Computer generated probe-microphone measurements in hearing aid selection

Verification of hearing aid performance through probe-microphone measurements has gained considerable popularity in recent years. This paper presents the basic concepts and terminology in computer generated probe-microphone measurements and reviews the clinical applications of this technology.     

助听器的声场验配法

在声场测听条件下，对17名儿童（33耳）进行助听前和助听后的声场听阈测试。以助听后听阈值能否进入言语香蕉图范围来评价助听效果，为使助听效果满意，在测试时可调节助听器的各种调节使扭；测试结果显示，该法不失为助听器验配的有效方法之一。本文亦对影响本方法的一些因素做了讨论。     

怎样理解和区分"验证"和"评估"在助听器验配中的使用

听力学是一门刚刚兴起的学科，在我国尚属起步阶段，许多专业词汇都是从英语翻译过来的。为了使广大读者对听力学基本概念有更清晰的认识和理解，本刊特别开辟专栏。约请加拿大达尔豪斯大学教授Dr．David Jiang撰写系列文章，对相关词汇及英语术语加以解释和界定。此间，Dr．David Jiang将选择一些容易混淆和误读的、有代表性的术语和词语，结合现实情况。给大家做更为详尽的介绍。以期我国听力语言康复科学学术界同仁对一些英文专业词汇有更为准确和精当的理解与应用。     

助听器验配的新进展--开放耳选配技术

本文描述了助听器验配的新进展之一——开放耳选配技术,该技术主要解决助听器患者的堵耳效应问题。传统的做法是使用通气孔及开放的耳模,但不能做到真正的开放。开放耳选配技术的挑战在于如何提供合适的增益并控制反馈。近几年一种全新的数字信号处理技术(digitalsignalprocessing,DSP)即舒适技术(ComforTec)能够达到这一目的,提供清晰、自然的音质,还可以消除反馈和堵耳效应,确保聆听舒适。舒适技术包括复合宽动态范围和数字反馈抑制稳定器技术。此美观且配戴舒适的开放式助听器,必将给越来越多的听力障碍病人带来帮助。     

New aspects of hearing aid fitting in noise-induced hearing loss

In the past hearing aid fitting frequently turned out to be a problem in patients with noise-induced hearing loss. Selective amplification in the high frequency range and at the same time natural sound and appropriate wearing comfort (open fitting) could not be achieved in numerous cases. Today these problems can be tackled by modern hearing aid technology providing us with efficient feedback suppression algorithms making open fittings possible for many more patients. This development is particularly beneficial for patients with noise-induced hearing loss. Unfortunately, open fitting is in opposition to wearing hearing aids at noisy workplaces. Tight fittings, however, can be used at work if a special listening program for noisy conditions is available. This dilemma is discussed and possible solutions are pointed out.     

怎样为聋儿验配好助听器

前已述及．对于感音神经性耳聋．目前尚无有效的治疗方法，若要补偿和重建已损失的听力．学会用语言进行思维．用言语进行交流．唯一科学的手段是配戴助听器或植入人工耳蜗．然后进行系统的言语康复训练和康复教育。     

Nonlinear hearing AIDS and verification of fitting targets

This paper addresses the issue of initial verification of hearing aid gain and output for nonlinear hearing aids. Specifically, "urban legend" has it that nonlinear hearing aids with digital noise reduction circuitry may not be accurately measured using functional gain and/or probe microphone measures. Discussed are the advantages and disadvantages of both measurement strategies, and how they may be used to "acoustically match" hearing aids to individual patients. An evaluation protocol that employs both optimal aided thresholds and probe microphone measurements to assess gain, output, and audibility in hearing-impaired patients.     

Surgical management of complications after hearing aid fitting

OBJECTIVES: Standard procedures for hearing aid fitting performed in accordance with established guidelines are well tolerated, safe, and effective. In this article, we present unusual complications after hearing aid fitting that required surgical management. METHODS: Four otologists at a major university center with a combined 65 years of experience performed a retrospective analysis of their surgical practice. Six patients were identified that had encountered severe complications from improper earmold fitting that required surgical intervention. RESULTS: One patient had a perforation of the tympanic membrane with earmold material found to have migrated into the middle ear cleft. The tympanic membrane healed spontaneously, resulting in persistent otalgia and a maximum air-bone gap. The earmold cast was successfully removed by means of a tympanomastoidectomy. Two patients with presbycusis and normal ear canals developed eardrum perforations and conductive hearing deficits. In both patients, earmold material was found partially occupying the middle ear cleft and removed by way of a transcanal approach. Three patients with prior canal wall down mastoidectomy defects and narrow external ear canals required microtoscopy under general anesthesia or canaloplasty for removal of impacted material. CONCLUSION: Proper fitting of hearing aids performed by well-trained medical professionals results in a very low incidence of significant complications. Perforation of the tympanic membrane with impaction of earmold material in the middle ear or mastoid bowl may occur and can be successfully managed by standard otologic surgical techniques.     

Societal effects of hearing aid fitting among the moderately hearing impaired

The objective of this study was to evaluate hearing aid fitting from a societal viewpoint, rather than the more traditional patient perspective. The effects of hearing aid fitting on generic quality of life (EuroQol), social functioning (SF36), auditory disability, productivity at paid and unpaid labour, and medical consumption, were assessed in a prospective study among 80 moderately hearing-impaired first-time hearing aid applicants. The study showed that hearing aid fitting solved problems with paid employment, but did not seem to affect unpaid work. Use of medical services remained relatively stable after first-time hearing aid fitting. The Amsterdam Inventory proved to be a useful questionnaire to assess the effects on hearing disability. No effects of hearing aid fitting on generic quality of life could be determined with the EuroQol, while hearing aid fitting did lead to an improvement in one aspect of generic quality of life; namely social functioning.     

Evaluation of an adaptive,directional-microphone hearing aid

The effectiveness of adaptive directional processing for improvement of speech recognition in comparison to non-adaptive directional and omni-directional processing was examined across four listening environments intended to simulate those found in the real world. The test environment was a single, moderately reverberant room with four loudspeaker configurations: three with fixed discrete noise source positions and one with a single panning noise source. Sentence materials from the Hearing in Noise Test (HINT) and Connected Speech Test (CST) were selected as test materials. Speech recognition across all listening conditions was evaluated for 20 listeners fitted binaurally with Phonak Claro behind-the-ear (BTE) style hearing aids. Results indicated improved speech recognition performance with adaptive and non-adaptive directional processing over that measured with the omnidirectional processing across all four listening conditions. While the magnitudes of directional benefit provided to subjects listening in adaptive and fixed directional modes were similar in some listening environments, a significant speech recognition advantage was measured for the adaptive mode in specific conditions. The advantage for adaptive over fixed directional processing was most prominent when a competing noise was presented from the listener's sides (both fixed and panning noise conditions), and was partially predictable from electroacoustically measured directional pattern data.     

Beyond hearing aid fitting: improving communication for older adults

Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids, and many do not choose to wear hearing aids. Two group communication education programs aimed at such older people are described. The 'Keep on Talking' program has a health promotion focus, and is aimed at maintaining communication for older adults living in the community. An experimental group (n = 120) attended the program, and a control group (n = 130) received a communication assessment but no intervention. Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills. At the follow-up evaluation at 1 year, 45% of the experimental group, compared to 10% of the control group, had acted to improve their communication skills. The 'Active Communication Education' program focuses on the development of problem-solving strategies to improve communication in everyday life situations. Preliminary outcomes have been assessed on a small scale (n = 14) to date. It is concluded that communication programs represent an important adjunct to, or supplement for, the traditional approach that focuses on hearing aid fitting.     

中国小儿助听器验配程序指南

日前，经中国残疾人康复协会听力语言康复专业委员会相关专家讨论，制定并颁布了《中国小儿助听器验配程序指南》(中国聋儿康复研究中心陈振声教授执笔)。为满足我国小儿助听器验配的需要及解决存在的问题。更好地为广大听障儿童服务。2005年第一季度，中国残疾人康复协会听力语言康复专业委员会将会同中国聋儿康复研究中心在全国行业内推行该指南。本刊特全文刊发以飨读者。     

Improvement of hearing aid fitting with digital aids and new fitting strategies

Hearing aids with digital signal processing demonstrate a large dynamic range with negligible distortion and no significant inherent noise. Furthermore, many acoustic parameters allow the compensation of even severe hearing loss, and the adjustment is extremely accurate. However, the new hearing aid generation not only requires computerized fitting, but also an experienced examination with new integrated fitting procedures. In addition to in situ measurement, the hearing aid fitting should include not only the Freiburg speech test, but also the G?ttingen sentence test and the monosyllable rhyme test with different noises, for example the Fastl noise or the D?ring babble noise. Loudness scaling with different methods is particularly important.     

Survey of hearing aid fitting practices for children with multiple impairments

The fitting of amplification on young children with multiple impairments in addition to hearing loss is a challenge faced regularly by audiologists. However, very little has been published on this topic in the audiological literature. The purpose of this survey was to document hearing aid fitting practices for this population within the United States. Specifically, audiologists who regularly serve children were asked to complete a series of questions on their educational preparation and their hearing aid selection, fitting, and verification practices for children with multiple impairments. For purposes of this survey, multiple impairments included vision impairment, mental retardation, physical impairment, and autism spectrum disorders. Findings from this survey suggest that children with special needs in addition to hearing loss are typically fit in the same way and with the same type of amplification as those with hearing loss only. In addition, differences were noted in hearing aid selection, fitting, and verification practices across work settings. Future directions and research needs are suggested.     

Detecting components of hearing aid fitting using a self-assessment-inventory

The evaluation of hearing-aid fitting includes numerous assessments such as electro- and psychoacoustic tests. The subjective estimation of the hearing aid user can be elicited with self-assessment inventories encompassing various parameters, e.g., benefit, satisfaction and usage. A questionnaire comprising 11 domains (disability, handicap, frequency and significance of the listening situation, importance of the hearing aid, expectation, demand, aided performance, benefit, satisfaction and usage) within three different conditions (speech in quiet and in noise and listening to sounds) was used to detect components underlying hearing aid fitting. The data show a three-factor structure (situation-, restriction- and aid-related variables) independent from the conditions. Usage depends on all of the three factors. Disability and handicap reveal the highest values for speech in noise, whereas the aid-related factor shows the lowest values for this condition. Global satisfaction with the hearing aid is significantly correlated with the aid-related factor, but independent from the restriction of hearing. The aid-related factor is positively influenced by the amount of social activity because more active persons report higher benefit and satisfaction for all listening conditions. Age does not exhibit a significant relationship to one of the components. Basically, all correlation coefficients are only intermediate, revealing that inter-individual differences of the patients are rather high. The data indicate that extra-audiological factors might also play an important role in the success of hearing aid fitting.     

助听器验配技术指南(草案)

前言 据2006年第二次全国残疾人抽样调查结果推算,我国现有听力障碍残疾人口2780万.随着我国经济社会的快速发展,听障患者对改善听力及交流障碍的需求越来越高,而助听器是对该人群提供听力补偿和康复的重要工具.改革开放30年来,我国的助听器服务虽然有了很大发展,但仍存在着公众认识不足、市场混乱、价格偏高、服务水平参差不齐、验配不规范等问题,距我国政府发布的<全国听力障碍预防与康复规划(2007-2015)>中关于"听力障碍人群中听力保健与康复知识的知晓率达60%;新生听力障碍儿童助听器配戴(含人工耳蜗植入)率达90%"的要求尚有较大距离,因此需要全社会,尤其是听力学专业人士的共同努力,使助听器验配规范化.