Hearing Handicap Ratings Among Different Profiles of Adult Cochlear Implant Users

To tell or not to tell? Exploring the social process of stigma for adults with hearing loss and their families: introduction to the special issue

OBJECTIVE

Stigma has long been implicated as a reason why adults with acquired hearing loss are slow to seek help and for sub-optimal uptake of hearing devices. However, the field has not developed a comprehensive understanding of why stigma occurs, nor has it related this comprehensive knowledge to a theoretical framework.

DESIGN

This special issue presents results from a two-phase, multi-method study to systematically investigate how stigma is experienced by adults with hearing loss and their families, how they manage it in everyday life, and how these experiences relate to the decision to wear hearing aids.

STUDY SAMPLE

Phase 1 of the study involved 20 dyads of adults with hearing loss and their family members. Phase 2 involved 331 adults with hearing loss and 313 family members.

RESULTS

Results of the study are presented in each of the subsequent papers that are part of this special issue. Results are mapped onto the Major and O'Brien model of stigma-induced identity threat in each paper.

CONCLUSIONS

This paper provides an introduction to the Special Issue and describes the methods for the overall study that is the focus of the papers within the issue.

Exploring the relationship between planned behavior and self-determination theory on health-seeking behavior among older adults with hearing impairment

This study aimed to examine the relationship between planned behavior and self-determination theory in predicting health-seeking behavior among older adults with hearing impairment. A total of 103 participants aged 60 years and above completed a self-administered questionnaire that measured variables related to health-seeking intention, knowledge competence, relatedness, attitudes, stigma, and perceived competence and autonomy. The results of the study indicated that both the planned behavior and self-determination theory models significantly predicted health-seeking intention and behavior among older adults with hearing impairment. Higher knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy were found to be significant predictors of health-seeking intention and behavior. The findings of this study suggest that interventions aimed at increasing knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy may be effective in promoting hearing health-seeking behavior among older adults with hearing impairment. Future research may further explore the role of these variables in predicting health-seeking behavior and the effectiveness of interventions in promoting hearing health in this population. Clinical practitioners and healthcare professionals may benefit from these findings in designing targeted interventions for this population.

The Psychometric Properties of the Persian Version of the Hearing Handicap Inventory Screening Scale (HHIE-S) among Older Adults

BACKGROUND

There is a great need for a valid hearing loss measurement tool in the Persian language to help identify hearing handicaps and potential communicational difficulties among Persian-speaking older adults. The present study aimed to validate and adapt the original English version of the Hearing Handicap Inventory for the Elderly (HHIE) into the Persian language.

METHODS

A tool development study was designed and data were collected from August to November 2019 in Tabriz, Iran among the older adults aged 60 years and above whose hearing loss had been confirmed by audiometry. The construct validity was assessed using Confirmatory Factor Analysis (CFA). The reliability of the tool was calculated by internal consistency and test-retest reliability. The statistical analysis was performed using SPSS 26.0 (SPSS and STATA 14).

RESULTS

The CFA was conducted to examine the construct validity of the HHIE-S. According to the results, the model fit indices were acceptable (TLI = 0.93, CFI = 0.97, RMSEA = 0.07 (90% CI: 0.04 to 0.10), and SRMR = 0.03). Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.73) indicated good internal consistency.

CONCLUSION

The results showed that HHIE-S is a valid and reliable tool for assessing hearing handicaps among Persian-speaking and Iranian older adults.

Audiometric profiles and patterns of benefit: a data-driven analysis of subjective hearing difficulties and handicaps

OBJECTIVE

Hearing rehabilitation attempts to compensate for auditory dysfunction, reduce hearing difficulties and minimise participation restrictions that can lead to social isolation. However, there is no systematic approach to assess the quality of the intervention at an individual level that might help to evaluate the need of further hearing rehabilitation in the hearing care clinic.

DESIGN

A data-driven analysis on subjective data reflecting hearing disabilities and handicap was chosen to explore "benefit patterns" as a result of rehabilitation in different audiometric groups. The method was based on (1) dimensionality reduction; (2) stratification; (3) archetypal analysis; (4) clustering; (5) item importance estimation.

STUDY SAMPLE

572 hearing-aid users completed questionnaires of hearing difficulties (speech, spatial and qualities hearing scale; SSQ) and hearing handicap (HHQ).

RESULTS

The data-driven approach revealed four benefit profiles that were different for each audiometric group. The groups with low degree of high-frequency hearing loss (HLHF) showed a priority for rehabilitating hearing handicaps, whereas the groups with HLHF > 50 dB HL showed a priority for improvements in speech understanding.

CONCLUSIONS

The patterns of benefit and the stratification approach might guide the clinical intervention strategy and improve the efficacy and quality of service in the hearing care clinic.

The Revised Hearing Handicap Inventory and Screening Tool Based on Psychometric Reevaluation of the Hearing Handicap Inventories for the Elderly and Adults

OBJECTIVES

The present study evaluates the items of the Hearing Handicap Inventory for the Elderly and Hearing Handicap Inventory for Adults (HHIE/A) using Mokken scale analysis (MSA), a type of nonparametric item response theory, and develops updated tools with optimal psychometric properties.

DESIGN

In a longitudinal study of age-related hearing loss, 1447 adults completed the HHIE/A and audiometric testing at baseline. Discriminant validity of the emotional consequences and social/situational effects subscales of the HHIE/A was assessed, and nonparametric item response theory was used to explore dimensionality of the items of the HHIE/A and to refine the scales.

RESULTS

The HHIE/A items form strong unidimensional scales measuring self-perceived hearing handicap, but with a lack of discriminant validity of the two distinct subscales. Two revised scales, the 18-item Revised Hearing Handicap Inventory and the 10-item Revised Hearing Handicap Inventory-Screening, were developed from the common items of the original HHIE/A that met the assumptions of MSA. The items on both of the revised scales can be ordered in terms of increasing difficulty.

CONCLUSIONS

The results of the present study suggest that the newly developed Revised Hearing Handicap Inventory and Revised Hearing Handicap Inventory-Screening are strong unidimensional, clinically informative measures of self-perceived hearing handicap that can be used for adults of all ages. The real-data example also demonstrates that MSA is a valuable alternative to classical psychometric analysis.

Self-assessment of unilateral and bimodal cochlear implant experiences in daily life

Objective

The subjective experiences were assessed of cochlear implant (CI) users either wearing or not wearing a hearing aid (HA) at the contralateral ear.

Design

Unilateral CI-recipients were asked to fill out a set of daily-life questionnaires on bimodal HA use, hearing disability, hearing handicap and general quality of life.

Study sample

Twenty-six CI-recipients who regularly use a contralateral HA (bimodal group) and twenty-two CI-recipients who do not use a HA in the contralateral ear (unilateral group).

Results

Comparisons between both groups (bimodal versus unilateral) showed no difference in self-rated disability, hearing handicap or general quality of life. However within the group of bimodal listeners, participants did report a benefit of bimodal hearing ability in various daily life listening situations.

Conclusions

Bimodal benefit in daily life can consistently be experienced and reported within the group of bimodal users.

Changes in Speech-Related Brain Activity During Adaptation to Electro-Acoustic Hearing

Objectives: Hearing improves significantly with bimodal provision, i.e., a cochlear implant (CI) at one ear and a hearing aid (HA) at the other, but performance shows a high degree of variability resulting in substantial uncertainty about the performance that can be expected by the individual CI user. The objective of this study was to explore how auditory event-related potentials (AERPs) of bimodal listeners in response to spoken words approximate the electrophysiological response of normal hearing (NH) listeners. Study Design: Explorative prospective analysis during the first 6 months of bimodal listening using a within-subject repeated measures design. Setting: Academic tertiary care center. Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear. Age-matched NH listeners served as controls. Intervention: Cochlear implantation. Main Outcome Measures: Obligatory auditory evoked potentials N1 and P2, and the event-related N2 potential in response to monosyllabic words and their reversed sound traces before, as well as 3 and 6 months post-implantation. The task required word/non-word classification. Stimuli were presented within speech-modulated noise. Loudness of word/non-word signals was adjusted individually to achieve the same intelligibility across groups and assessments. Results: Intelligibility improved significantly with bimodal hearing, and the N1-P2 response approximated the morphology seen in NH with enhanced and earlier responses to the words compared to their reversals. For bimodal listeners, a prominent negative deflection was present between 370 and 570 ms post stimulus onset (N2), irrespective of stimulus type. This was absent for NH controls; hence, this response did not approximate the NH response during the study interval. N2 source localization evidenced extended activation of general cognitive areas in frontal and prefrontal brain areas in the CI group. Conclusions: Prolonged and spatially extended processing in bimodal CI users suggests employment of additional auditory-cognitive mechanisms during speech processing. This does not reduce within 6 months of bimodal experience and may be a correlate of the enhanced listening effort described by CI listeners.

Cochlear implantation for single-sided deafness in children and adolescents

OBJECTIVE

To evaluate outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation.

METHODS

A retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage.

RESULTS

Nine pediatric and adolescent patients with SSD were implanted between 2011 and 2017. The median age at implantation was 8.9 years (range, 1.5-15.1) and the children had a median duration of deafness 2.9 years (range, 0.8-9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3-27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5% points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5% points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved.

CONCLUSION

Pediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.

Cochlear Implantation for Single-Sided Deafness: A New Treatment Paradigm

Unilateral severe-to-profound sensorineural hearing loss (SNHL), also known as single sided deafness (SSD), is a problem that affects both children and adults, and can have severe and detrimental effects on multiple aspects of life including music appreciation, speech understanding in noise, speech and language acquisition, performance in the classroom and/or the workplace, and quality of life. Additionally, the loss of binaural hearing in SSD patients affects those processes that rely on two functional ears including sound localization, binaural squelch and summation, and the head shadow effect. Over the last decade, there has been increasing interest in cochlear implantation for SSD to restore binaural hearing. Early data are promising that cochlear implantation for SSD can help to restore binaural functionality, improve quality of life, and may faciliate reversal of neuroplasticity related to auditory deprivation in the pediatric population. Additionally, this new patient population has allowed researchers the opportunity to investigate the age-old question "what does a cochlear implant (CI) sound like?."

Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status

Objectives: Patient-reported outcomes gain importance for the assessment of auditory abilities in cochlear implant users and for the evaluation of auditory rehabilitation. Aims of the study were to explore the interrelation of self-reported improvements in auditory ability with improvements in speech comprehension and to identify factors other than audiological improvement that affect self-reported auditory ability.

Study Design: Explorative prospective analysis using a within-subjects repeated measures design.

Setting: Academic tertiary care center.

Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear (bimodal hearing).

Intervention: Cochlear implantation.

Main Outcome Measures: Self-reported auditory ability/disability assessed by the comparative version of the Speech, Spatial and Qualities of Hearing Scale (SSQ-B), and monosyllable as well as sentence comprehension in quiet and within speech modulated noise from different directions assessed pre- as well as 3 and 6 months post-implantation.

Results: Data of 17 individuals were analyzed. At the endpoint of the study, improvement of self-reported auditory ability was significant. Regarding audiometric measures, significant improvement was seen for CI-aided pure tone thresholds, for monaural CI-assisted and bimodal sentence comprehension in quiet and in speech-modulated noise that was presented from the same source or at the side of the HA-ear. Correlations between self-reported and audiometric improvements remained weak, with the exception of the improvement seen for monaural CI-aided sentence comprehension in quiet and self-perceived improvement of sound quality. Considerable correlations existed between self-reported improvements and current level of depression and anxiety, and with general self-efficaciousness. Regression analyses substantiated a positive influence of self-efficaciousness on self-reported improvement in speech comprehension and between the improvement of monaural CI-aided sentence comprehension in quiet and perceived sound quality as well as a negative influence of anxiety on self-reported improvement in spatial hearing. Self-reported improvements were significantly better in the subgroup with intensive as compared to regular rehabilitation.

Conclusions: Self-reported auditory ability/disability represents an important measure for the success of bimodal CI-provision. It is influenced by personal and mental health factors that may improve CI-rehabilitation results if addressed during rehabilitation.

A hearing self-reported survey in people over 80 years of age in China by hearing handicap inventory for the elderly-complete version vs screening version

CONCLUSION

HHIE-S can be a useful tool in investigating hearing loss among people over 80 years old, with the same validity as HHIE.

OBJECTIVE

To investigate the effect of hearing loss on the quality-of-life in people over 80 years of age in China, and to compare the results of the Chinese mandarin version Hearing Handicap Inventory for the Elderly (HHIE) and its screening version (HHIE-S).

METHODS

Eighty-four people over 80 years participated in the study. Both HHIE and HHIE-S were completed, and the hearing handicap degrees were rated according to HHIE scores and HHIE-S scores, respectively. Results obtained by HHIE and HHIE-S were compared. Multi-factor analysis of variance was used to analyze the impact of eight factors on hearing handicap in the oldest old people over 80 years of age, including age, noise exposure, ear surgery, infection, ototoxic drugs use, cardiovascular and cerebrovascular diseases, diabetes, and tumors.

RESULTS

Both HHIE and HHIE-S revealed 48 subjects (57.1%) with no self-perceived hearing problem, and 36 subjects (42.9%) with hearing handicap. No statistical difference was found between results of the functional hearing handicap rating by HHIE and HHIE-S (Chi-square = 1.532, p = 0.465). The HHIE and HHIE-S were in agreement with each other (kappa = 0.772, p < 0.001). All the eight factors had no significance on both HHIE and HHIE-S scores (p > 0.05), except noise exposure on S-score of HHIE-S (p = 0.032), and the R-squares of these factors were less than 5%.

Monaural Beamforming in Bimodal Cochlear Implant Users: Effect of (A)symmetric Directivity and Noise Type

OBJECTIVE

To evaluate monaural beamforming in bimodally aided cochlear implant (CI) users.

DESIGN

The study enrolled twelve adult bimodal listeners with at least six months of CI-experience and using a contralateral hearing aid (HA) most of the daytime. Participants were uniformly fitted with the same CI speech processor and HA, giving access to an identical monaural beamformer in both ears. A within-subject repeated measures design evaluated three directional configurations [omnidirectional, asymmetric directivity (in CI alone) and symmetric directivity (in both CI and HA)] in two noise types [stationary and fluctuating]. Bimodal speech reception thresholds (SRT) as well as listening effort ratings were assessed in a diffuse noise field.

RESULTS

Symmetric monaural beamforming provided a significant SRT improvement of 2.6 dB SNR, compared to 1.6 dB SNR for asymmetric monaural beamforming. Directional benefits were similarly observed in stationary and fluctuating noise. Directivity did not contribute to less listening effort in addition to improvement in speech intelligibility. Bimodal performance was about 7 dB SNR worse in fluctuating than in stationary noise.

CONCLUSIONS

Monaural beamforming provided substantial benefit for speech intelligibility in noise for bimodal listeners. The greatest benefit occurred when monaural beamforming was activated symmetrically in both CI and HA. Monaural beamforming does not bridge the gap between bimodal and normal hearing performance, especially in fluctuating noise. Results advocate further bimodal co-operation.

TRIAL REGISTRATION

This trial was registered in www.trialregister.nl under number NTR4901.

From hearing with a cochlear implant and a contralateral hearing aid (CI/HA) to hearing with two cochlear implants (CI/CI): a within-subject design comparison

OBJECTIVE

To compare within-subject bilateral-binaural and bimodal complementary abilities between bimodal (cochlear implant and hearing aid; CI/HA) and bilateral CI hearing (CI/CI), thereby enabling better-informed counseling of experienced CI/HA users contemplating contralateral implantation.

STUDY DESIGN

Comparative within-subject case review.

SETTING

Outpatient hearing clinic.

PATIENTS

Ten experienced adult CI/HA users with severe-to-profound hearing loss in the HA ear, who converted to CI/CI between 2 and 11 years after initial implantation.

INTERVENTION

Task-specific testing of bilateral-binaural hearing (sound lateralization, binaural summation/redundancy/unmasking, head-shadow effect), bimodal complementary benefit (contribution of low-frequency information), and a self-report Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire, all before and 1 year after contralateral cochlear implantation.

MAIN OUTCOME MEASURES

Test result differences between CI/HA and CI/CI conditions.

RESULTS

CI/CI hearing was better than CI/HA for speech lateralization and for perception of semantically unpredictable sentences in speech noise with speech at 0 degrees and noise at +90 degrees azimuth on the old CI side. CI/HA was better than CI/CI only for differences between perception of natural prosody speech and of speech with flattened fundamental frequency (F0) contour with speech and noise in front (at 0 degrees azimuth). Total scores on the SSQ questionnaire were higher in CI/CI than in CI/HA users.

CONCLUSION

Counseling regarding contralateral implantation for CI/HA users with severe-to-profound hearing loss in the HA ear, though generally positive, should consider individual functional needs, and cover expectations about the expected trade-off between gaining improved understanding and speech lateralization in challenging listening conditions and losing some low-frequency cues still available with CI/HA hearing.

Stages of Change Profiles among Adults Experiencing Hearing Difficulties Who Have Not Taken Any Action: A Cross-Sectional Study

The aim of the current study was to test the hypothesis that adults experiencing hearing difficulties who are aware of their difficulties but have not taken any action would fall under contemplation and preparation stages based on the transtheoretical stages-of-change model. The study employed a cross-sectional design. The study was conducted in United Kingdom and 90 participants completed University of Rhode Island Change Assessment (URICA) scale as well as measures of self-reported hearing disability, self-reported anxiety and depression, self-reported hearing disability acceptance, and provided additional demographic details online. As predicted, the results indicate that a high percentage of participants (over 90%) were in the contemplation and preparation stages. No statistically significant differences were observed among groups of stage with highest URICA scores and factors such as: years since hearing disability, self-reported hearing disability, self-reported anxiety and depression, and self-reported hearing disability acceptance. Cluster analysis identified three stages-of-change clusters, which were named as: decision making (53% of sample), participation (28% of sample), and disinterest (19% of sample). Study results support the stages-of-change model. In addition, implications of the current study and areas for future research are discussed.

Sequential bilateral cochlear implantation improves working performance, quality of life, and quality of hearing

CONCLUSIONS

This prospective study shows that working performance, quality of life (QoL), and quality of hearing (QoH) are better with two compared with a single cochlear implant (CI). The impact of the second CI on the patient's QoL is as significant as the impact of the first CI.

OBJECTIVES

To evaluate the benefits of sequential bilateral cochlear implantation in working, QoL, and QoH.

METHODS

We studied working performance, work-related stress, QoL, and QoH with specific questionnaires in 15 patients with unilateral CI scheduled for sequential CI of another ear. Sound localization performance and speech perception in noise were measured with specific tests. All questionnaires and tests were performed before the second CI surgery and 6 and 12 months after its activation.

RESULTS

Bilateral CIs increased patients' working performance and their work-related stress and fatigue decreased. Communication with co-workers was easier and patients were more active in their working environment. Sequential bilateral cochlear implantation improved QoL, QoH, sound localization, and speech perception in noise statistically significantly.

Older and younger adult cochlear implant users: speech recognition in quiet and noise, quality of life, and music perception

PURPOSE

To determine whether older cochlear implant (CI) listeners differ from younger CI listeners on measures of speech understanding, music perception, and health-related quality of life (HRQoL). In the study, the authors hypothesized that speech recognition would be more difficult for older adults, especially in noisy conditions. Performance on music perception was expected to be lower for older implanted listeners. No differences between age groups were expected on HRQoL.

METHOD

Twenty older (>60 years) and 20 younger (<60 years) implanted adults participated. Speech understanding was assessed using words and sentences presented in quiet, and sentences presented at +15, +10, and +5 dB signal-to-noise ratio conditions. Music perception was tested using the University of Washington Clinical Assessment of Music, and HRQoL was measured using the Njimegen CI survey.

RESULTS

Speech understanding was significantly lower for the older compared with the younger group in all conditions. Older implanted adults showed lower performance on music perception compared with younger implanted adults on 1 of 3 subtests. Older adults reported lower HRQoL benefit than younger adults on 3 of 6 subdomains.

CONCLUSION

Data indicate that older CI listeners performed more poorly than younger CI listeners, although group differences appear to be task specific.

Audio-visual speech intelligibility benefits with bilateral cochlear implants when talker location varies

One of the key benefits of using cochlear implants (CIs) in both ears rather than just one is improved localization. It is likely that in complex listening scenes, improved localization allows bilateral CI users to orient toward talkers to improve signal-to-noise ratios and gain access to visual cues, but to date, that conjecture has not been tested. To obtain an objective measure of that benefit, seven bilateral CI users were assessed for both auditory-only and audio-visual speech intelligibility in noise using a novel dynamic spatial audio-visual test paradigm. For each trial conducted in spatially distributed noise, first, an auditory-only cueing phrase that was spoken by one of four talkers was selected and presented from one of four locations. Shortly afterward, a target sentence was presented that was either audio-visual or, in another test configuration, audio-only and was spoken by the same talker and from the same location as the cueing phrase. During the target presentation, visual distractors were added at other spatial locations. Results showed that in terms of speech reception thresholds (SRTs), the average improvement for bilateral listening over the better performing ear alone was 9 dB for the audio-visual mode, and 3 dB for audition-alone. Comparison of bilateral performance for audio-visual and audition-alone showed that inclusion of visual cues led to an average SRT improvement of 5 dB. For unilateral device use, no such benefit arose, presumably due to the greatly reduced ability to localize the target talker to acquire visual information. The bilateral CI speech intelligibility advantage over the better ear in the present study is much larger than that previously reported for static talker locations and indicates greater everyday speech benefits and improved cost-benefit than estimated to date.

Self-reported spatial hearing abilities across different cochlear implant profiles

PURPOSE

The goal of this study was to determine how self-reported spatial hearing abilities differ across various cochlear implant (CI) profiles and to examine the degree of subjective benefit following cochlear implantation across different groups of CI users.

METHOD

This was a retrospective study of subjective spatial hearing ability of CI recipients. The subjects consisted of 99 unilateral CI users, 49 bilateral CI users, 32 subjects with a CI and contralateral hearing aid (bimodal users), and 37 short-electrode CI users. All subjects completed the Spatial Hearing Questionnaire (Tyler, Perreau, & Ji, 2009), a questionnaire assessing spatial hearing ability, after implantation, and a subset of the subjects completed the questionnaire pre- and postimplantation.

RESULTS

Subjective spatial hearing ability was rated higher for the bilateral and short electrode CI users compared to the unilateral and bimodal users. There was no significant difference in subjective spatial hearing performance between the bilateral and short electrode CI users and the unilateral CI and bimodal users. A separate analysis of pre- and postimplant performance revealed that all CI groups reported significant improvements in spatial hearing ability after implantation.

CONCLUSION

This study suggests that there are substantial differences in perceived spatial hearing ability among unilateral and bimodal CI users compared with bilateral and short electrode CI users.

Importance of "process evaluation" in audiological rehabilitation: examples from studies on hearing impairment

The main focus of this paper is to discuss the importance of “evaluating the process of change” (i.e., process evaluation) in people with disability by studying their lived experiences. Detailed discussion is made about “why and how to investigate the process of change in people with disability?” and some specific examples are provided from studies on patient journey of persons with hearing impairment (PHI) and their communication partners (CPs). In addition, methodological aspects in process evaluation are discussed in relation to various metatheoretical perspectives. The discussion has been supplemented with relevant literature. The healthcare practice and disability research in general are dominated by the use of outcome measures. Even though the values of outcome measures are not questioned, there seems to be a little focus on understanding the process of change over time in relation to health and disability. We suggest that the process evaluation has an additional temporal dimension and has applications in both clinical practice and research in relation to health and disability.

The acceptance of hearing disability among adults experiencing hearing difficulties: a cross-sectional study

OBJECTIVE

This study developed the Hearing Disability Acceptance Questionnaire (HDAQ) and tested its construct and concurrent validities.

DESIGN

Cross-sectional.

PARTICIPANTS

A total of 90 participants who were experiencing hearing difficulties were recruited in the UK.

OUTCOME MEASURES

The HDAQ was developed based on the Tinnitus Acceptance Questionnaire (TAQ). Participants completed self-report measures regarding hearing disability acceptance, hearing disability, symptoms of anxiety and depression and a measure of stages of change.

RESULTS

The HDAQ has a two-factor structure that explains 75.69% of its variance. The factors identified were activity engagement and avoidance and suppression. The scale showed a sufficient internal consistency (Cronbach's α=0.86). The HDAQ also had acceptable concurrent validity with regard to self-reported hearing disability, self-reported anxiety and depression and readiness to change measures.

CONCLUSIONS

Acceptance is likely an important aspect of coping with chronic health conditions. To our knowledge, no previously published and validated scale measures the acceptance of hearing disability; therefore, the HDAQ might be useful in future research. However, the role of acceptance in adjusting to hearing disability must be further investigated.

Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings: study protocol for a cluster randomized controlled trial

BACKGROUND

Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age.

METHODS/DESIGN

In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis.

DISCUSSION

The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov, NCT01217502.

The effectiveness of bilateral cochlear implants for severe-to-profound deafness in adults: a systematic review

OBJECTIVE

Assessment of the clinical effectiveness of bilateral cochlear implantation compared with unilateral cochlear implantation or bimodal stimulation, in adults with severe-to-profound hearing loss. In 2007, the National Institute for Health and Clinical Excellence (NICE) in the U.K. conducted a systematic review on cochlear implantation. This study forms an update of the adult part of the NICE review.

DATA SOURCES

The electronic databases MEDLINE and Embase were searched for English language studies published between October 2006 and March 2011.

STUDY SELECTION

Studies were included that compared bilateral cochlear implantation with unilateral cochlear implantation and/or with bimodal stimulation, in adults with severe-to-profound sensorineural hearing loss. Speech perception in quiet and in noise, sound localization and lateralization, speech production, health-related quality of life, and functional outcomes were analyzed.

DATA EXTRACTION

Data extraction forms were used to describe study characteristics and the level of evidence.

DATA SYNTHESIS

The effect size was calculated to compare different outcome measures.

CONCLUSION

Pooling of data was not possible because of the heterogeneity of the studies. As in the NICE review, the level of evidence of the included studies was low, although some of the additional studies showed less risk of bias. All studies showed a significant bilateral benefit in localization over unilateral cochlear implantation. Bilateral cochlear implants were beneficial for speech perception in noise under certain conditions and several self-reported measures. Most speech perception in quiet outcomes did not show a bilateral benefit. The current review provides additional evidence in favor of bilateral cochlear implantation, even in complex listening situations.

Speech Recognition and Subjective Perceptions of Neck-Loop FM Receivers With Cochlear Implants

Purpose

The goal of this investigation was to determine the potential benefit of using electromagnetically coupled frequency modulation (FM) neck-loop receivers to address common communication difficulties of adults and adolescents with cochlear implants (CIs).

Method

Fourteen participants with CIs used the neck-loop FM receiver for a trial period and participated in pre- and posttrial sessions consisting of speech-recognition-in-noise measures with and without the FM system and a subjective rating scale. Most participants also recorded their experiences during the FM-system trial period in a journal.

Results

The results suggested significantly improved speech recognition in noise with the neck-loop FM system before and after the trial period, with no changes in performance between test sessions. On average, the rating scale and journals revealed improvements with the FM system, relative to the CI alone, in noisy environments or situations at a distance from the primary talker or sound source.

Conclusion

The results of the study suggest that neck-loop FM receivers significantly improved speech recognition in noise and everyday listening challenges of people using the CIs in 2 separate test sessions. Additional research is warranted for other types of neck-loop receivers and CI sound processors.

Use of the 'patient journey' model in the internet-based pre-fitting counseling of a person with hearing disability: study protocol for a randomized controlled trial

BACKGROUND

Hearing impairment is one of the most frequent chronic conditions. Persons with a hearing impairment (PHI) have various experiences during their 'journey' through hearing loss. In our previous studies we have developed a 'patient journey' model of PHI and their communication partners (CPs). We suggest this model could be useful in internet-based pre-fitting counseling of a person with hearing disability (PHD).

METHODS/DESIGN

A randomized controlled trial (RCT) with waiting list control (WLC) design will be used in this study. One hundred and fifty eight participants with self-reported hearing disability (that is, score > 20 in the Hearing Handicap Questionnaire (HHQ)) will be recruited to participate in this study. They will be assigned to one of two groups (79 participants in each group): (1) Information and counseling provision using the 'patient journey' model; and (2) WLC. They will participate in a 30 day (4 weeks) internet-based counseling program based on the 'patient journey' model. Various outcome measures which focuses on hearing disability, depression and anxiety, readiness to change and acceptance of hearing disability will be administered pre (one week before) and post (one week and six months after) intervention to evaluate the effectiveness of counseling.

DISCUSSION

Internet-based counseling is being introduced as a viable option for audiological rehabilitation. We predict that the 'patient journey' model will have several advantages during counseling of a PHD. Such a program, if proven effective, could yield cost and time-efficient ways of managing hearing disability.

TRIAL REGISTRATION

ClinicalTrials.gov Protocol Registration System NCT01611129.

Sequential bilateral cochlear implantation: speech perception and localization pre- and post-second cochlear implantation

PURPOSE

In this study, the authors sought to compare speech perception and localization in subjects who wear 1 cochlear implant (unilateral CI) or 1 cochlear implant and hearing aid (CI+HA) and then receive a second cochlear implant (bilateral CI), and to evaluate the importance of the duration between implant surgeries and duration of deafness.

METHOD

Nine subjects were tested on speech perception in quiet, and 13 subjects were tested on speech perception and localization in noise using an array of 8 loudspeakers. All subjects were tested with unilateral CI prior to bilateral implantation and then again with bilateral CI after at least 3 months of bilateral experience.

RESULTS

No significant difference was found between bilateral CI and unilateral CI on averaged speech perception in quiet performance. A significant benefit was found for bilateral CI on averaged speech perception in noise and on localization. Nonsignificant correlations were found for duration between surgeries, duration of deafness, and duration of bilateral use.

CONCLUSIONS

Improvements for speech perception and localization played in background noise were indicated for most subjects after they received their 2nd implant. The correlations should be reassessed with a larger number of subjects to appropriately evaluate the effects of duration between surgeries, duration of deafness, and duration of bilateral use.

Predictors of rehabilitation intervention decisions in adults with acquired hearing impairment

PURPOSE

This study investigated the predictors of rehabilitation intervention decisions in middle-age and older adults with acquired hearing impairment seeking help for the first time.

METHOD

Using shared decision making, 139 participants were offered intervention options: hearing aids, communication programs (group or individual), and no intervention. Multivariate analysis (logistic regression) provided odds ratios and 95% confidence intervals for intervention decision predictors when all other variables were held constant.

RESULTS

Seven intervention decision predictors were identified: (a) application for subsidized hearing services (participants more likely to choose hearing aids and less likely to choose communication programs), (b) hearing impairment (hearing aids more likely and no intervention less likely), (c) communication self-efficacy (hearing aids less likely), (d) powerful others as locus of control (hearing aids less likely), (e) hearing disability perceived by others and self (hearing aids more likely), (f) perceived communication program effectiveness (communication programs more likely), and (g) perceived suitability of individual communication program (hearing aids less likely and communication programs more likely).

CONCLUSION

Findings suggest the need for clinicians to explicitly elicit the predictors identified by this study when involving adults with acquired hearing impairment in intervention decisions.

Younger- and older-age adults with unilateral and bilateral cochlear implants: speech and spatial hearing self-ratings and performance

OBJECTIVE

Compare results of cochlear implantation in younger and older adults in the domains of disability and handicap, as well as in tests of word recognition and localization, across unilateral implant (CI), bilateral (CI + CI), and CI with an acoustic hearing aid in the nonimplanted ear (CI + HA).

DESIGN

Three parts: retrospective (postimplant only) analysis; prospective (preimplant versus postimplant); correlation between age and benefit from CI versus CI + CI. Two age groups, older and younger than 60 years, for the first 2 analyses; age is a continuous variable for the third analysis.

SETTING

Tertiary referral hospital clinic.

PATIENTS

Postlingually severely-to-profoundly hearing-impaired adults: Totals of 68 CI, 36 CI + CI, and 38 CI + HA in the retrospective part of the study; totals of 30 CI, 18 CI + CI, and 16 CI + HA in the prospective parts. Numbers vary from these totals on individual measures.

INTERVENTIONS

Patients receive either 1 or 2 cochlear implants; some with 1 CI opt to retain a hearing aid in the nonimplanted ear.

OUTCOME MEASURES

Principal measures: Hearing Handicap Inventory for the Elderly, Hearing Handicap Questionnaire, Speech, Spatial and Qualities of Hearing Scale, word recognition test, and soundfield localization test. The study is exploratory, but proceeding from a null hypothesis of no expected contrast as a function of patient age.

RESULTS

All patient groups show significant benefit after implantation. No significant age-related differences are observed in patients with unilateral implant, nor in CI + HA group. In the CI + CI group, the younger cohort showed very substantial increases in both performance and self-rated abilities; the older cohort provides more mixed outcomes.

CONCLUSION

Results for the CI group confirm and extend earlier research. The result for the younger group of CI + CI patients demonstrates the consistent incremental benefit obtained from a bilateral procedure. The mixed outcome observed in the older CI + CI group might be due to individual differences in interaction between effects of aging and the ability to integrate binaural cues.

Auditory reality and self-assessment of hearing

Analyses are made of three problem areas in the realm of hearing disorder and its management, all of which are cogently informed by self-assessment: (a) prosthetic technology and the auditory ecology, (b) dimensions of benefit from amplification, and (c) dimensions of disability. Technology and ecology addresses the matter of "fitness for purpose" of different prosthetic schemes, moderated by people's hearing and listening environments (ecologies) and by what they bring to the task of hearing and listening. Dimensions of benefit covers what is achievable with prevailing technology, and also what people are aware of and identify as their needs. Dimensions of disability examines what has been recently learned about the range of hearing functions that need attending to in management of impaired hearing. A closing section provides a portrait of "auditory reality," whose characteristics may be better appreciated when analyzed in contrast to and comparison with "visual reality."

Unilateral and bilateral cochlear implants and the implant-plus-hearing-aid profile: comparing self-assessed and measured abilities

Patients fitted with one (CI) versus two (CI+CI) cochlear implants, and those fitted with one implant who retain a hearing aid in the non-implanted ear (CI+HA), were compared using the speech, spatial, and qualities of hearing scale (SSQ) (Gatehouse & Noble, 2004). The CI+CI profile yielded significantly higher ability ratings than the CI profile in the spatial hearing domain, and on most aspects of other qualities of hearing (segregation, naturalness, and listening effort). A subset of patients completed the SSQ prior to implantation, and the CI+CI profile showed consistently greater improvement than the CI profile across all domains. Patients in the CI+HA group self-rated no differently from the CI group, post-implant. Measured speech perception and localization performance showed some parallels with the self-rating outcomes. Overall, a unilateral CI provided significant benefit across most hearing functions reflected in the SSQ. Bilateral implantation offered further benefit across a substantial range of those functions.