Magnitude of extended high frequency hearing loss associated with auditory related tinnitus distress, when controlling for magnitude of hearing loss at standard frequenciesa)

Impaired thresholds at extended high frequencies (EHF) are tightly linked to the prevalence of tinnitus, but little is known about how EHF status relates to tinnitus characteristics. In the present study, 93 individuals with tinnitus underwent standard (from 0.125 to 8 kHz) and EHF (from 10 to 16 kHz) audiometry and indicated their degree of tinnitus distress by completing the tinnitus functional index and their perceived tinnitus loudness by using a numeric rating scale. Partial correlation analyses indicated that the magnitude of EHF loss was significantly associated with degree of auditory related tinnitus distress (r = 0.343, p < 0.001) when controlling for pure tone average at standard frequencies and compensating for multiple testing. It is concluded that EHF status is related specifically to auditory related tinnitus distress, but not to intrusive-, sense of control-, cognitive-, sleep-, relaxation-, quality of life-, emotional-related tinnitus distress, total tinnitus distress, or perceived tinnitus loudness.

Extended High Frequency Hearing, but Not Tinnitus, Is Associated With Every-Day Cognitive Performance

Research into the potential associations between tinnitus and cognition has investigated specific cognitive domains in laboratory settings despite adults with tinnitus reporting broad cognitive difficulties in every-day life. To address this limitation, the present study compared performance and perceived exertion on a visual office-like task in 38 adults with tinnitus (19 with normal hearing and 19 with hearing loss) and 38 adults without tinnitus (19 with normal hearing and 19 with hearing loss) matched for age, sex and educational background. All participants were also assessed for hearing, anxiety and depression, and participants with tinnitus were also assessed for tinnitus handicap. No associations were found between presence of tinnitus and cognitive performance (mean total rate correct score on the visual office-like task being 2.9 for the tinnitus group, 2.8 for the control group, p = 0.612) and perceived exertion (mean ratings of perceived exertion on the Borg CR10-scale being 5.8 for the tinnitus group, 6.5 for the control group, p = 0.063) on the visual office-like task when corrected for standard (0.125 to 8 kHz) and extended high frequency (10 to 16 kHz) hearing thresholds, anxiety, and depression. The correction for extended high frequency average (10, 12.5, 14, and 16 kHz) hearing threshold was significant for performance (p = 0.009) but not perceived exertion on the visual office-like task. Overall, the results showed extended high frequency hearing, but not tinnitus, was associated with every-day cognitive performance. This indicates clinical testing of hearing thresholds above 8 kHz could support clinicians’ identification and management of cognitive difficulties. One management method suggested by the current findings would include provision of auditory stimulation at frequencies exceeding the frequency response of many current hearing aids.

Development of an Auditory Passage Comprehension Task for Swedish Primary School Children of Cultural and Linguistic Diversity

Purpose This study reports on the development of an auditory passage comprehension task for Swedish primary school children of cultural and linguistic diversity. It also reports on their performance on the task in quiet and in noise. Method Eighty-eight children aged 7-9 years and showing normal hearing participated. The children were divided into three groups based on presumed language exposure: 13 children were categorized as Swedish-speaking monolinguals, 19 children were categorized as simultaneous bilinguals, and 56 children were categorized as sequential bilinguals. No significant difference in working memory capacity was seen between the three language groups. Two passages and associated multiple-choice questions were developed. During development of the passage comprehension task, steps were taken to reduce the impact of culture-specific prior experience and knowledge on performance. This was achieved by using the story grammar principles, universal topics and plots, and simple language that avoided complex or unusual grammatical structures and words. Results The findings indicate no significant difference between the two passages and similar response distributions. Passage comprehension performance was significantly better in quiet than in noise, regardless of language exposure group. The monolinguals outperformed both simultaneous and sequential bilinguals in both listening conditions. Conclusions Because the task was designed to minimize the effect of cultural knowledge on auditory passage comprehension, this suggests that compared with monolinguals, both simultaneous and sequential bilinguals have a disadvantage in auditory passage comprehension. As expected, the findings demonstrate that noise has a negative effect on auditory passage comprehension. The magnitude of this effect does not relate to language exposure. The developed auditory passage comprehension task seems suitable for assessing auditory passage comprehension in primary school children of linguistic and cultural diversity.

Importance of personality and coping expectancy on patient-reported hearing disability, quality of life and distress level: a study of patients referred to an audiology service

Purpose

According to the World Health Organization (WHO), hearing loss (HL) affects up to 15% of the world’s adult population. Coping and personality are hypothesized to underlie quality of life (QoL) and distress scores. We aimed to study the importance of personality and coping in persons with HL for self-reported hearing disability, QoL, and distress.

Methods

A cross-sectional survey was carried out, including one hundred and fifty-eight adults seeking hearing aids. Pure-tone average hearing thresholds (PTA) were determined for each ear. A revised version of the Abbreviated Profile of Hearing Aid Benefit (APHAB) served as a measure of self-reported hearing disability. Further, the generic part of the European Organization for Research and Treatment (EORTC) QoL questionnaire and the General Health Questionnaire (GHQ) (distress measure) were answered. Levels of neuroticism and the Theoretically Originated Measure of the Cognitive Activation Theory of Stress (TOMCATS) coping expectancy were determined.

Results

Hearing disability was determined by PTA (better ear) and level of neuroticism. Distress and QoL were determined by neuroticism and coping.

Conclusion

More neuroticism was associated with worse outcome for the variables hearing disability, distress, and QoL. Helplessness and hopelessness were associated with worse hearing disability, increased distress, and lowered QoL. Patient reported hearing disability was also associated with PTA (better ear). There is a need to investigate further the associations between hearing disability and QoL to psychosocial parameters.

Listening effort and fatigue in native and non-native primary school children

Background noise makes listening effortful and may lead to fatigue. This may compromise classroom learning, especially for children with a non-native background. In the current study, we used pupillometry to investigate listening effort and fatigue during listening comprehension under typical (0 dB signal-to-noise ratio [SNR]) and favorable (+10 dB SNR) listening conditions in 63 Swedish primary school children (7-9 years of age) performing a narrative speech-picture verification task. Our sample comprised both native (n = 25) and non-native (n = 38) speakers of Swedish. Results revealed greater pupil dilation, indicating more listening effort, in the typical listening condition compared with the favorable listening condition, and it was primarily the non-native speakers who contributed to this effect (and who also had lower performance accuracy than the native speakers). Furthermore, the native speakers had greater pupil dilation during successful trials, whereas the non-native speakers showed greatest pupil dilation during unsuccessful trials, especially in the typical listening condition. This set of results indicates that whereas native speakers can apply listening effort to good effect, non-native speakers may have reached their effort ceiling, resulting in poorer listening comprehension. Finally, we found that baseline pupil size decreased over trials, which potentially indicates more listening-related fatigue, and this effect was greater in the typical listening condition compared with the favorable listening condition. Collectively, these results provide novel insight into the underlying dynamics of listening effort, fatigue, and listening comprehension in typical classroom conditions compared with favorable classroom conditions, and they demonstrate for the first time how sensitive this interplay is to language experience.

Psychometric properties of the Norwegian translation of the Tinnitus Handicap Inventory (THI-NOR)

OBJECTIVE

To assess the psychometric properties of a Norwegian translation of the Tinnitus Handicap Inventory (THI-NOR).

DESIGN

A survey was sent by post to patients referred with tinnitus as their main complaint to an audiology department. Patients completed a Norwegian version of the Tinnitus Handicap Inventory (THI-NOR), a Norwegian translation of two revised subscales of the Abbreviated profile of hearing aid benefit (APHAB), the General Health Questionnaire (GHQ-12) as well as questionnaires measuring coping expectancies (TOMCATS) and neuroticism (EPI).

STUDY SAMPLE

Ninety-nine persons with tinnitus.

RESULTS

No associations were found between THI-scores or pure-tone audiometry, gender or age. The proposed subscales of the original THI were not formed by responses from responders. The total scale shows good psychometric properties. Significant correlations were found between distress as measured by the GHQ-12, coping expectancies as measured by TOMCATS and neuroticism as measured by EPI and THI scores.

CONCLUSIONS

THI-NOR has psychometric properties similar to those of the Danish translation (THI-DK), from which it was adapted, and to the original THI. THI-NOR seems to be a valid measure of the impact of tinnitus on a person's everyday life. Findings show that the suggested subscales of the questionnaire should be interpreted with caution.

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.

Prediction of IOI-HA Scores Using Speech Reception Thresholds and Speech Discrimination Scores in Quiet

Background: Outcome measures can be used to improve the quality of the rehabilitation by identifying and understanding which variables influence the outcome. This information can be used to improve outcomes for clients. In clinical practice, pure-tone audiometry, speech reception thresholds (SRTs), and speech discrimination scores (SDSs) in quiet or in noise are common assessments made prior to hearing aid (HA) fittings. It is not known whether SRT and SDS in quiet relate to HA outcome measured with the International Outcome Inventory for Hearing Aids (IOI-HA).

Purpose: The aim of the present study was to investigate the relationship between pure-tone average (PTA), SRT, and SDS in quiet and IOI-HA in both first-time and experienced HA users.

Research Design: SRT and SDS were measured in a sample of HA users who also responded to the IOI-HA.

Study Sample: Fifty-eight Danish-speaking adult HA users.

Data Collection and Analysis: The psychometric properties were evaluated and compared to previous studies using the IOI-HA. The associations and differences between the outcome scores and a number of descriptive variables (age, gender, fitted monaurally/binaurally with HA, first-time/experienced HA users, years of HA use, time since last HA fitting, best ear PTA, best ear SRT, or best ear SDS) were examined. A multiple forward stepwise regression analysis was conducted using scores on the separate IOI-HA items, the global score, and scores on the introspection and interaction subscales as dependent variables to examine whether the descriptive variables could predict these outcome measures.

Results: Scores on single IOI-HA items, the global score, and scores on the introspection (items 1, 2, 4, and 7) and interaction (items 3, 5, and 6) subscales closely resemble those previously reported. Multiple regression analysis showed that the best ear SDS predicts about 18–19% of the outcome on items 3 and 5 separately, and about 16% on the interaction subscale (sum of items 3, 5, and 6)

Conclusions: The best ears SDS explains some of the variance displayed in the IOI-HA global score and the interaction subscale. The relation between SDS and IOI-HA suggests that a poor unaided SDS might in itself be a limiting factor for the HA rehabilitation efficacy and hence the IOI-HA outcome. The clinician could use this information to align the user’s HA expectations to what is within possible reach.

Acceptance of Background Noise, Working Memory Capacity, and Auditory Evoked Potentials in Subjects with Normal Hearing

Background: The acceptable noise level (ANL) test is a method for quantifying the amount of background noise that subjects accept when listening to speech. Large variations in ANL have been seen between normal-hearing subjects and between studies of normal-hearing subjects, but few explanatory variables have been identified.

Purpose: To explore a possible relationship between a Swedish version of the ANL test, working memory capacity (WMC), and auditory evoked potentials (AEPs).

Research Design: ANL, WMC, and AEP were tested in a counterbalanced order across subjects.

Study Sample: Twenty-one normal-hearing subjects participated in the study (14 females and 7 males; aged 20–39 yr with an average of 25.7 yr).

Data Collection and Analysis: Reported data consists of age, pure-tone average (PTA), most comfortable level (MCL), background noise level (BNL), ANL (i.e., MCL − BNL), AEP latencies, AEP amplitudes, and WMC. Spearman’s rank correlation coefficient was calculated between the collected variables to investigate associations. A principal component analysis (PCA) with Varimax rotation was conducted on the collected variables to explore underlying factors and estimate interactions between the tested variables. Subjects were also pooled into two groups depending on their results on the WMC test, one group with a score lower than the average and one with a score higher than the average. Comparisons between these two groups were made using the Mann-Whitney U-test with Bonferroni correction for multiple comparisons.

Results: A negative association was found between ANL and WMC but not between AEP and ANL or WMC. Furthermore, ANL is derived from MCL and BNL, and a significant positive association was found between BNL and WMC. However, no significant associations were seen between AEP latencies and amplitudes and the demographic variables, MCL, and BNL. The PCA identified two underlying factors: One that contained MCL, BNL, ANL, and WMC and another that contained latency for wave Na and amplitudes for waves V and Na-Pa. Using the variables in the first factor, the findings were further explored by pooling the subjects into two groups according to their WMC (WMClow and WMChigh). It was found that the WMClow had significantly poorer BNL than the WMChigh.

Conclusions: The findings suggest that there is a strong relationship between BNL and WMC, while the association between MCL, ANL, and WMC seems less clear-cut.

Hearing Aid Fitting Outcome: Clinical Application and Psychometric Properties of a Swedish Translation of the International Outcome Inventory for Hearing Aids (IOI-HA)

Background: The International Outcome Inventory for Hearing Aids (IOI-HA) is a seven-item hearing-specific questionnaire. It was developed with the purpose of evaluating the efficacy of hearing aid rehabilitation. Few psychometric properties have been presented for a Swedish translation of the IOI-HA. Furthermore, previous studies have examined the IOI-HA in mainly sensorineural hearing losses, and we do not know how the type of hearing loss affects the outcome.

Purpose: To evaluate the hearing aid fitting outcome measured in a clinical setting using a Swedish translation of the International Outcome Inventory for Hearing Aids (IOI-HA), to determine the psychometric properties of the translation, and to examine how a number of demographic variables such as type of hearing loss affect the outcome.

Research Design: A descriptive and correlational study in a retrospective sample.

Study Sample: Two hundred and twenty-four (107 females and 117 males; ages 27–94 yr with an average of 66.1 yr) first-time hearing aid users.

Intervention: Mostly digital hearing aids (97.8%) were fitted monaurally (60%) or binaurally (40%) between 2007 and 2009.

Data Collection and Analysis: The subjects were mailed the IOI-HA questionnaire six months after their final appointment, and the completed questionnaire was returned by mail to the clinic. The psychometric properties were evaluated and compared to previous studies using the IOI-HA. The associations between the outcome scores and a number of demographic variables (age, gender, degree of hearing loss, type of hearing loss, number of hearing aids, and type of hearing aids) were examined. Based on the pure tone audiograms, the subjects were divided into three groups; those with conductive hearing losses, sensorineural hearing losses, and mixed hearing losses. For these groups, the differences in outcome measured as IOI-HA were examined.

Results: The psychometric properties of the present translation of the IOI-HA showed resemblance in many aspects to previous reports. Furthermore, the type of hearing loss seems to affect the IOI-HA outcome. Hearing loss increases with increasing age, and hearing aid use increases with increasing degree of hearing loss. Subjects with sensorineural hearing losses show significantly poorer scores on items concerning introspective aspects of the outcome in comparison to subjects with mixed hearing losses and subjects with conductive hearing losses. Monaurally fitted subjects tend to report lower scores on average, but monaural or binaural hearing aid fitting do not significantly affect the subjective outcome.

Conclusions: The psychometric properties of the present Swedish translation of the IOI-HA show resemblance in many aspects to previous reports, but the differences observed could be due to differences in the study populations. Overall, the demographic variables examined could not be used as predictors for the hearing aid fitting outcome, and more reliable predictors need to be identified.

Perceived listening effort in children with hearing loss: listening to a dysphonic voice in quiet and in noise

AIM

The present study investigates the effect of signal degradation on perceived listening effort in children with hearing loss listening in a simulated class-room context. It also examines the associations between perceived listening effort, passage comprehension performance and executive functioning.

METHODS

Twenty-four children (aged 06:03-13:00 years) with hearing impairment using cochlear implant (CI) and/or hearing aids (HA) participated. The children made ratings of perceived listening effort after completing an auditory passage comprehension task. All children performed the task in four different listening conditions: listening to a typical (i.e. normal) voice in quiet, to a dysphonic voice in quiet, to a typical voice in background noise and to a dysphonic voice in background noise. In addition, the children completed a task assessing executive function.

RESULTS

Both voice quality and background noise increased perceived listening effort in children with CI/HA, but no interaction with executive function was seen.

CONCLUSION

Since increased listening effort seems to be a consequence of increased cognitive resource spending, it is likely that less resources will be available for these children not only to comprehend but also to learn in challenging listening environments such as classrooms.

Listening Effort: Order Effects and Core Executive Functions

Listening effort seems to depend on input-related listening demands and several factors internal to the individual listener. Input-related demands may be listening in noise compared with listening in quiet, and internal factors may be cognitive functions.

The purpose was to apply measures of listening effort and perceived listening effort in participants with normal hearing, to determine if there are any presentation order effects, and to explore the relationship between listening effort measured as accuracy, response times, efficiency of information encoding into long-term memory, perceived listening effort, and core executive functions.

A within-subject design with repeated measures was used and a study of relationships between variables was made.

Thirty-two healthy adults with normal hearing.

Participants were tested individually by a listening task using a dual-task paradigm. The listening task was performed in quiet and in multitalker babble noise at 10 dB signal-to-noise ratio (SNR). Perceived listening effort and core executive functions (working memory, inhibitory control, and cognitive flexibility) were also assessed.

The measures of listening effort (correct responses, response times, and immediate and delayed listening comprehension) failed to demonstrate increased listening effort in multitalker babble noise (10 dB SNR) compared with quiet, although a significant test order effect was seen for correct responses indicating that participants who first listened in noise did not improve in quiet. Perceived listening effort increased significantly in noise compared with quiet. No relationship was found between measures of listening effort and ratings of perceived listening effort. Working memory and cognitive flexibility were not related to ratings of perceived listening effort. In contrast, better inhibitory control was related to higher ratings in both quiet and in noise.

It is possible that the SNR and measures used were not as sensitive as required to measure listening effort behaviorally. In the present experimental setup, prior noise exposure impedes the beneficial effects of performing a task in quiet. Self-reports seem to provide a valid measure of perceived listening effort that is related to the individual’s inhibitory control. The present findings suggest that participants with better inhibitory control are more susceptible to the task demand level both in quiet and in noise.

Hearing thresholds and cognitive flexibility in young healthy individuals with normal hearing

Objective: Pure tone audiometry may seem to be a relatively easy task for the participant but it may involve cognitive as well as sensory abilities. The aim of this study is to examine the relationship between hearing thresholds in the frequency range 0.125-8 kHz and the core executive function cognitive flexibility in healthy individuals with normal hearing.Design: Experimental study measuring correlations between different pure-tone hearing threshold measures and cognitive flexibility. Pure tone air conduction audiometry (frequencies 0.125-8.0 kHz) and two tests of cognitive flexibility (information updating and shifting ability) were conducted.Study sample: Seventy-two subjects (aged between 21 and 36) with normal hearing (<20 dB HL) for the tested frequencies.Results: Four measures of average pure tone hearing thresholds were negatively correlated with cognitive flexibility.Conclusions: Pure-tone air conduction hearing thresholds seem to be related to cognitive flexibility in healthy individuals with normal hearing.

Reading Comprehension in Quiet and in Noise: Effects on Immediate and Delayed Recall in Relation to Tinnitus and High-Frequency Hearing Thresholds

BACKGROUND

A common complaint by people with tinnitus is that they experience that the tinnitus causes attention and concentration problems. Previous studies have examined how tinnitus influences cognitive performance on short and intensive cognitive tasks but without proper control of hearing status.

PURPOSE

To examine the impact tinnitus and high-frequency hearing thresholds have on reading comprehension in quiet and in background noise.

RESEARCH DESIGN

A between-group design with matched control participants.

STUDY SAMPLE

One group of participants with tinnitus (n = 20) and an age and gender matched control group without tinnitus (n = 20) participated. Both groups had normal hearing thresholds (20 dB HL at frequencies 0.125 to 8 kHz).

DATA COLLECTION AND ANALYSIS

Measurements were made assessing hearing thresholds and immediate and delayed recall using a reading comprehension test in quiet and in noise. All participants completed the Swedish version of the Hospital Anxiety and Depression Scale, and participants with tinnitus also completed the Tinnitus Questionnaire.

RESULTS

The groups did not differ in immediate nor delayed recall. Accounting for the effect of age, a significant positive correlation was found between best ear high-frequency pure tone average (HF-PTA; 10000, 12500, and 14000 Hz) and the difference score between immediate and delayed recall in noise.

CONCLUSIONS

Tinnitus seems to have no effect on immediate and delayed recall in quiet or in background noise when hearing status is controlled for. The detrimental effect of background noise on the processes utilized for efficient encoding into long-term memory is larger in participants with better HF-PTA. More specifically, when reading in noise, participants with better HF-PTA seem to recall less information than participants with poorer HF-PTA.

Increasing Cognitive Interference Modulates the Amplitude of the Auditory Brainstem Response

BACKGROUND

Despite the presence of efferent neural pathways from the cortex to brainstem, evidence for cognitive inhibition and sensory gating on the auditory brainstem has been mixed. Some previous studies have suggested auditory brainstem responses (ABR) can be affected by cognitive load whereas others have not.

PURPOSE

The present study explores if the ABR recorded from adults with normal hearing was affected by increased cognitive load involving cognitive interference.

RESEARCH DESIGN

Within-subject repeated measures.

STUDY SAMPLE

Twenty young adults with normal hearing (ten females and ten males, aged 21-26 yr).

DATA COLLECTION AND ANALYSIS

ABRs were collected with and without cognitive load (a visual Stroop task). Two measures of cognitive interference, that is, the ability to suppress task-irrelevant input, were derived from the performance on the Stroop task.

RESULTS

No main effect of cognitive load on ABR wave V amplitudes was found. Participants with higher cognitive interference showed increased response times and larger decreases in ABR wave V amplitudes from the no cognitive load to cognitive load conditions.

CONCLUSIONS

The present study showed that ABR wave V amplitudes did not change with increased overall cognitive load (cognitive load with and without cognitive interference), but ABR amplitude was related to cognitive interference. Increased cognitive load in the form of increased cognitive interference could trigger cognitive inhibition and/or sensory gating to suppress the processing of task-irrelevant information at the level of the brainstem. This suppression could present as reduced ABR wave V amplitudes.

Can the Lateralized Readiness Potential Detect Suppressed Manual Responses to Pure Tones?

BACKGROUND

Willfully not responding to auditory stimuli hampers accurate behavioral measurements. An objective measure of covert manual suppression recorded during response tasks may be useful to assess the veracity of responses to stimuli.

PURPOSE

To investigate whether the lateralized readiness potential (LRP), an electrophysiological measure of corticomotor response and suppression, may be of use in determining when participants hear but do not respond to pure tones.

RESEARCH DESIGN

Within-subject repeated measures with a Go-NoGo paradigm.

STUDY SAMPLE

Five males and five females (mean age = 38.8 years, standard deviation = 8.8) underwent electrophysiology testing. All had normal hearing, except one.

INTERVENTION

Participants were tested in a condition where they consistently responded to tonal stimuli, and in a condition where intensity cued whether they should respond or not. Scalp-recorded cortical potentials and behavioral responses were recorded, along with a question that probed the perceived effort required to suppress responses to the stimuli.

DATA COLLECTION AND ANALYSIS

Electrophysiology data were processed with independent component analysis and epoch-based artifact rejection. Averaged group and individual LRPs were calculated.

RESULTS

Group averaged waveforms show that suppressed responses, cued by NoGo stimuli, diverge positively at approximately 300 msec poststimulus, when compared with performed (Go) responses. LRPs were comparable when Go responses were recorded in a separate condition in which participants responded to all stimuli, and when Go and NoGo trials were included in the same condition. The LRP was not observed in one participant.

CONCLUSIONS

Subsequent to further investigation, the LRP may prove suitable in assessing the suppression of responses to audiometric stimuli, and, thereby, useful in cases where functional hearing loss is suspected.

Passage comprehension performance in children with cochlear implants and/or hearing aids: the effects of voice quality and multi-talker babble noise in relation to executive function

Purpose: Speech signal degradation such as a voice disorder presented in quiet or in combination with multi-talker babble noise could affect listening comprehension in children with hearing impairment. This study aims to investigate the effects of voice quality and multi-talker babble noise on passage comprehension in children with using cochlear implants (CIs) and/or hearing aids (HAs). It also aims to examine what role executive functioning has for passage comprehension in listening conditions with degraded signals (voice quality and multi-talker babble noise) in children using CI/HA. Methods: Twenty-three children (10 boys and 13 girls; mean age 9 years) using CI and/or HA were tested for passage comprehension in four listening conditions: a typical voice or a (hoarse) dysphonic, voice presented in quiet or in multi-talker babble noise. Results: The results show that the dysphonic voice did not affect passage comprehension in quiet or in noise. Multi-talker babble noise decreased passage comprehension compared to performance in quiet. No interactions with executive function were found. Conclusions: In conclusion, children with CI/HA seem to struggle with comprehension in poor sound environments, which in turn may reduce learning opportunities at school.

Extended high-frequency pure tone hearing thresholds and core executive functions

OBJECTIVE

To examine the relationship between extended high-frequency pure tone hearing thresholds (frequencies 10 to 14 kHz) and working memory capacity (WMC), inhibitory control, and cognitive flexibility.

DESIGN

Experimental study measuring correlations between different high-frequency hearing threshold measures and cognitive measures.

STUDY

Pure tone audiometry was assessed in the extended high-frequency (frequencies 10, 12.5 and 14 kHz). Subjects were also tested regarding WMC, inhibitory control (response inhibition), and cognitive flexibility (information updating and shifting ability).

SAMPLE

Forty-three subjects between 20 and 29 years old with normal hearing (≤ 20 dB HL) in the frequency range between 0.125 to 8 kHz.

RESULTS

No significant correlations were seen between high-frequency hearing thresholds defined as average best and worst ear high-frequency hearing thresholds and the cognitive measures. Differences between the best and the worst ear showed significant negative correlations with inhibitory control and global executive function (combination score for WMC, inhibitory control and cognitive flexibility).

CONCLUSIONS

The present study suggests that global executive functions, more specifically response inhibition, and hearing threshold asymmetry in the extended high-frequency range are interrelated.

Immediate Passage Comprehension and Encoding of Information Into Long-Term Memory in Children With Normal Hearing: The Effect of Voice Quality and Multitalker Babble Noise

PURPOSE

This study examines how voice quality and multitalker babble noise affect immediate passage comprehension and the efficiency of information encoding into long-term memory in children with normal hearing.

METHOD

Eighteen children (mean age = 9 years) with normal hearing participated. Immediate passage comprehension performance and delayed performance (after 5 to 8 days) were assessed for 4 listening conditions: a typical voice in quiet, a typical voice in noise, a dysphonic voice in quiet, and a dysphonic voice in noise.

RESULTS

Multitalker babble noise had a significant effect on immediate and delayed performance. This effect was more pronounced for delayed performance. No significant main effect of voice quality was seen on immediate or delayed performance.

CONCLUSIONS

Multitalker babble noise impairs immediate passage comprehension and encoding of information into long-term memory for later recall in children with normal hearing. In learning situations where competing speech signals are present, background noise may reduce the prerequisites for optimal learning.

Doppler Audio Signal Analysis as an Additional Tool in Evaluation of Umbilical Artery Circulation

Purpose To investigate the predictive capacity of a new method for sound spectrum analysis of Doppler signals recorded from the umbilical artery in high-risk pregnancies. Material and Methods The retrospective study comprised 127 pregnant women with various pregnancy complications between 23 and 39 gestational weeks. Umbilical artery blood flow velocity waveforms were recorded with Doppler ultrasound and characterized by pulsatility index (PI) and blood flow class (BFC). Doppler audio signals were stored on a digital video recorder and the sound frequency at the energy level 15 dB below its peak (MAX_peak-15 dB) was estimated off-line. The prediction of probability for composite adverse pregnancy outcome (operative delivery for fetal distress, admission to neonatal intensive care unit, perinatal death) was evaluated using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. Results With increasing umbilical artery BFC, the MAX_peak-15 dB frequencies decreased (p < 0.0001) and the PI increased (p < 0.0001). The ROC AUCs for adverse outcome for MAX_peak-15 dB and for PI were 0.842 and 0.836 (p = 0.88), respectively. For the combination of MAX_peak-15 dB and PI, the corresponding AUC was 0.894, significantly higher than that of PI (p < 0.03) and of MAX_peak-15 dB (p < 0.05). Conclusion Umbilical artery Doppler sound spectrum analysis might be a useful supplement to PI in the clinical evaluation of fetoplacental circulation.

Stages of change in audiology: comparison of three self-assessment measures

OBJECTIVE

In a clinical setting, theories of health behaviour change could help audiologists and other hearing health care professionals understand the barriers that prevent people with hearing problems to seek audiological help. The transtheoretical (stages of change) model of health behaviour change is one of these theories. It describes a person's journey towards health behaviour change (e.g. seeking help or taking up rehabilitation) in separate stages: precontemplation, contemplation, preparation, action, and, finally, maintenance. A short self-assessment measure of stages of change may guide the clinician and facilitate first appointments. This article describes correlations between three stages of change measures of different lengths, one 24-item and two one-item.

DESIGN

Participants were recruited through an online hearing screening study. Adults who failed the speech-in-noise recognition screening test and who had never undergone a hearing aid fitting were invited to complete further questionnaires online, including the three stages of change measures.

STUDY SAMPLE

In total, 224 adults completed the three measures.

RESULTS

A majority of the participants were categorised as being in one of the information- and help-seeking stage of change (contemplation or preparation). The three stages of change measures were significantly correlated. Conclusions Our results support further investigating the use of a one-item measure to determine stages of change in people with hearing impairment.

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.