Sounds perceived as annoying by hearing-aid users in their daily soundscape

Abstract

Background: The noises in modern soundscapes continue to increase and are a major origin for annoyance. For a hearing-impaired person, a hearing aid is often beneficial, but noise and annoying sounds can result in non-use of the hearing aid, temporary or permanently. Objective: The purpose of this study was to identify annoying sounds in a daily soundscape for hearing-aid users. Design: A diary was used to collect data where the participants answered four questions per day about annoying sounds in the daily soundscape over a two-week period. Study sample: Sixty adult hearing-aid users. Results: Of the 60 participants 91% experienced annoying sounds daily when using hearing aids. The annoying sound mentioned by most users, was verbal human sounds, followed by other daily sound sources categorized into 17 groups such as TV/radio, vehicles, and machine tools. When the hearing-aid users were grouped in relation to age, hearing loss, gender, hearing-aid experience, and type of signal processing used in their hearing aids, small and only few significant differences were found when comparing their experience of annoying sounds. Conclusions: The results indicate that hearing-aid users often experience annoying sounds and improved clinical fitting routines may reduce the problem.     

Self-report outcome in new hearing-aid users: Longitudinal trends and relationships between subjective measures of benefit and satisfaction

This study focussed on self-report outcome in new hearing-aid users. The objectives of the experiment were changes in self-report outcome over time, and relationships between different subjective measures of benefit and satisfaction. Four outcome inventories and a questionnaire on auditory lifestyle were administered to 25 hearing-aid users repeatedly after hearing-aid fitting, and assessments took place one week, four weeks, and 13 weeks after hearing-aid provision. The results showed that, for first-time users who used their hearing aids more than four hours per day, self-reported outcome increased over 13 weeks in some scales, although there was no change in amplification during this time. Furthermore, it was found that, for data collected immediately post-fitting, some subscales were much less face valid than for data collected later. This result indicates that the way in which hearing-aid users assess outcome changes over time. The practical consequence of the results is that early self-report outcome assessment may be misleading for some self-report outcome schemes.

Sumario

El estudio se enfocó en los resultados auto-reportados en nuevos usuarios de auxiliares auditivos (AA). Los objetivos del experimento fueron los cambios en los resultados auto-reportados en el tiempo y las relaciones entre las diferentes mediciones subjetivas de beneficio y satisfacción. Se aplicaron cuatro inventarios de resultados y un cuestionario sobre estilo de vida auditivo a 25 usuarios de AAdespués de la adaptación; la evaluación tuvo lugar una, cuatro y trece semanas después. Los resultados muestran que para los nuevos usuarios que utilizan su AA más de 4 horas al día, los resultados auto-reportados mejoran en algunas escalas en el curso de 13 semanas, aun cuando no hubiera cambio en la amplificación durante este tiempo. Incluso, se encontró que los datos colectados inmediatamente después de la adaptación, fueron menos válidos que los colectados posteriormente. Estos resultados indican que la forma en que los usuarios evalúan los resultados, cambia con el tiempo. La consecuencia práctica es que los resultados auto-reportados tempranamente pueden ser engañosos en algunos esquemas de resultados auto-reportados.     

Changes in activation of the auditory cortex following long-term amplification: an fMRI study

Conclusion. Speech-elicited activation decreased after monaural amplification bilaterally during unaided or aided ear stimulation, but tended to recover later at the contralateral hemisphere during aided ear stimulation. Objectives. The purpose of this study was to investigate the changes in the activation pattern of auditory cortex following long-term monoaural amplification. Patients and methods. Serial functional magnetic resonance images were obtained while speech sounds were presented to the aided (right) and unaided (left) ears of eight hearing-impaired subjects before, 3 months, and 9 months after beginning the use of a single hearing aid. The results were analyzed by group analysis. Results. Before hearing aid fitting, we found that activation patterns of the auditory cortex were somewhat segmented in the left hemisphere, regardless of whether the speech sounds were delivered to right or left ear. Cross projection was lost in response to right ear stimulation. After hearing aid fitting, on the unaided side stimulation, the activation tended to decrease progressively on both sides 3 months and 9 months after beginning monoaural amplification. On the aided side stimulation, activation also decreased 3 months after amplification bilaterally, but tended to recover at the contralateral hemisphere after 9 months of amplification. Cross projection was restored in response to right ear stimulation.     

Hearing-aid use and its determinants in the UK National Health Service: A cross-sectional study at the Royal Surrey County Hospital

Objectives: The aim of this study was to investigate the rate of and factors contributing to non-adherence to hearing-aid use in the UK National Health Service. Design: A cross-sectional postal questionnaire survey. Study sample: A questionnaire, including the International Outcome Inventory for Hearing Aids, was sent to all patients fitted with hearing aids at the Royal Surrey County Hospital between 2011 and 2012 (N = 1874). A total of 1023 questionnaires were completed and returned (response rate of 55%). Results: A total of 29% of responders did not use their hearing aids on a regular basis (i.e. used them less than four hours per day). Non-regular use was more prevalent in new (40%) than in existing patients (11%). Factors that reduced the risk of non-regular use included bilateral versus unilateral amplification, and moderate or severe hearing loss in the better ear. 16% of responders fitted with bilateral amplification used only one of their hearing aids. Conclusions: The level of non-regular use of hearing aids in NHS found in this study was comparable to those for other countries. Additional support might be needed for patients at a higher risk of non-regular use.     

Discrimination of release time constants in hearing-aid compressors

We examined the ability of twenty-five hearing-impaired and eight normal-hearing listeners to discriminate between release time constants used for compression in hearing aids. The compressor was a standard three-channel system. The stimuli were normal and ‘vocoded’ sentences from a male and female database. In agreement with other studies looking at different outcomes, performance varied greatly across individuals. This variation was greater in hearing-impaired listeners, for whom the discriminability of a release time of 5 ms from one of 5000 ms (with the attack time fixed at 5 ms) ranged from chance to perfect. This variability was not significantly related to hearing impairment nor to individuals’ compression ratios.     

A randomized controlled trial evaluating the effects of online rehabilitative intervention for adult hearing-aid users

Abstract

Objective: Previous research shows that the internet can be used in the rehabilitation of hearing-aid users. By further developing the online program, it might be possible to foster behavioral changes that will positively affect hearing-aid users. Design: A randomized controlled study with two groups of participants. The intervention group underwent a five-week online intervention while the control group was referred to a waiting list. Questionnaires were used as outcome measures. Study sample: Seventy-six experienced hearing-aid users participated in the study, ranging in age from 26 to 81 years (mean 69.3 years). Results: The findings showed significant improvements in the intervention group after the intervention, measured by the hearing handicap inventory for the elderly. The effects were maintained and improved at the follow-up. Furthermore, the results indicated that the participants in the intervention group improved at two items of the international outcome inventory for hearing aids, and the effects were partly maintained at the follow-up. Finally, significant improvements in the domain of psychosocial wellbeing were found at the follow-up. Conclusions: This study provides further evidence that the internet can be used to deliver intervention of rehabilitation to hearing-aid users.     

Variation in preferred gain with experience for hearing-aid users

This study aimed to determine whether gain adaptation occurs, and at which frequency bands, among new hearing aid (HA) users. Fifty new and 26 experienced HA users were fitted with three listening programs (NAL-NL1 and NAL-NL1 with low- and high-frequency cuts) in the same hearing instrument family. Real-life gain preferences and comfortable loudness levels were measured one, four, and 13 months post-fitting for the new HA users, and one month post-fitting for the experienced HA users. Relative to experienced HA users, new HA users preferred progressively less overall gain than prescribed as the hearing loss became more severe. Gain adaptation occurred in new HA users with greater hearing loss, but was not complete 13 months post-fitting, and was not explained by changes in loudness perception. Preferences for a high-frequency gain cut by half of all study participants could not be predicted from audiological data. Gain adaptation management is recommended for new HA users with more than a mild hearing loss.     

A review of clinical trials regarding treatment of acute otitis media

A survey was made of the English language literature on clinical trials of therapy in acute otitis media. The articles were analysed systematically for 24 parameters related to study design. We retrieved 50 studies published between 1965 and 1989. Surprisingly, the combination of a double-blind method, clearly defined inclusion criteria, and criteria for outcome was found in only 13 studies. Most of these 13 compared different antibiotic regimens and only 4 were placebo-controlled. A recommendation based on the conclusions reached can, even in these 13 studies, hardly be obtained due to failure to show an overall difference in favour of a specific treatment regimen. Our study shows that many trials are methodologically flawed which makes it difficult to accept their results. In view of current controversy on management of acute otitis media, well conducted placebo-controlled clinical trials are still needed.     

Night-to-night variation in snoring sound severity: one night studies are not reliable

Clin. Otolaryngol. 2010, 35 , 198–203 Objectives: To quantify the night-to-night variation in snoring severity; to compare this with inter-subject variation in snoring intensity: to compare multinight mean snoring scores with self-reported subjective scores. Design: Prospective observational study. Setting: Subjects were recorded during sleep at their own homes. Participants: Twenty patients with socially disruptive snoring awaiting surgery. Main outcome measures: Over four consecutive nights using a solid-state sound recording device, the mean, standard deviation and intra-class correlation coefficient were calculated for (a) the loudest 1% of sound, (b) snore frequency and (c) total snore duration. Results were correlated with Snoring Symptom Inventory scores assessed immediately prior to these recordings. Results: Overall mean and intrasubject standard deviation for the loudest 1% of sound was 65.0 (±4.1) dB, for snore frequency was 245 (±104) per hour and for total snore duration was 4.3% (±2.1). Intraclass correlation coefficients were 0.78, 0.74 and 0.67, respectively, suggesting only moderate reliability of these outcome measures. No significant correlation was found between objective and subjective scores for either endpoint. Conclusion: Natural night-to-night variation in snoring severity represents a significant proportion of overall snoring variance, thus one night studies of snoring are not reliable. The random error associated with one-night studies exceeds the expected effect size of snoring interventions and so multi-night studies of at least four nights are recommended to reduce the error. However, even multi-night objective measurements correlate poorly with subjective scores of snoring.     

Comparison of study designs for acute otitis media trials

BACKGROUND: A framework for evaluating the efficacy of antibiotics in development as well as those currently approved for acute otitis media (AOM) is needed. OBJECTIVE: Review strengths and limitations of various antibiotic trial designs and their outcome measures. METHODS: A review of 157 published trials involving 36,710 subjects for the treatment of AOM. RESULTS: AOM trials have three designs: (1) clinical, clinical diagnosis and assessment of outcomes; (2) single tympanocentesis, microbiologic diagnosis (by middle ear fluid culture) and clinical assessment of outcomes; and (3) double tympanocentesis, microbiologic diagnosis and microbiologic outcome assessment. Identifiable strengths and limitations of each design are reviewed. Case definitions for entry of children in trials of AOM vary widely. The lack of stringent diagnostic criteria in a clinical design allows for inclusion of a significant proportion of children with a non-bacterial etiology (i.e., viral AOM or otitis media with effusion). Tympanocentesis increases diagnostic accuracy at study entry; however, the procedure is confounding because of its potentially therapeutic benefit and the procedure is not performed in a uniform manner. A second tympanocentesis allows a high sensitivity to detect microbiologic eradication, but it does not correlate with clinical outcomes in half of the cases. The timing of outcome assessment also varies widely among trials. CONCLUSIONS: Improved clinical diagnosis criteria for AOM are needed to enhance specificity; emphasis on a bulging tympanic membrane has the best evidence base. Tympanocentesis within study designs has merits. At study entry it assures diagnostic accuracy but may alter outcomes and it is useful to document microbiologic outcomes but lacks specificity for clinical outcomes. For all designs, test of cure assessment 2-7 days after completion of therapy seems most appropriate.     

Is pseudosulcus alone a reliable sign of gastroesophago‐pharyngeal reflux?

Is pseudosulcus alone a reliable sign of gastroesophago‐pharyngeal reflux? To investigate if laryngeal pseudosulcus (bilateral infraglottic oedema) is a reliable sign of pharyngeal reflux, the video recordings of 59 patients and 18 controls were examined off‐line by two phoniatricians. Eleven video segments were duplicated for calculation of intrarater reliability. The frequency of pseudosulcus was correlated to the results of 24‐h double‐probe pH monitoring. The intrarater reliability was moderate (K = 0.582; P = 0.005). The sensitivity of pseudosulcus in the diagnosis of pharyngeal reflux among the patients was 30% and among the controls it was 0%. The positive predictive value (PPV) of pseudosulcus for patients with pharyngeal and laryngeal symptoms was 67%, while for the controls it was 0%. The negative predictive value (NPV) of pseudosulcus for patients with pharyngeal or laryngeal symptoms was 32% and for the controls it was 64%. The single finding of pseudosulcus is not a very sensitive predictor of pharyngeal reflux but if the patient has laryngeal symptoms and a pseudsulcus, the probability that the patient has pharyngeal reflux is almost 70%.     

The effect of frequency-dependent microphone directionality on horizontal localization performance in hearing-aid users

Abstract

Frequency-dependent microphone directionality alters the spectral shape of sound as a function of arrival azimuth. The influence of this on horizontal-plane localization performance was investigated. Using a 360° loudspeaker array and five stimuli with different spectral characteristics, localization performance was measured on 21 hearing-impaired listeners when wearing no hearing aids and aided with no directionality, partial (from 1 and 2 kHz) directionality, and full directionality. The test schemes were also evaluated in everyday life. Without hearing aids, localization accuracy was significantly poorer than normative data. Due to inaudibility of high-frequency energy, front/back reversals were prominent. Front/back reversals remained prominent when aided with omnidirectional microphones. For stimuli with low-frequency emphasis, directionality had no further effect on localization. For stimuli with sufficient mid- and high-frequency information, full directionality had a small positive effect on front/back localization but a negative effect on left/right localization. Partial directionality further improved front/back localization and had no significant effect on left/right localization. The field test revealed no significant effects. The alternative spectral cues provided by frequency-dependent directionality improve front/back localization in hearing-aid users.

Sumario

La direccionalidad de un micrófono frecuencia-dependiente altera la configuración espectral del sonido como función del azimuth de llegada. Se investigó la influencia de esto en el desempeño para la localización en el plano horizontal. Usando un sistema de altoparlante 360° y cinco estímulos con diferentes características espectrales, se midió el desempeño para la localización en 21 hipoacúsicos, sin usar auxiliares auditivos y con el apoyo de no direccionalidad, de direccionalidad parcial (de 1 y 2 kHz) y con direccionalidad total. Los esquemas de la prueba también se evaluaron en la vida cotidiana. Sin auxiliares auditivos, la precisión para localizar fue significativamente más pobre que los datos normativos. Debido a la inaudibilidad de la energía de altas frecuencias, las inversiones frente/atrás fueron prominentes. Las inversiones frente/atrás permanecieron prominentes cuando hubo apoyo con micrófonos omnidireccionales. Para estímulos con énfasis en frecuencias graves, la direccionalidad no tuvo un efecto adicional en la localización. Con estímulos cuya información de frecuencias medias y altas fue suficiente, la direccionalidad total tuvo un pequeño efecto positivo para la localización frente/atrás, pero un efecto negativo en la localización izquierda/derecha. La direccionalidad parcial mejoró adicionalmente la localización frente/atrás pero no tuvo un efecto significativo en la localización izquierda/derecha. La prueba de campo no mostró efectos significativos. Las claves espectrales alternativas proporcionadas por la direccionalidad frecuencia-dependiente, mejoraron la localización frente/atrás en usuarios de auxiliares auditivos.     

Psychological implications in ENT diseases

We are sometimes faced with psychic derangement or overlay in some of the ENT diseases and the link between patient’s psyche and any ENT disease at times becomes signifi cant and troublesome. The conditions in the fi eld between otorhinolaryngology and psychiatry can be classifi ed as psychiatric symptoms resulting from ENT diseases or interventions and those expressing themselves as ENT symptoms due to mental ailment. The former include hearing impairment, dizziness, tinnitus, choked airway, bad oral breath, stuffy nose, traumatic interventions and external nasal deformities. The later include exaggerated and diminished pharyngeal refl ex, globus hystericus, speech disorders, vasomotor rhinitis, nose picking, choked feeling, dizziness and headache. At times diseases originate in the human mind (consciousness), causing negative thoughts like jealousy, anger, and depression due to frustration. p ]A healthy mind in a healthy body generates sound and noble thoughts. Once a healthy body-mind relationship is established, we can be reasonably sure that greater happiness and success is within our reach. Patient seeking help from ENT surgeons to change their physical appearances and or function may not understand that the ultimate goal of surgery is to bring about psychological change by modifying the physical change, which is important aspect in septorhinoplastic surgery. At times patients asking for corrective rhinoplasty for minor external nasal deformities may have underlying psychological disturbance and use even slight external nasal deformity as scapegoat for psychological upset. Males are more diffi cult patients psychologically for any facial cosmetic surgery. These days some patients read about their diseases or treatment on the Internet and get more confused and psychologically disturbed due to rare causes of their illness, rare complications and diversity of treatment available.     

Acceptable noise level (ANL) and real-world hearing-aid success in Taiwanese listeners

Abstract

Objective: The objective of this prospective study was to investigate the relationship between acceptable noise level (ANL), which was measured using Taiwanese and the international speech test signal (ISTS), and real-world hearing-aid success for listeners who were representative of the population commonly seen in clinics. Design: Unaided ANLs were measured pre-hearing-aid fitting. Hearing-aid success was assessed three months post-fitting using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Study sample: Eighty adults with hearing impairment completed the study. Results: Both Taiwanese and ISTS ANLs were significantly associated with hearing-aid success, with higher ANLs suggesting poorer outcomes. However, the ANL's prediction accuracy for the probability of hearing-aid success was either much lower than that suggested by some literature, or was not much different from that of simply predicting all listeners as successful users. Conclusions: The current study suggested the possibility of using ANL to predict hearing-aid success. However, the usefulness of ANL as a clinical tool is unlikely to be as great as indicated by the literature.     

Development of the speech test signal in Brazilian Portuguese for real-ear measurement

Abstract

Objective: Recommended practice is to verify the gain and/or output of hearing aids with speech or speech-shaped signals. This study has the purpose of developing a speech test signal in Brazilian Portuguese that is electroacoustically similar to the international long-term average speech spectrum (ILTASS) for use in real ear verification systems. Design: A Brazilian Portuguese speech passage was recorded using standardized equipment and procedures for one female talker and compared to ISTS. The passage consisted of simple, declarative sentences making a total of 148 words. Study sample: The recordings of a Brazilian Portuguese passage were filtered to the ILTASS and compared to the International Speech Test Signal (ISTS). Aided recordings were made at three test levels, for three audiograms for the Brazilian Portuguese passage and the ISTS. Results: The unaided test signals were spectrally matched to within 0.5 dB. Aided evaluation revealed that the Brazilian Portuguese passage produced aided spectra that were within 1 dB on average, within about 2 dB per audiogram, and within about 3 dB per frequency for 95% of fittings. Conclusion: Results indicate that the Brazilian Portuguese passage developed in this study provides similar electroacoustic hearing-aid evaluations to those expected from the standard ISTS passage.     

Health-related quality of life in adults with hearing impairment before and after hearing-aid rehabilitation in Finland

Objective: The aim of this study was to evaluate health-related quality of life (HRQoL) in adults with hearing impairment in Finland before and after hearing rehabilitation. Design: The study was prospective with hearing-aid rehabilitation as the intervention. The data was collected, using the 15D instrument, before and six months after hearing-aid rehabilitation. The data was analysed using t-tests and multiple linear regression methods. Study sample: The study sample included 949 adults with hearing impairment, and the control group included a sample of age- and gender-standardized general population. Results: The study population had significantly poorer HRQoL on most dimensions of the 15D when compared to the control group both before and after hearing-aid rehabilitation. Hearing-aid rehabilitation resulted in improved mean scores on the dimensions of hearing and in the overall 15D score that were statistically significant, although the mean improvement in the overall score was marginal. Self-reported hearing ability can better predict the change in HRQoL, as a result of a hearing aid, when compared with measured hearing sensitivity. Conclusions: The study supports the hypothesis that on average, use of a unilateral hearing aid results in improved subjective hearing and marginal improvement in HRQoL in adults with hearing impairment.     

Acceptable noise level (ANL) with Danish and non-semantic speech materials in adult hearing-aid users

Abstract

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.     

Stimulus and transducer effects on threshold

Abstract

Objective: This study examined differences in thresholds obtained under Sennheiser HDA200 circumaural earphones using pure tone, equivalent rectangular noise bands, and 1/3 octave noise bands relative to thresholds obtained using Telephonics TDH-39P supra-aural earphones. Design: Thresholds were obtained via each transducer and stimulus condition six times within a 10-day period. Study sample: Forty-nine adults were selected from a prior study to represent low, moderate, and high threshold reliability. Results: The results suggested that (1) only small adjustments were needed to reach equivalent TDH-39P thresholds, (2) pure-tone thresholds obtained with HDA200 circumaural earphones had reliability equal to or better than those obtained using TDH-39P earphones, (3) the reliability of noise-band thresholds improved with broader stimulus bandwidth and was either equal to or better than pure-tone thresholds, and (4) frequency-specificity declined with stimulus bandwidths greater than one equivalent rectangular band, which could complicate early detection of hearing changes that occur within a narrow frequency range. Conclusions: These data suggest that circumaural earphones such as the HDA200 headphones provide better reliability for audiometric testing as compared to the TDH-39P earphones. These data support the use of noise bands, preferably ERB noises, as stimuli for audiometric monitoring.