Elisabet Sundewall Thorén

Working Memory Capacity May Influence Perceived Effort during Aided Speech Recognition in Noise

BACKGROUND Recently there has been interest in using subjective ratings as a measure of perceived effort during speech recognition in noise. Perceived effort may be an indicator of cognitive load. Thus, subjective effort ratings during speech recognition in noise may covary both with signal-to-noise ratio (SNR) and individual cognitive capacity. PURPOSE The present study investigated the relation between subjective ratings of the effort involved in listening to speech in noise, speech recognition performance, and individual working memory (WM) capacity in hearing impaired hearing aid users. RESEARCH DESIGN In two experiments, participants with hearing loss rated perceived effort during aided speech perception in noise. Noise type and SNR were manipulated in both experiments, and in the second experiment hearing aid compression release settings were also manipulated. Speech recognition performance was measured along with WM capacity. STUDY SAMPLE There were 46 participants in all with bilateral mild to moderate sloping hearing loss. In Experiment 1 there were 16 native Danish speakers (eight women and eight men) with a mean age of 63.5 yr (SD = 12.1) and average pure tone (PT) threshold of 47. 6 dB (SD = 9.8). In Experiment 2 there were 30 native Swedish speakers (19 women and 11 men) with a mean age of 70 yr (SD = 7.8) and average PT threshold of 45.8 dB (SD = 6.6). DATA COLLECTION AND ANALYSIS A visual analog scale (VAS) was used for effort rating in both experiments. In Experiment 1, effort was rated at individually adapted SNRs while in Experiment 2 it was rated at fixed SNRs. Speech recognition in noise performance was measured using adaptive procedures in both experiments with Dantale II sentences in Experiment 1 and Hagerman sentences in Experiment 2. WM capacity was measured using a letter-monitoring task in Experiment 1 and the reading span task in Experiment 2. RESULTS In both experiments, there was a strong and significant relation between rated effort and SNR that was independent of individual WM capacity, whereas the relation between rated effort and noise type seemed to be influenced by individual WM capacity. Experiment 2 showed that hearing aid compression setting influenced rated effort. CONCLUSIONS Subjective ratings of the effort involved in speech recognition in noise reflect SNRs, and individual cognitive capacity seems to influence relative rating of noise type.

Rehabilitative online education versus internet discussion group for hearing aid users: a randomized controlled trial.

BACKGROUND By using the Internet in the audiological rehabilitation process, it might be possible in a cost-effective way to include additional rehabilitation components by informing and guiding hearing aid users about such topics as communication strategies, hearing tactics, and how to handle hearing aids. PURPOSE To evaluate the effectiveness of an online education program for adult experienced hearing aid users including professional guidance by an audiologist and compare it with the effects of participation in an online discussion forum without any professional contact. RESEARCH DESIGN A randomized controlled study with two groups of participants. Repeated measures at prestudy, immediate follow-up, and a 6 mo follow-up. STUDY SAMPLE Fifty-nine experienced hearing aid users participated in the study, ranging in age from 24 to 84 yr (mean 63.5 yr). INTERVENTION The intervention group (N = 29) underwent a five-week rehabilitative online education in which activities for each week included information, tasks, and assignments, and contact with a professional audiologist was included. The participants in the control group (N = 30) were referred to an online discussion forum without any audiologist contact. DATA COLLECTION AND ANALYSIS A set of questionnaires administered online were used as outcome measures: (1) Hearing Handicap Inventory for the Elderly, (2) International Outcome Inventory for Hearing Aids, (3) Satisfaction with Amplification in Daily Life, and (4) Hospital Anxiety and Depression Scale. RESULTS Significant improvements measured by the Hearing Handicap Inventory for the Elderly were found in both groups of participants, and the effects were maintained at the 6 mo follow-up. The results on the Hospital Anxiety and Depression Scale showed that the participants in the intervention group showed reduced symptoms of depression immediately/6 mo after the intervention. At the 6 mo follow-up participants in the control group reported fewer symptoms of anxiety than they did before the intervention started. CONCLUSIONS This study provides preliminary evidence that the Internet can be used to deliver education to experienced hearing aid users who report residual hearing problems such that their problems are reduced by the intervention. The study also suggests that online discussion forums could be used in rehabilitation. A combination of online professional supervised education and online informal discussions could be a promising rehabilitation tool.

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.

The use of research questionnaires with hearing impaired adults: online vs. paper-and-pencil administration.

BackgroundWhen evaluating hearing rehabilitation, it is reasonable to use self-report questionnaires as outcome measure. Questionnaires used in audiological research are developed and validated for the paper-and-pencil format. As computer and Internet use is increasing, standardized questionnaires used in the audiological context should be evaluated to determine the viability of the online administration format.The aim of this study was to compare administration of questionnaires online versus paper- and pencil of four standardised questionnaires used in hearing research and clinic. We included the Hearing Handicap Inventory for the Elderly (HHIE), the International Outcome Inventory for Hearing Aids (IOI-HA), Satisfaction with Amplification in Daily Life (SADL), and the Hospital Anxiety and Depression Scale (HADS).MethodsA cross-over design was used by randomly letting the participants complete the questionnaires either online or on paper. After 3 weeks the participants filled out the same questionnaires again but in the other format. A total of 65 hearing-aid users were recruited from a hearing clinic to participate on a voluntary basis and of these 53 completed both versions of the questionnaires.ResultsA significant main effect of format was found on the HHIE (p < 0.001), with participants reporting higher scores on the online format than in the paper format. There was no interaction effect. For the other questionnaires were no significant main or interaction effects of format. Significant correlations between the two ways of presenting the measures was found for all questionnaires (p<0.05). The results from reliability tests showed Cronbachs α’s above .70 for all four questionnaires and differences in Cronbachs α between administration formats were negligible.ConclusionsFor three of the four included questionnaires the participants’ scores remained consistent across administrations and formats. For the fourth included questionnaire (HHIE) a significant difference of format with a small effect size was found. The relevance of the difference in scores between the formats depends on which context the questionnaire is used in. On balance, it is recommended that the administration format remain stable across assessment points.

Internet Access and Use in Adults With Hearing Loss

Background The future rehabilitation of adults with hearing loss is likely to involve online tools used by individuals at home. Online tools could also be useful for people who are not seeking professional help for their hearing problems. Hearing impairment is a disability that increases with age, and increased age is still associated with reduced use of the Internet. Therefore, to continue the research on online audiological rehabilitative tools for people with hearing loss, it is important to determine if and to what extent adults with hearing loss use the Internet. Objective To evaluate the use of the Internet and email in a group of adults with hearing loss and to investigate if their use of Internet and email differed between genders, among different age groups, and how it compared with the general population in Sweden. Methods Questionnaires containing multiple-choice questions about Internet access, email use, and educational level were mailed to individuals with hearing loss, who were registered as patients at a hearing aid clinic. Out of the 269 invited participants, 158 returned a completed questionnaire, which was a response rate of 58.7%. Results The results showed that 60% (94/158) of the participants with hearing loss used computers and the Internet. The degree of hearing loss in the group of participants did not explain the level of Internet usage, while factors of age, gender, and education did (P<.001). More men than women used the Internet (OR 2.54, 95% CI 1.32-4.91, P<.001). Use of the Internet was higher in the youngest age group (25-64 years) compared to the oldest age group (75-96 years, P=.001). A higher usage of the Internet was observed in the participants with hearing loss, especially the elderly, when compared with the general population of Sweden (OR 1.74, 95% CI 1.23-3.17, P=.04). Conclusions We conclude that the use of computers and the Internet overall is at least at the same level for people with hearing loss as for the general age-matched population in Sweden, but that this use is even higher in specific age groups. These results are important for the future work in developing and evaluating rehabilitative educational online tools for adults with hearing loss.

Readability of Internet Information on Hearing: Systematic Literature Review

PURPOSE This systematic literature review asks the following question: “ What is the readability of Internet information on hearing that people with hearing impairment and their significant others can access in the context of their hearing care?” METHOD Searches were completed in three databases: CINAHL, PubMed, and Scopus. Seventy-eight records were identified and systematically screened for eligibility: 8 records were included that contained data on the readability of Internet information on hearing that people with hear ing impairment and their significant others can access in the context of their hearing care. RESULTS Records reported mean readability levels from 9 to over 14. In other words, people with hearing impairment and their significant others need 9 to 14 years of education to read and understand Internet information on hearing that they access in the context of their hearing care. CONCLUSION The poor readability of Internet information on hearing has been well documented; it is time to focus on valid and sustainable initiatives that address this problem.

Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance

Abstract Objective: This study provides descriptive statistics of the Danish reading span (RS) test for hearing-impaired adults. The combined effect of hearing loss, RS score, and age on speech-in-noise performance in different spatial settings was evaluated in a subset of participants. Design: Data from published and unpublished studies were re-analysed. Data regarding speech-in-noise performance with co-located or spatially separated sound sources were available for a subset of participants. Study sample: RS scores from 283 hearing-impaired participants were extracted from past studies, and 239 of these participants had completed a speech-in-noise test. Results: RS scores (mean = 41.91%, standard deviation = 11.29%) were related to age (p <0.01), but not pure-tone average (PTA) (p = 0.29). Speech-in-noise performance for co-located sound sources was related to PTA and RS score (both p < 0.01, adjusted R-squared = 0.226). Performance for spatially separated sounds was related to PTA (p < 0.01, adjusted R-squared = 0.10) but not RS score (p = 0.484). We found no differences between the standardized coefficients of the two regression models. Conclusions: The distribution of RS scores indicated a high test difficulty. We found that age should be controlled when RS scores are compared across populations. The experimental setup of the speech-in-noise test may influence the relationship between performance and RS score.

Internet Interventions for Hearing Loss.

PURPOSE The purpose of the two studies presented in this research forum article was to develop audiological rehabilitation programs for experienced hearing aid users and evaluate them in online versions. In this research forum article, the differences between the two studies are discussed. METHOD Two randomized controlled trials (RCTs) were performed evaluating the efficacy of online rehabilitation, including professional guidance by an audiologist. In each RCT, the effects of the online programs were compared with the effects measured in a control group. RESULTS The results from the first RCT showed a significant increase in activity and participation for both groups with participants in the intervention group improving more than those in the control group. At the 6-month follow-up, after the study, the significant increase was maintained; however, amounts of increase in the two groups were no longer significantly different. The results from the second RCT showed significant increase in activity and participation for the intervention group, although the control group did not improve. CONCLUSIONS The results from the RCTs provide evidence that the Internet can be used to deliver rehabilitation to hearing-aid users and that their problems are reduced by the intervention; however, the content of the online rehabilitation program requires further investigation.

Experiences of an Internet-based aural rehabilitation (IAR) program for hearing aid users: a qualitative study

Abstract Objective: Internet interventions for hearing aid (HA) users have been shown to be effective in helping persons with hearing problems. As earlier research refers to objective data on these effects, little is known about how participants experience the Internet interventions subjectively. The aim of the present study was to explore participants’ experiences of an Internet-based aural rehabilitation (IAR) program for HA-users, and to explore the possible subjective benefits of such a program. Design: A qualitative exploratory design was implemented involving semi-structured telephone interviews. The interviews were transcribed and analysed using content analysis. Study sample: Interviews were conducted with 20 participants (9 men and 11 women) who had completed an IAR program for HA-users. The participants were 57–81 years old and had used HAs for 2–25 years. Results: The results are organised in three main categories: general experiences associated with participating in the program, knowledge obtained from the program and perceived impact of taking part in the program. Conclusions: The overall results indicate positive experiences of the IAR program, and an overreaching theme of increased self-esteem was identified. The findings provide some valuable information for developers of future IAR programs.

Self-Assessment of Hearing, 2nd Edition

rst version of the book Self-assessment of hearing and related functions resulted from a task force of the International Collegium of Rehabilitative Audiology (ICRA) in 1998. The task force was mandated to review available literature describing the development and use of different questionnaires. As it became clear to the author (William Noble) and his colleague Stuart Gatehouse during the review process that there was need for a new questionnaire, they developed and tested the questionnaire ‘ Speech, Spatial and Qualities of Hearing ’ (SSQ). After the fi rst version of the book Self-assessment of hearing was published in 1998, the World Health Organization (WHO) redefi ned the term ‘ handicap ’ . This affected questionnaires designed to capture how a person perceives his or her handicap. In light of the above, it was natural to draft a new edition of the book to include the latest work with SSQ and also to demonstrate how the edited WHO-defi nitions affect outcome measures in the different subjective tools. The book Self-assessment of hearing is divided into two parts. The fi rst part presents basic theories, concepts and defi nitions relevant to the subject of self-assessment. The second part presents more than 300 references divided into categories, e.g. hearing aids, CI, and tinnitus. In Chapter 1 the author presents the theoretical background relevant for self-assessment and discusses the importance of selfassessment. The theoretical parts are kept on a general level, including concepts relevant for the questionnaires. In Chapter 2 the author discusses the WHO defi nitions (ICF, WHO 2001), and voices criticism and scepticism against the revised defi nitions and reasons, on the concept of communication, under which category the revised defi nitions can be placed. The author expresses that the concepts of impairment , disability, and handicap give a clearer framework where consequences of hearing loss fi t better than in the revised defi nition. In Chapter 3 the author provides an overview of 136 references for hearing in general, divided into three subcategories describing (1) the composition of new questionnaires from 1964 to 2004, (2) the further development of already existing questionnaires, and (3) the use of questionnaires in different situations. The author writes about the development of the self-assessment SSQ in Chapter 4 and explains that the starting point was to develop a ‘ ... self-assessment device that drills more effectively into the function of hearing in the everyday world ’ , where the goal was to construct a tool with focus on handicap-emotional distress and social withdrawal. The original version of the questionnaire contained 49 questions divided into three domains (speech, spatial, and qualities) with a continuous focus on communication. In recent years, various versions of the questionnaire have been tested, and today also shorter versions are available. In Chapters 5 – 8, the author gives a solid overview of how to use self-assessment to evaluate different domains of rehabilitation. The author begins with rehabilitation including hearing aids when seeking answers to questions that do not relate to acoustic or psychoacoustic achievements and/or improvements. He divides the review-results in subsections and ends the chapter with a table including 105 references that evaluate HA amplifi cation using different forms of questionnaires. Chapter 6 focuses on cochlear implants (CI) and middle-ear implants, and both methods are described at a general level that requires no prior knowledge. The chapter concludes with two tables giving an overview of the literature in which the effect of CI (17 references) and middle-ear implants (4 references) were evaluated. In Chapter 7 the author presents an overview of studies that used self-assessment to identify the degree of tinnitus. The chapter deals with various approaches including masking, hearing aids, cognitive behavioural therapy (CBT) and/or placebo; and concludes with a table of 44 references that have all used different forms of questionnaires to diagnose/categorize the degree of tinnitus within a clinical as well as a research context. In the fi nal chapter the author touches on other areas and medical conditions, e.g. dizziness, communication tactics, and single-sided deafness. The author discusses the importance of interdisciplinary science to help this group of patients, especially cooperation between clinical psychology and audiology. On a concluding note, tools such as questionnaires have many functions within the fi eld of audiology; they can be used as screening tools to identify people with mild hearing losses, but they can also be applied to evaluate the result of aural rehabilitation. Effective tools are needed in different areas within audiology, objective as well as subjective, and the author of the book, Self-assessment of hearing, believes that. But it is important to be clear about what makes a questionnaire a good tool; are the questions suitable and what answers can you expect to get? How should one interpret the result? The book is written so that regardless of background or previous experience with the questionnaires, you are clearly guided through theoretical psychometrics, defi nitions, and practical applications. Moreover, the book demonstrates how to apply the questionnaires in clinical work and research and the book thereby plays an important role in the audiology literature. I believe, and so does the author, that in the future self-assessments will play an important role within the fi eld of audiology.