A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures

Objectives: To raise awareness and propose a good practice guide for translating and adapting any hearing-related questionnaire to be used for comparisons across populations divided by language or culture, and to encourage investigators to publish detailed steps. Design: From a synthesis of existing guidelines, we propose important considerations for getting started, followed by six early steps: (1) Preparation, (2, 3) Translation steps, (4) Committee Review, (5) Field testing and (6) Reviewing and finalising the translation. Study sample: Not applicable. Results: Across these six steps, 22 different items are specified for creating a questionnaire that promotes equivalence to the original by accounting for any cultural differences. Published examples illustrate how these steps have been implemented and reported, with shared experiences from the authors, members of the International Collegium of Rehabilitative Audiology and TINnitus research NETwork. Conclusions: A checklist of the preferred reporting items is included to help researchers and clinicians make informed choices about conducting or omitting any items. We also recommend using the checklist to document these decisions in any resulting report or publication. Following this step-by-step guide would promote quality assurance in multinational trials and outcome evaluations but, to confirm functional equivalence, large-scale evaluation of psychometric properties should follow.     

Interpreting the Tinnitus Questionnaire (German version): what individual differences are clinically important?

Objective: Reporting of clinical significance is recommended because findings can be statistically significant without being relevant to patients. For aiding clinical interpretation of the Tinnitus Questionnaire (TQ), many investigators use a 5-point change cut-off as a minimal clinically important difference (MCID). But there are shortcomings in how this value was originally determined. Design: The MCID was evaluated by analysing retrospective clinical data on the TQ (German version). Following recommended standards, multiple estimates were computed using anchor- and distribution-based statistical methods. These took into account not only patients’ experience of clinical improvement, but also measurement reliability. Study sample: Pre- and post-intervention scores were assessed for 202 patients. Results: Our six estimates ranged from 5 to 21 points in TQ change score from pre- to post- intervention. The 5-point TQ change score was obtained using a method that considered change between groups, and did not account for measurement error or bias. The size of the measurement error was considerable, and this comprises interpretation of individual patient change scores. Conclusions: To enhance confidence that a TQ change over time in individual patients is clinically meaningful, we advise at least the median MCID of 12 points.     

Experiences of hearing loss and views towards interventions to promote uptake of rehabilitation support among UK adults

Objective: Effective hearing loss rehabilitation support options are available. Yet, people often experience delays in receiving rehabilitation support. This study aimed to document support-seeking experiences among a sample of UK adults with hearing loss, and views towards potential strategies to increase rehabilitation support uptake. People with hearing loss were interviewed about their experiences of seeking support, and responses to hypothetical intervention strategies, including public awareness campaigns, a training programme for health professionals, and a national hearing screening programme. Design: Semi-structured qualitative interview design with thematic analysis. Study sample: Twenty-two people with hearing loss, aged 66–88. Results: Three themes, representing barriers to receiving rehabilitation support and potential areas for intervention, were identified: making the journey from realization to readiness, combatting social stigma, and accessing appropriate services. Barriers to receiving support mostly focused on appraisal of hearing loss symptoms. Interventions enabling symptom appraisal, such as routine screening, or demonstrating how to raise the topic effectively with a loved one, were welcomed. Conclusions: Interventions to facilitate realization of hearing loss should be prioritized. Raising awareness of the symptoms and prevalence of hearing loss may help people to identify hearing problems and reduce stigma, in turn increasing hearing loss acceptance.     

Development of a hearing help-seeking questionnaire based on the theory of planned behavior

Objective: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults’ behaviours towards seeking a hearing test.

Design: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores.

Study Sample: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings.

Results: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not.

Conclusions: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.     

Development of a method for determining binaural sensitivity to temporal fine structure

Objective: To develop and evaluate a test of the ability to process binaural temporal-fine-structure (TFS) information. The test was intended to provide a graded measure of TFS sensitivity for all listeners. Design: Sensitivity to TFS was assessed at a sensation level of 30?dB using the established TFS-LF test at centre frequencies of 250, 500 and 750?Hz, and using the new TFS-AF test, in which the interaural phase difference (IPD) was fixed and the frequency was adaptively varied. IPDs varied from 30 to 180°. Study Sample: Nine young (19–25 years) and 23 older (47–84 years) listeners with normal hearing over the tested frequency range. Results: For the young listeners, thresholds on the TFS-AF test did not improve significantly with repeated testing. The rank-ordering of performance across listeners was independent of the size of the IPD, and moderate-to-strong correlations were observed between scores for the TFS-LF and TFS-AF tests. Older listeners who were unable to complete the TFS-LF test were all able to complete the TFS-AF test. Conclusions: No practice effects and strong correlations with an established test of binaural TFS sensitivity make the TFS-AF test a good candidate for the assessment of supra-threshold binaural processing.     

Factors influencing degree of hearing loss at presentation,hearing aid choice,and usage in first time hearing aid users in Singapore

Abstract

Objective: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore.

Design: Retrospective cross-sectional study.

Study sample: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013.

Results: Half of the subjects presented with more severe (>55?dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4?h of daily HA usage.

Conclusions: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly.     

Hearing impairment and hearing aid usage in Singapore

Objective: To examine the epidemiological and audiological profile, pattern of hearing aid (HA) fitting and usage among HA users in Singapore. Design: Retrospective cross-sectional study. Study sample: Cohort of 1068 subjects issued with HAs at a tertiary hospital between 2001 and 2013. Results: Mean age was 70?years with 50.8% male. Mean hearing loss (HL) was 63.1?dB and 69.5% had at least moderate-severe HL. Sensorineural HL was present in 66.4% and 69.8% had symmetrical HL. “Behind-the-Ear” HAs were cheaper than “In-Ear” HAs. Standard “Behind-The-Ear” HAs were also cheaper than “Receiver-in-Canal” HAs. Among In-Ear HAs, “In-the-Canal” and “Completely-in-Canal” were more popular than “In-the-Ear” HAs despite costing more. HA was used ≥4?days/week by 85.6% but >7?h per day by only 35.7%. Only 18% received bilateral first HA fitting. In multivariate analysis, younger age and symmetrical HL were predictors of bilateral HA uptake while better Pure-Tone-Audiometry of aided ear and >7?h of daily HA usage were predictors of successive HA fitting. Conclusions: HA users in Singapore were elderly and presented with advanced HL. Bilateral HA adoption and average daily use were low compared to other developed countries. Future research on understanding the suboptimal HA usage should explore patients' motivation, hearing disability, and HA effectiveness.     

Loudness and annoyance of disturbing sounds – perception by normal hearing subjects

Objective: Sounds in the daily environment may cause loudness and annoyance. The present study investigated the perception of loudness and annoyance for eight different sounds present in a daily sound environment and at nine different levels varying by ±20?dB around the recorded level. The outcomes were related to tests of participants’ auditory and cognitive abilities. Design: The participants undertook auditory and working memory (WM) tests prior to ratings of everyday sounds previously shown to be disturbing for persons with hearing impairment (hearing aid users). Study sample: Twenty-one participants aged between 24 and 71 years, with normal hearing threshold levels. Results: Both perceived loudness and annoyance were primarily driven by the sound level. Sounds emitted from paper were rated as having greater loudness and being more annoying than the other sound sources at the same sound level. Auditory and cognitive abilities did not influence the perception of loudness and annoyance. Conclusions: Loudness and annoyance ratings were mainly driven by sound level. Expectations of a sound seemed to influence the assessment of loudness and annoyance while auditory performance and WM capacity showed no influence on the ratings.     

Knowledge and attitude of mothers regarding infant hearing loss in Changsha,Hunan province,China

Objective: The objective of this study was to explore the knowledge and attitude among mothers of newborns regarding infant hearing loss (HL) in Changsha, Hunan province, China. Design: A questionnaire including 18 items was given to mothers. Study sample: A total of 115 mothers participated in the study. Results: Seven risk factors for hearing loss were identified correctly by above 60% of respondents and the top three were prolonged noise (88.7%), high fever (82.6%) and ear discharge (82.6%). Poor knowledge was demonstrated on risk factors jaundice (20.0%), measles (22.6%), convulsion (33.0%) and traditional Chinese medicine (39.1%). Maternal knowledge scores in identification and intervention (2.68?±?0.31) was slightly higher than the score in risk factors (2.47?±?0.34). Ninety-nine per cent of the mothers expressed the willingness to test baby’s hearing soon after birth and concern about hearing. Conclusions: Mothers were concerned about baby’s hearing and the attitude was positive. However, the correct recognition rate towards some risk factors for HL was low. Action needs to be taken to raise awareness about ear and hearing care, prevent HL caused by preventable causes and prompt early identification, early diagnosis and intervention of HL.     

A Swedish cross-cultural adaptation and validation of the Tinnitus Functional Index

Objective: The Tinnitus Functional Index (TFI) is a recent self-report instrument for tinnitus with potential advantages over other existing instruments, including a demonstrated high responsiveness. The objectives of this study were to translate and cross-culturally adapt the TFI into Swedish and to investigate its validity and reliability. Design: The development of the Swedish version (TFI-SE) followed published guidelines on cross-cultural adaptation of health questionnaires. Validity and reliability was investigated by correlating responses on the TFI-SE with other tinnitus measures [Tinnitus Handicap Inventory (THI) and visual analogue scale (VAS)] and a scale measuring anxiety and depression (HADS). Study sample: Consecutively recruited tinnitus patients (n?=?100) from four Swedish clinics completed the questionnaires. The mean age of the sample was 51 years (SD =17). Results: The internal consistency of the TFI-SE was good (α?=?0.95) and the test–retest reliability was high (ICC =0.93). Our results supported the eight-factor structure proposed for the original TFI, and a high correlation between the TFI-SE and the THI (r?=?0.8; p?r?=?0.60; p?r?=?0.59; p?Conclusions: We found that the Swedish translation and cross-cultural adaptation of the TFI is valid and reliable for use with adult tinnitus patients.     

Development and evaluation of a tablet-based diagnostic audiometer

Objective: To develop and evaluate a software application capable of conducting Pure-Tone Audiometry tests in clinical practice.

Design: We designed and developed a mobile software application for iPad devices that performs Pure-Tone Audiometry according to ANSI and IEC standards. The application is proposed to be operated by a trained audiologist inside a sound booth. No extra equipment is required. Hence, it updates the procedure by showing the versatility of the proposed system. Particularly, it provides manual and automated measurement, including air- and bone-conduction audiometry.

Study sample: Twenty-nine participants-patients of Papageorgiou Hospital, Thessaloniki, Greece were tested, with all degrees of hearing sensitivity. Manual air- and bone-conduction Pure-Tone Audiometry was conducted inside a sound booth. Participants were tested with conventional audiometry and the audiometric application, in order to validate the tablet-based audiometer for measuring hearing thresholds.

Results: The majority (90.9%) of air-conduction estimated hearing thresholds and (90.8%) of air-bone gaps were within 5?dB, compared to results obtained by conventional audiometry. Thus, threshold differences were not significant.

Conclusions: The proposed audiometer is a reliable and valid tool for hearing assessment. Owing to certain limitations, mobile devices can provide a feasible substitute for conventional audiometry in clinical practice.     

Characteristics of children with unilateral hearing loss

Objective: The purpose of this study was to describe the clinical characteristics of children with unilateral hearing loss (UHL), examine deterioration in hearing, and explore amplification decisions. Design: Population-based data were collected prospectively from time of diagnosis. Serial audiograms and amplification details were retrospectively extracted from clinical charts to document the trajectory and management of hearing loss. Sample: The study included all children identified with UHL in one region of Canada over a 13-year period (2003–2015) after implementation of universal newborn hearing screening. Results: Of 537 children with permanent hearing loss, 20.1% (108) presented with UHL at diagnosis. They were identified at a median age of 13.9 months (IQR: 2.8, 49.0). Children with congenital loss were identified at 2.8 months (IQR: 2.0, 3.6) and made up 47.2% (n?=?51), reflecting that a substantial portion had late-onset, acquired or late-identified loss. A total of 42.4% (n?=?39) showed deterioration in hearing, including 16 (17.4%) who developed bilateral loss. By study end, 73.1% (79/108) of children had received amplification recommendations. Conclusions: Up to 20% of children with permanent HL are first diagnosed with UHL. About 40% are at risk for deterioration in hearing either in the impaired ear and/or in the normal hearing ear.     

Prevalence and risk factors of hearing loss among infants in Jordan: Initial results from universal neonatal screening

Abstract

Objective: To determine the association of reported risk factors with hearing loss, and explore the possible contribution of other risk factors that may improve identifying Jordanian children for whom interventions should be provided. Design: A cross-sectional study was performed in 37 hospitals and mother-child clinics from different health sectors in Jordan. The hearing screening protocol was performed in three stages. Data collected as risk factors for infant hearing loss included those on the 2007 Joint Committee on Infant Hearing list as well as other factors believed to be possibly significant. Study sample: All babies born in or attending any of these hospitals or clinics were screened for hearing loss, which included a total of 63 041. Results: Of the 63 042 infants, 966 (1.5%) were confirmed to have significant hearing loss. We identified additional risk factors that were associated with hearing loss in infants. Conclusion: These preliminary data add to the understanding of the epidemiology of hearing loss in Jordan. The presence of at least one JCIH risk factor, admission to NICU for > 5 days, age, birth weight, postnatal hypoxia, and mode of delivery were independently associated with hearing loss.     

Evidence-based interventions of dichotic listening training,compensatory strategies and combined therapies in managing pupils with auditory processing disorders

Objective: The need to develop a measure of managing children with a single profile of auditory processing disorders (APDs), and differentiate between true and artefactual improvements necessitated the study. The study also sought to determine the efficacy of interventions – both single and combined on APD, against no-treatment. Design: A randomised controlled trial of interventions (RCT) was adopted. Participants were randomly allocated to each of the intervention groups or the no intervention group. The 10 weeks intervention included 45?minutes three times a week therapeutic intervention on listening with noise and sound localisation ability in the home and school environments. Study sample: 80 pupils (7–11 years) with a single profile of APD participated in the study. Results: Treatments were effective on the cocktail party and sound localisation. The best result was realised with the combined therapy (CT), and there was no significant difference in performance in the remaining treatment groups. Conclusion: The intervention groups were beneficial to pupils with APD and should be adopted by clinicians.     

Investigating the association between tinnitus severity and symptoms of depression and anxiety,while controlling for neuroticism,in a large middle-aged UK population

Objective: Clinical studies indicate increased risk for depression and anxiety among tinnitus patients. However population data are scarce, and no studies have controlled for neuroticism. We examined associations between tinnitus and symptoms of depression and anxiety in a large UK population, controlling for neuroticism, to explore whether neuroticism, as previously reported, fully explains the association between symptoms of depression and anxiety, and tinnitus. Design: We used the UK Biobank resource. Study sample: 171 728 participants answered hearing questions. Results: Using generalized linear modelling, we examined associations between tinnitus (mild to severe) and symptoms of depression and anxiety. Controlling for neuroticism, patients with severe tinnitus were at increased risk of depression (odds ratio (OR) = 1.27) and anxiety (OR = 1.11) symptoms, compared to those without tinnitus. Conclusions: Although it is not possible to determine whether tinnitus is a predisposing factor to depression, these results suggest an association. We suggest further exploration to determine the clinical significance of this association. Early psychosocial intervention aimed at reducing anxiety and depression in patients at increased risk might influence the extent to which tinnitus is experienced as troubling, and therefore psychological distress associated with it. Likewise, with tinnitus patients, assessment for anxiety/depression should be considered.     

Neonatal Hearing Screening: failures,hearing loss and risk indicators

To check the rate of failure, hearing loss and its association with demographic variables and risk indicators for hearing loss in newborns submitted to the Newborn Hearing Screening in a secondary hospital.Materials and MethodsCross-sectional and retrospective study, involving 1,570 newborns submitted to the different stages of the Newborn Hearing Screening Program. Initially, we carried out otoacoustic emission tests (ILO Echocheck) and the cochlear-eyelid reflex. Afterwards, we analyzed the demographic and clinical characteristics of the newborns, screening rate of failure, hearing loss and its association with demographic variables and risk indicators.ResultsTwenty-six newborns had failures in the first stages of the Program (1.7%), who were then referred to diagnostic evaluation. Of these, 16 (61.5%) did not come, two (7.7%) had normal results and eight (30.8%) were diagnosed with hearing disorders. The screening failure rate was 1.7% and the frequency of hearing disorders was 0.5%.ConclusionsPre-term newborns of very low birth weights had higher rates of screening failures and a greater occurrence of hearing changes. The factors associated with screening failure and hearing changes were similar to the ones described in the literature.     

A comparison of an audiometric screening survey with an in-depth research questionnaire for hearing loss and hearing loss risk factors

Objective: We assessed the reliability of a hearing risk factor screening survey used by hearing conservation programmes for noise-exposed workers. Design: We compared workers’ answers from the screening survey to their answers to a confidential research questionnaire regarding hearing loss risk factors. We calculated kappa statistics to test the correlation between yes/no questions in the research questionnaire compared to answers from 1 and 5 years of screening surveys. Study sample: We compared the screening survey and research questionnaire answers of 274 aluminum plant workers. Results: Most of the questions in the in-company screening survey showed fair to moderate agreement with the research questionnaire (kappa range: ?0.02, 0.57). Workers’ answers to the screening survey had better correlation with the research questionnaire when we compared 5 years of screening answers. For nearly all questions, workers were more likely to respond affirmatively on the research questionnaire than the screening survey. Conclusions: Hearing conservation programmes should be aware that workers may underreport hearing loss risk factors and functional hearing status on an audiometric screening survey. Validating company screening tools could help provide more accurate information on hearing loss and risk factors.     

Barriers to timely diagnosis and treatment for children with hearing impairment in a southern Indian city: a qualitative study of parents and clinic staff

Objective: In low income countries, deaf children are identified late due to the absence of a universal screening. Hearing impairment is a common yet neglected disability in India that leads to loss of speech and language. This qualitative study explored barriers to accessing appropriate hearing services in one city in southern India. Design: To identify the barriers in timely management of deafness, 25 semi-structured interviews were conducted. Data were examined using Applied Thematic Analysis. Study sample: Seventeen mothers of deaf children, primarily from low socioeconomic backgrounds, and eight staff members at a charitable hearing centre in Hyderabad. Results: Barriers to accessing hearing services included failure to recognise deafness, the dominant role of elders in household decisions, belief that deafness would resolve, reassurance from a child’s overall good health, lack of funds and transportation barriers to reach the centre particularly from rural areas. Parents frequently learned about services through word of mouth. Conclusions: The challenges to accessing appropriate services for deafness operate prior to presentation and include educational, cultural, navigational and financial barriers especially for those of lower socioeconomic status and residents of rural areas. The findings highlighted the need to raise awareness and implement wider screening programmes for early interventions.     

Brazilian young adults and noise: Attitudes,habits, and audiological characteristics

The objective of this study was to examine behaviors and attitudes of Brazilian teenagers towards noise, and determine their audiological characteristics. Participants were 245 young persons (14 to 18 years old) who attended private school. Behaviors and attitudes were measured using the validated Portuguese version of the Youth Attitude to Noise Scale (YANS). Pure-tone audiometry was used to evaluate the hearing of a sub-sample of 24 participants. Music played through personal media players was the most common exposure reported. A substantial percentage of participants reported temporary tinnitus (69%) after attending discos, music concerts, and listening to music through headphones. Tinnitus complaints were more frequent among females (41%) than males (27%). Four participants (1.6%) reported use of a hearing protector. Among a subsample of 24 participants, two (8%) young women had bilateral audiometric notches. YANS scores in the present study were slightly lower than those obtained in Sweden and the US, indicating a more negative attitude towards noise. Gender, age, country, and/or region are variables that will influence exposure to noise or music and possibly hearing outcomes.