Anders Ringdahl

Severe-profound hearing impairment and health-related quality of life among post-lingual deafened Swedish adults

Health-related quality of life (HRQL) was measured with the Nottingham Health Profile (NHP) in 311 Swedish adults suffering from severe-profound hearing impairment (sensorineural hearing loss in the better ear of ≥70 dB HL at a frequency of 1.0 kHz) for comparisons with a normal-hearing population. The subjects completed NHP and a questionnaire regarding bio-psycho-social status. Generally, subjects with profound hearing loss reported lower HRQL. Significant differences were obtained for lack of energy, emotional reactions and social isolation. Females with profound impaired hearing tended overall to have lower HRQL than the males. The persons with severe-profound hearing impairment working full-time reported higher HRQL than those with a partial or full disablement pension and were comparable with the hearing population. Severe-profound hearing impairment is associated with an impact on HRQL of the sufferers, especially their emotional and social coping and energy resources. The profound hearing-impaired persons seem to constitute a risk group for worse psychosocial adjustment and need greater attention and support.

Activity limitation and participation restriction in adults seeking hearing aid fitting and rehabilitation

Purposes: We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics. Subjects and methods: During one year consecutive patients (n = 343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5 – 1 – 2 – 4 kHz in the better ear. Results: Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p < 0.01). In a multivariable model, the explained adjusted variance of activity limitation (R2) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors. Conclusions: As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.

Living with cochlear implants: experiences of 17 adult patients in Sweden

The aim of this grounded theory study was to gain a deeper understanding of what it means to profoundly deaf adults to undergo cochlear implantation and their experience of living with it daily. The aim of grounded theory is theorizing, i.e. constructing from data an explanatory scheme that systematically integrates various concepts and their relationships. The study group consisted of 10 women and seven men (age 29-78 years; mean age 56.5 years), who had had their cochlear implant (CI) for between 1 and 12 years (mean 4.1 years). Open taped interviews were carried out and analysed. The core category, coming back to life, defines a psychological process basic to existence, elucidating the existential value of hearing, including perceived harmony in life and becoming a part of the living world as important dimensions. This core concept is related to four additional emerging categories in a temporal order. Preventing disappointment concerns the decision to undergo the operation governed by the conception of having nothing to lose combined with low expectations of successful outcomes. Waiting in silence relates to experiences during the postoperative period such as sensations from the head and uncertainty about the outcome of surgery. The ‘switch-on’ was experienced as a significant revelation and the emotionally loaded starting point for their coming back to life. Retraining the brain concerns the lengthy audiovisual learning process, finally resulting in ‘a car sounding like a car’. Strengthening of self-worth concerns psychosocial outcomes of cochlear implantation, in terms of less dependency and increased social participation. CIs provide a substantial improvement in the quality of life, as identi- fied in the emerging generic process of coming back to life, fundamental for psychological existence. Sumario El objetivo de este estudio de teoría fundamentada en datos (grounded theory study) fue lograr un entendimiento más profundo de lo que significa para los adultos con sordera profunda la experiencia de someterse a un implante coclear y vivir con él diariamente. El propósito de la teoría fundamentada en datos es teorizar, p.e., construir un esquema explicativo basado en datos que integre sistemáticamente varios conceptos y sus relaciones. El grupo de estudio consistió de 10 mujeres y 7 hombres (29 a 78 an˜os de edad; edad media: 56.5 an˜os), quienes habían utilizado su implante coclear de 1 a 12 an˜os (media: 4.1 an˜os). Se realizaron y analizaron entrevistas grabadas abiertas. La categoría central, regresando a la vida, define un proceso psicológico básico para la existencia, dilucidando el valor existencial de la audición, e incluyendo como dimensiones importantes la armonía vital percibida y el volverse parte del mundo vivo. Este concepto central está relacionado con cuatro categorías emergentes adicionales en un orden temporal. La prevención de la decepción se relaciona con la decisión de someterse a una operación, decisión gobernada por el concepto de no tener nada que perder y combinada con una expectativa limitada de resultados exitosos. Esperar en silencio se relaciona con las experiencias durante el período post-operatorio, tales como sensaciones en la cabeza y la incertidumbre sobre el resultado de la cirugía. La “activación” del implante fue experimentada como una revelación significativa y como el punto inicial, lleno de emoción, para su retorno a la vida. El re-aprendizaje cerebral se involucra con el prolongado proceso de aprendizaje audiovisual, que resulta finalmente en un “auto que suena como auto”. El fortalecimiento de la autoestima se relaciona con el resultado psico-social de la implantación coclear, en términos de una menor dependencia y de un incremento en la participación social. Los CI aportan una mejoría sustancial en la calidad de vida, tal y como se identifica en el emergente proceso genérico de volver a la vida, que es fundamental para la existencia psicológica.

Psychological general well-being (quality of life) in patients with cochlear implants: Importance of social environment and age

The purpose of this study was to investigate the variables that affect psychological general well-being (quality of life) in patients with cochlear implants (CIs). The study sample consists of 96 adult patients with a CI, aged 24–86 years (Mean = 61.8 yrs; SD = 15.3 yrs). 48 were patients from the Sahlgrenska University Hospital in Sweden and 48 were patients from the University of Florida, USA. The Psychological General Well-being Index and the International Outcome Inventory-Cochlear implants were used in collecting data. Possible independent variables were socioeconomic factors such as age, gender, nationality, living arrangement, education, and social support; as well as length of time since implantation, age when hearing loss became a problem, and subjective benefit of the CI. A stepwise multiple regression analysis showed that 49% of the variance was explained by attitudes from others, restricted social participation, perceived social support and age. Sumario El propósito de este estudio fue el de investigar las variables que afectan el bienestar general psicológico (calidad de vida) en pacientes con implante coclear (CI). La muestra del estudio consistió en 96 adultos implantados con edades de 24–86 años (Media = 61.8 años; DS = 15.3 años): 48 pacientes del Hospital Universitario Sahlgrenska en Suecia y 48 de la Universidad de Florida, USA. Se utilizó el índice psicológico general de bienestar y el cuestionario internacional de resultados con IC para la recolección de datos. Las posibles variables independientes fueron factores socio-económicos, tales como edad, género, nacionalidad, formas de vida, educación, apoyo social y también el tiempo desde la implantación, la edad al presentarse la hipoacusia como problema y el beneficio subjetivo con el IC. Un análisis cuidadoso de regresión múltiple mostró que el 49% de la varianza puede explicarse por las actitudes de los demás, participación social restringida, percepción de apoyo social y edad.

Preferred Hearing Aid Gain in Everyday Use after Prescriptive Fitting

The insertion gain preferred by a group of 26 moderately hearing-impaired, elderly hearing-aid users was investigated in everyday listening situations. The subjects used monaural behind-the-ear aids, carefully fitted according to a prescription formula of the half-gain type, validated and used at National Acoustic Laboratories, Australia. The fitting was checked with real-ear measurements of insertion gain and reviewed at one or more follow-up sessions. The subjects were strictly instructed to try the recommended volume control setting before reporting which setting they preferred. The prescription significantly over-estimated preferred gain by about 7 dB. No correlation could be detected between prescribed versus preferred gain differences and the amount of previous hearing-aid use or the degree of subjective hearing problems.

Allergic contact dermatitis from the earmolds of hearing aids.

Hearing aid users with longstanding and severe dermatitis in the ear canal were examined by a dermatologist and patch tested. In 6 of 22 (27%) patients, contact allergy to the earmold material was found. Four of the six had a positive test reaction to methyl methacrylate and two also to triethyleneglycol dimethacrylate and urethane dimethacrylate. Positive patch test reactions to substances used for topical treatment were found as well. Routines including liberal patch testing for this group of patients are suggested.

Sound quality and speech reception for prescribed hearing aid frequency responses

Four different prescriptions of hearing aid insertion gain versus frequency were validated with a group of 26 moderately hearing-impaired, elderly hearing aid users. Three prescriptions were based on calculating the loudness and articulation index (AI) for aided speech, and ranged from a frequency response with moderate high-frequency emphasis, restoring normal loudness for speech peaks, to a response with the greatest high-frequency emphasis, maximizing the AI. The fourth prescription was a well-established formula of the half-gain type. The frequency responses were evaluated by paired comparison ratings of the pleasantness and intelligibility of speech in noise, and by speech identification tests in noise. The subjects rated the flattest response as significantly more pleasant than the other responses, and significantly more intelligible than the prescription with maximal high-frequency emphasis. There were no detectable differences in signal/noise ratios required for 50% speech identification. These results indicate that a prescription that restores normal loudness for speech peaks in each critical band is probably more easily accepted than either a procedure which is intended to make all speech bands equally loud, or a prescription which maximizes the AI.

Comparison of calculated, measured and self-assessed intelligibility of speech in noise for hearing-aid users.

The Speech Intelligibility Index (SII) was used along with paired-comparison judgements and speech recognition scores to compare the speech intelligibility provided by two hearing-aid frequency responses in two different background noises. The purpose was to validate an SII-based procedure. Test subjects were 26 hearing-aid users representing a wide range of hearing loss configurations. One hearing-aid setting was in close agreement with the NAL-R prescription, whereas the other setting was achieved by reducing the high-frequency gain by about 10 dB compared to NAL-R. There were good overall agreements between results of the three methods. Average speech recognition scores were about 4 percentage points higher for the NAL-R frequency response, which also was subjectively judged as significantly better in terms of speech intelligibility. The SII based procedure was found to be suitable for comparing hearing-aid characteristics within subjects.

Reported benefits and shortcomings of cochlear implantation by patients and their significant others.

Abstract Ninety four consecutive adults who had been fitted with cochlear implants for at least six months were sent open-ended questionnaires asking them to list the benefits and shortcomings they experienced as a result of their implants. Partners of the patients were asked to complete similar questionnaires. A wide range of benefits was reported, predominantly acoustical and psychosocial. Most of the shortcomings were acoustical and practical. Significant others reported fewer benefits and fewer shortcomings than the patients. However, the overall pattern of responses was similar. More acoustical and psychosocial benefits were reported by those fitted with cochlear implants than by those with hearing aids or bone-anchored hearing aids. Copyright

Prevalence of cochlear implants in postlingually deafened adults in a Swedish region

Cochlear implantation (CI) rates vary between countries, depending on identification routines and economic restrictions. The present study aimed at determining the prevalence of CIs in postlingually deafened, aged 20–69 years old, in Göteborg, Sweden. Three patient databases with information on PTA, a questionnaire, medical records and consultations identified 88 subjects with sensorineural hearing loss ≥80 dB HL (PTA of 500, 1000, 3000 Hz), PB word score of ≤30% (better ear), regular use of hearing-aid, and oral language. The prevalence of CIs was 11.8 per 100 000 population, and of subjects fulfilling the audiometric candidacy criteria 18.6 per 100 000. The mean PTA (op. ear) of subjects awaiting operation was 97 dB HL (SD 12.3), and of already implanted subjects 106 dB HL (SD 10.2). Mean PB word score was 9% (SD 8.9) and 3% (SD 4.9) respectively. Subjects awaiting operation had significantly better residual hearing, emphasizing recent changes in candidacy criteria. Comparing with prevalence from other countries demonstrated that more patients could be candidates for cochlear implantation. Sumario La tasa de implantes cocleares (CI) varía según los países, dependiendo de las rutinas de identificación y de las restricciones económicas. Este estudio pretende determinar la prevalencia de los CI en adultos ensordecidos de 20 a 69 años en Goteborg, Suecia. Mediante una base de datos con información sobre PTA, un cuestionario, antecedentes médicos y de consulta se identificaron 88 sujetos con hipoacusia sensorineural ≥80 dB HL (PTA de 0.5, 1.0, 3.0 kHz), calificación en palabras PB ≤ 30% (mejor oído), uso regular de auxiliares auditivos y de lenguaje oral. La prevalencia de CI fue de 11.8 por 100,000 personas y de 18.6 por 100,000 la de los sujetos que reunían los criterios audiométricos para ser candidatos. El promedio de PTA del oído propuesto en los sujetos que esperaban la operación fue de 97dB HL (SD 12.3) y en los sujetos ya implantados de 106 dB HL (SD 10.2). La calificación promedio de la prueba con palabras PB fue de 9% (SD 8.9) y 3% (SD 4.9) respectivamente. Los sujetos que estaban esperando la cirugía tenían una audición residual significativamente mejor, con énfasis en los recientes cambios en los criterios de candidatura. Comparando la prevalencia de otros países, queda demostrado que más pacientes podrían ser candidatos para implante coclear.