postintervention.Study sample: Selected clients at five different clinics were randomised to an intervention group (n = 78) that took part in online hearing support and a control group (n = 58) that received standard care.Results: The analyses (intention-to-treat) showed statistically significant improvements in the HHIE-total and Emotional subscale scores for the intervention group compared with the control group. The intervention group also showed significantly greater improvement in the CSS-total and Verbal and Nonverbal subscale scores. A subgroup analysis was performed including two groups: HA use <1 year and HA use >1 year. A statistically significant improvement was found for the HA users >1 year compared with HA use <1 year.Conclusions: It is effective to clinically include online hearing support for HA users when addressing self-perceived hearing difficulties and to sharpen communication strategy skills.

Does Illness Behavior Contribute to the Understanding of Self-Efficacy and Quality of Life Among People With Hearing Loss? A Test of Concept

PURPOSE

The study sought to first confirm the mediating role of self-efficacy (SE) in the link between hearing loss and reduced quality of life (QOL) and introduce the construct of illness behavior (IB) as a further correlate of self-reported QOL that may itself be mediated by SE.

METHOD

Cross-sectional data were attained using a questionnaire that was completed by 61 adults with self-reported acquired hearing loss.

RESULTS

Support was provided for low SE being a barrier to QOL, with hearing loss only predictive of emotional QOL when SE was an intermediary (mediating) variable. Cognitive and affective indices of IB also predicted QOL. Those participants with elevated emotional distress and, to a lesser extent, exaggerated concerns for their health, were found to have both lower SE and poorer QOL.

CONCLUSIONS

Attempts to replicate these findings longitudinally and with larger and more diverse samples (e.g., congenital or illness-derived hearing loss) are encouraged. A more objective assessment of hearing loss may also reduce the potential for spurious associations that may arise from the use of self-reported data. Nevertheless, the analytical results provide encouragement for the continued consideration of IB in the evaluation of the well-being of individuals with hearing loss. It is proposed that IB could be a useful supplement to the study of motivation among this cohort, such as an addition to the commonly used Health Belief Model, to improve the predictive validity of appropriate health behaviors.

Clinical Application and Psychometric Properties of a Swedish Translation of the Abbreviated Profile of Hearing Aid Benefit

BACKGROUND

The impact of hearing loss on the individual and his/her everyday life can be assessed using questionnaires with the purpose to improve rehabilitation quality. The Abbreviated Profile of Hearing Aid Benefit (APHAB) can be used to evaluate disability in everyday life associated with hearing loss. Previous studies have examined APHAB outcomes in sensorineural hearing loss and we do not know whether the type of hearing loss influence questionnaire outcomes.

PURPOSE

The purpose was to evaluate the psychometric properties of a Swedish translation of the APHAB and the influence of demographic variables on the outcome in a clinical sample.

RESEARCH DESIGN

A descriptive, cross-sectional study in a clinical sample.

STUDY SAMPLE

Forty-eight participants with no hearing aid experience seeking audiological rehabilitation for the first time. These participants represented different degrees of hearing loss and three types of hearing loss: monaural mixed, binaural mixed, and binaural sensorineural hearing loss.

DATA COLLECTION AND ANALYSIS

Pure-tone audiometry was conducted and the participants completed the unaided APHAB during their first appointment at the clinic. Psychometric properties of the questionnaire were examined and the influence of age, gender, type of hearing loss, and degree of hearing loss on APHAB scores were studied.

RESULTS

The psychometric properties indicate high test-retest reliability but there seems to be some potential issues with the properties of the reverberation (RV) subscale. The items from the RV subscale failed to load as a separate component and the internal consistency of the subscale improved by removing four items (items 1, 9, 11, and 16). With few exceptions, APHAB scores were not influenced by age, gender, or type of hearing loss. APHAB scores were generally influenced by degree of hearing loss in both the best and the worst ear.

CONCLUSION

This Swedish version of the APHAB can be additionally improved by addressing the inconsistencies found in the RV subscale by rephrasing or removing some items. The degree of hearing loss has some influence on questionnaire outcomes but not age, gender, and type of hearing loss.

Development of the Communication and Acceptance Scale (CAS) for group aural rehabilitation

OBJECTIVE

The aim of the current study was to develop a reliable instrument for the Active Communication Education (ACE) programme evaluating changes in communication strategies and the emotional consequences, knowledge and acceptance of hearing loss and to examine its reliability and face, content and construct validity.

DESIGN

Semistructured interviews and questionnaires were conducted with participants and clinicians engaged in the ACE intervention.

STUDY SAMPLE

The psychometric properties were evaluated in two phases for two samples of adults with hearing loss who participated in the ACE programme, including 61 and 41 participants, respectively.

RESULTS

The final Communication and Acceptance Scale (CAS) contained 18 items, and the reliability of the overall scale (Cronbach's alpha 0.86) and the test-retest reliability (r = 0.89, p < 0.001) were good. The construct validity, evaluated with principal component analysis, suggested a five-factor solution explaining 72% of the variance. The questionnaire revealed statistically significant short- and long-term effects of the ACE programme. Both participants and clinicians found the questionnaire relevant, useful and easy to administer.

CONCLUSION

The CAS questionnaire was found to be valid and reliable, but because of the low sample size, further analysis with a larger population is needed.

Hearing aid or "band aid"? Evaluating large scale hearing aid donation programmes in the Philippines

Objective: This study aimed to evaluate the effectiveness of two large scale hearing aid donation programmes in the Philippines.Design: Real ear measurements were made on all hearing aids, for comparison to NAL-RP prescription targets. Performance measures and the International Outcomes Inventory for Hearing Aids (IOI-HA) data was collected from a subsample of participants.Study sample: A total of 101 and 153 low socioeconomic status participants were sampled just after, or 6 months after receiving their hearing devices in each of the programmes evaluated, respectively.Results: Of the 189 hearing aids sampled at fitting, and the 195 hearing aids sampled at 6 months post fitting, less than 2% were within ±5dB of prescription target. At 6 months post fitting IOI-HA outcomes were essentially comparable to those described in the literature but were not a good predictor of fit to prescriptive target.Conclusions: Objective measures of hearing aid outcome were poor and showed no relationship to subjective outcome measures. Although able to fit large numbers in short time frames, to avoid a band aid solution, changes to such programmes should be made including: a focus on those with aidable hearing losses, increased opportunity for follow up care, and improved device quality.

International Outcome Inventory for Hearing Aids: Data From a Large Swedish Quality Register Database

PURPOSE

The purpose of this study was to analyze a database of completed International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires obtained from over 100,000 clients fitted with new hearing aids in Sweden during the period of 2012-2016. Mean IOI-HA total scores were correlated with degree of hearing loss, unilateral versus bilateral fitting, first-time versus return clients, gender, and variation among dispensing clinics. The correlations with expectations, service quality, and technical functioning of the hearing aids were also analyzed.

METHOD

Questionnaires containing the 7 IOI-HA items as well as questions concerning some additional issues were mailed to clients 3-6 months after fitting of new hearing aids. The questionnaires were returned to and analyzed by an independent research institute.

RESULTS

More than 100 dispensing clinics nationwide take part in this project. A response rate of 52.6% resulted in 106,631 data sets after excluding incomplete questionnaires. Forty-six percent of the responders were women, and 54% were men. The largest difference in mean score (0.66) was found for the IOI-HA item "use" between return clients and first-time users. Women reported significantly higher (better) scores for the item "impact on others" compared with men. The bilaterally fitted subgroup reported significantly higher scores for all 7 items compared with the unilaterally fitted subgroup. Experienced users produced higher scores on benefit and satisfaction items, whereas first-time users gave higher scores for residual problems. No correlation was found between mean IOI-HA total score and average hearing threshold level (pure-tone average [PTA]). Mean IOI-HA total scores were found to correlate significantly with perceived service quality of the dispensing center and with the technical functionality of the hearing aids.

CONCLUSIONS

When comparing mean IOI-HA total scores from different studies or between groups, differences with regard to hearing aid experience, gender, and unilateral versus bilateral fitting have to be considered. No correlation was found between mean IOI-HA total score and degree of hearing loss in terms of PTA. Thus, PTA is not a reliable predictor of benefit and satisfaction of hearing aid provision as represented by the IOI-HA items. Identification of a specific lower fence in PTA for hearing aid candidacy is therefore to be avoided. Large differences were found in mean IOI-HA total scores related to different dispensing centers.

A multicentre study evaluating the effects of the Swedish ACE programme

OBJECTIVE

This study investigated the effects of a modified Swedish version of an interactive group education programme, the Active Communication Education (ACE) programme, in five Swedish regions. This study also explored whether the pre- and post-programme outcomes differed with regard to region, age, gender, hearing loss (HL) or the attendance of significant others (SOs).

DESIGN

An intervention study with between- and within-group measurements was applied.

STUDY SAMPLE

Seventy-seven individuals with hearing impairments and a mean age of 73.9 years (SD = 9.8) from five different regions in Sweden participated in this study.

RESULTS

Statistically significant short- and long-term effects on communication strategy use, activity and participation were observed. The ACE programme was most effective for older individuals, women and participants with more severe HL. Individuals who attended with an SO tended to use better communication strategies. No regional differences were observed. The qualitative results indicated that the programme increased individuals' ability to cope and restored their social identities.

CONCLUSIONS

The ACE programme is effective, is recommended for implementation in clinical settings and is considered an alternative or additional treatment to hearing aid rehabilitation. Additional studies that include younger individuals and a control group are recommended.

Validation of the Swedish Hearing Handicap Inventory for the Elderly (Screening Version) and Evaluation of Its Effect in Hearing Aid Rehabilitation

Self-reports of subjective hearing difficulties by people with hearing loss may be a useful complement to audiometry in hearing aid rehabilitation. To be useful, such self-reports need to be reliable. This study investigated the reliability and the validity of the Swedish Hearing Handicap Inventory for the Elderly (Screening Version; HHIE-S). Sixty-nine participants completed a questionnaire before hearing aid rehabilitation. Of these individuals, 49 completed hearing aid rehabilitation (aged between 23 and 94 years), and 41 of these 49 participants completed the questionnaire after completing the rehabilitation. The Swedish HHIE-S exhibited good internal consistency (Cronbach's alpha coefficient of .77). The questionnaire was effective for evaluating hearing aid rehabilitation, and a statistically significant reduction in hearing difficulties was observed. The clinicians found the questionnaire easy to administer and effective in hearing aid rehabilitation. The findings from the study support the use of the HHIE-S in clinical practice.

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.

Decision-making and outcomes of hearing help-seekers: A self-determination theory perspective

OBJECTIVE

To explore the explanatory power of a self-determination theory (SDT) model of health behaviour change for hearing aid adoption decisions and fitting outcomes.

DESIGN

A quantitative approach was taken for this longitudinal cohort study. Participants completed questionnaires adapted from SDT that measured autonomous motivation, autonomy support, and perceived competence for hearing aids. Hearing aid fitting outcomes were obtained with the international outcomes inventory for hearing aids (IOI-HA). Sociodemographic and audiometric information was collected.

STUDY SAMPLE

Participants were 216 adult first-time hearing help-seekers (125 hearing aid adopters, 91 non-adopters).

RESULTS

Regression models assessed the impact of autonomous motivation and autonomy support on hearing aid adoption and hearing aid fitting outcomes. Sociodemographic and audiometric factors were also taken into account. Autonomous motivation, but not autonomy support, was associated with increased hearing aid adoption. Autonomy support was associated with increased perceived competence for hearing aids, reduced activity limitation and increased hearing aid satisfaction. Autonomous motivation was positively associated with hearing aid satisfaction.

CONCLUSION

The SDT model is potentially useful in understanding how hearing aid adoption decisions are made, and how hearing health behaviour is internalized and maintained over time. Autonomy supportive practitioners may improve outcomes by helping hearing aid adopters maintain internalized change.

Self-reported hearing loss and manual audiometry: A rural versus urban comparison

OBJECTIVE

To examine whether self-reported hearing difficulty is an accurate measure of hearing loss compared with standard hearing screening with pure tone audiometry in rural and urban communities.

DESIGN

Convenience sampling.

SETTING

Urban and rural areas of Western Australia.

PARTICIPANTS

A total of 2090 participants (923 men; 1165 women; 2 unknown) aged 20-100 years presenting for community-based hearing screening in urban (982) and rural (1090) areas.

INTERVENTIONS

Self-reported hearing difficulty assessed with the Hearing Handicap Inventory for the Elderly - Screening questionnaire. Hearing loss defined as average hearing thresholds >25 dB in the better ear using screening audiometry conducted at 500, 1000, 2000 and 4000 Hz.

MAIN OUTCOME MEASURES

Nil.

RESULTS

The Hearing Handicap Inventory for the Elderly - Screening was sensitive (≥60 years = 76.69%; <60 years = 71.67%) but not specific (≥60 years = 45.15%; <60 years = 49.63%) for identifying hearing loss. The <60 age group had a hearing loss prevalence of 25.6%, and a false-positive rate of 67.12% compared with a prevalence of 69.12% and false-positive rate of 29.77% for the ≥60 age group. For all ages, rural participants were more likely to have a disabling hearing loss (odds ratio 2.04 (95% confidence interval, 1.55-2.67); χ(2)(1) = 27.28; P < 0.001), but there were no significant differences in hearing aid uptake.

CONCLUSIONS

Patients in rural areas presenting for hearing screenings are more likely to suffer hearing loss than adults in urban areas. We suggest rural health practitioners incorporate a self-reported hearing loss questionnaire into health check-ups for adults, particularly patients aged ≥60 years due to the high prevalence of hearing loss in this group.

Measuring cognitive anxiety through the consultation process for hearing aids: Older adults and their significant others

The purpose of this study was to assess the level of cognitive anxiety experienced by first-time hearing aid adopters and their significant others before, during, and after hearing aid fitting. A total of 16 couples were interviewed at three points: (1) at the initial consultation for hearing aids, (2) during the hearing aid trial, and (3) 1 month following the final clinical appointment in which the hearing aids were formally adopted. Cognitive anxiety was assessed through a content analysis of the interviews using the Cognitive Anxiety Scale. Results of this study show that the levels of cognitive anxiety generally decreased across the entire consultation process for both adults with hearing impairment and their significant others. The results also indicated that couples generally experienced similar levels of cognitive anxiety at initial consultation, but their levels of cognitive anxiety differed throughout the remainder of the study. These findings highlight the importance of inclusion of significant others in the rehabilitation process.

LEARNING OUTCOMES

The reader will be able to: (1) discuss the relationship between cognitive anxiety and hearing impairment, (2) define cognitive anxiety, (3) discuss the impact of hearing impairment on significant others, (4) describe the experience of cognitive anxiety through the hearing aid consultation process.

Self-reported outcomes after hearing aid fitting in Minas Gerais, Brazil

PURPOSE: To analyze the self-reported outcomes after hearing aid fitting among individuals in the northern region of Minas Gerais and associated factors. METHODS: A cross-sectional and analytical study with a random sample of adults and elderly attending the public health care service was conducted in the northern region of Minas Gerais (86 municipalities), Brazil. Study's participants answered International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires. Data were analyzed descriptively and analytically with Poisson regression analysis. RESULTS: We interviewed 272 adults and 112 individuals reported not using their hearing aids regularly. The mean of IOI-HA global score was lower than expected. The individual's relationship with their hearing aid (Factor 1) was worse than the individual's relationship with their environment (Factor 2). Lower global scores were statistically associated with no work. CONCLUSIONS: The observed scores for the study's population are lower than those recorded in other studies. The results suggest that there are limitations in the fitting and follow-up of individuals who received hearing aids.

Relationships between self-report and cognitive measures of hearing aid outcome

This present study examined the relationship between cognitive measures and self-report hearing aid outcome. A sentence-final word identification and recall (SWIR) test was used to investigate how hearing aid use may relate to experienced explicit cognitive processing. A visually based cognitive test battery was also administered. To measure self-report hearing aid outcome, the International Outcome Inventory – Hearing Aids (IOI-HA) and the Speech, Spatial and Qualities of Hearing Scale (SSQ) were employed. Twenty-six experienced hearing aid users (mean age of 59 years) with symmetrical moderate-to-moderately severe sensorineural hearing loss were recruited. Free recall performance in the SWIR test correlated negatively with item 3 of IOI-HA, which measures residual difficulty in adverse listening situations. Cognitive abilities related to verbal information processing were correlated positively with self-reported hearing aid use and overall success. The present study showed that reported residual difficulty with hearing aid may relate to experienced explicit processing in difficult listening conditions, such that individuals with better cognitive capacity tended to report more remaining difficulty in challenging listening situations. The possibility of using cognitive measures to predict hearing aid outcome in real life should be explored in future research.

Hearing-aid use and benefit: a long-term follow-up in patients undergoing surgery for otosclerosis

OBJECTIVES

The aims of the study were to assess hearing-aid uptake in patients with otosclerosis 28-30 years after stapedectomy and to evaluate hearing-aid benefit to users.

DESIGN

A retrospective study was performed; it included a review of medical records and follow-up 28-30 years after surgery, including audiometry, clinical examination, structured interview, and a validated questionnaire, IOI-HA.

STUDY SAMPLE

Sixty-five patients, who had undergone stapedectomy at a tertiary referral center in 1977-79.

RESULTS

In 95% of the subjects there was a theoretical need for hearing-aid amplification at follow-up; 46% of the subjects had no hearing aids, while 26% had unilateral and 28% bilateral hearing aids. Hearing sensitivity in the best ear predicted hearing-aid uptake. Of the subjects with a hearing aid, 94% were everyday users and 54% were full-time users (> 8 hours/day). The subjects reported a high level of satisfaction (mean 4.5) and benefit (mean 4.2), but also residual activity limitations (mean 3.1).

CONCLUSIONS

The study shows that there is an unmet need for long-term hearing rehabilitation among patients previously undergoing surgery for otosclerosis. The patients who were using hearing aids were generally very satisfied with their hearing aids, but they still reported residual activity limitations.

The use of research questionnaires with hearing impaired adults: online vs. paper-and-pencil administration

Background

When evaluating hearing rehabilitation, it is reasonable to use self-report questionnaires as outcome measure. Questionnaires used in audiological research are developed and validated for the paper-and-pencil format. As computer and Internet use is increasing, standardized questionnaires used in the audiological context should be evaluated to determine the viability of the online administration format.

The aim of this study was to compare administration of questionnaires online versus paper- and pencil of four standardised questionnaires used in hearing research and clinic. We included the Hearing Handicap Inventory for the Elderly (HHIE), the International Outcome Inventory for Hearing Aids (IOI-HA), Satisfaction with Amplification in Daily Life (SADL), and the Hospital Anxiety and Depression Scale (HADS).

Methods

A cross-over design was used by randomly letting the participants complete the questionnaires either online or on paper. After 3 weeks the participants filled out the same questionnaires again but in the other format. A total of 65 hearing-aid users were recruited from a hearing clinic to participate on a voluntary basis and of these 53 completed both versions of the questionnaires.

Results

A significant main effect of format was found on the HHIE (p < 0.001), with participants reporting higher scores on the online format than in the paper format. There was no interaction effect. For the other questionnaires were no significant main or interaction effects of format. Significant correlations between the two ways of presenting the measures was found for all questionnaires (p<0.05). The results from reliability tests showed Cronbachs α’s above .70 for all four questionnaires and differences in Cronbachs α between administration formats were negligible.

Conclusions

For three of the four included questionnaires the participants’ scores remained consistent across administrations and formats. For the fourth included questionnaire (HHIE) a significant difference of format with a small effect size was found. The relevance of the difference in scores between the formats depends on which context the questionnaire is used in. On balance, it is recommended that the administration format remain stable across assessment points.

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.