Gary P. Jacobson

The Voice Handicap Index (VHI)Development and Validation

To date, no instruments exist to quantify the psychosocial consequences of voice disorders. The aim of the present investigation was the development of a statistically robust Voice Handicap Index (...

The Hearing Handicap Inventory for Adults: Psychometric Adequacy and Audiometric Correlates

The Hearing Handicap Inventory for the Elderly (HHIE) was modified for use with younger hearing-impaired adults (less than 65 years of age). Similar to the HHIE, the Hearing Handicap Inventory for Adults (HHIA), is a 25-item self-assessment scale composed of two subscales (emotional and social/situational). Replacement questions from the HHIE which form the HHIA focus on the occupational effects of hearing loss. For 67 hearing-impaired adults, the HHIA demonstrated high internal consistency reliability and a low standard error of measurement. Audiometric correlates of the HHIA revealed weak, yet statistically significant relationships with pure-tone sensitivity and supra-threshold word recognition ability. These findings support the use of self-report handicap measures with adults in that audiometric measures alone are insufficient in describing a patients reaction to their hearing loss.

The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus.

Objectives: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. Design: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1. Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent—constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2. Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. Results: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions. In the final TFI, Cronbach’s alpha was 0.97 and test–retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. Conclusions: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

The Henry Ford Hospital Headache Disability Inventory (HDI)

Article abstract –To quantify the impact of headache on daily living, we developed a 25-item headache disability inventory (HDI). The alpha version of the HDI (α-HDI) consisted of 40 items, each requiring a “yes” (four points), “sometimes” (two points), or “no” (zero points) response based on items derived empirically from case history responses of subjects with headache. From the α-HDI, we derived a 25-item beta version (β-HDI) with the items subgrouped into functional and emotional subscales. The internal consistency/reliability was strong, as was construct validity. The test-retest reliability for the β-HDI was acceptable for the total score and functional and emotional subscale scores. A 29-point change (95% confidence interval) or greater in the total score from test-retest must occur before the changes can be attributed to treatment effects. The HDI is useful in assessing the impact of headache, and its treatment, on daily living.

Test-retest Reliability of the Hearing Handicap Inventory for Adults

The test-retest reliability of the Hearing Handicap Inventory for Adults (HHIA) was assessed on a sample of 28 hearing-impaired adults. Reliability estimates were obtained to set the stage for using the HHIA as an outcome measure in aural rehabilitation. The test-retest reliability was quite high (r = 0.97) and the standard error of measurement was low for the HHIA and its screening version (HHIA-S). In light of the psychometric adequacy, the HHIA and HHIA-S have potential as indices of hearing aid benefit in hearing-impaired adults.

Perceived Hearing Handicap of Patients with Unilateral or Mild Hearing Loss

Using the Hearing Handicap Inventory for Adults (HHIA), we assessed self-perceived hearing handicap in a sample of 63 patients having either unilaterally normal hearing or a mild hearing loss (pure tone average ≤40 dB hearing level). Large intersubject variability in responses to the HHIA confirmed observations that reactions to minimal hearing impairment vary greatly among patients. The individual differences in responses highlight the importance of quantifying the perceived communication and psychosocial handicap, which cannot be determined from the audiogram alone. An item examination of responses to the HHIA revealed a number of emotional and social-situational problems encountered by patients with minimal hearing loss.

Electrophysiological indices of selective auditory attention in subjects with and without tinnitus

The present investigation was conducted in an attempt to determine whether selective auditory attention abilities differed between normal subjects and subjects with bothersome tinnitus. Subjects were 37 adults with tinnitus and high-frequency hearing loss (not affecting thresholds at 500 and 1000 Hz) and 15 subjects who were audiometrically and otologically normal. Results suggested that an electrophysiological index of early selective auditory attention (i.e., the negative difference wave, Nd) was of greater magnitude in tinnitus patients. Also, the cortical NI component occurred significantly later in the presence of selective attention in tinnitus subjects only. Results of this investigation may support the view that early selective auditory attention in subjects with bothersome tinnitus differs from that of normal subjects.

The effects of stimulus frequency and recording site on the amplitude and latency of multichannel cortical auditory evoked potential (CAEP) component N1

Magnetoencephalographic (MEG) applications in auditory evoked field (AEF) recordings have demonstrated that both tonotopicity and amplitopicity exist in the auditory cortex. The present study was conducted to determine whether previously reported characteristics of the AEF could be identified in multichannel cortical auditory evoked potential N1e (e.g., the electrical correlate of the magnetically recorded N1m) component recordings. Multichannel auditory evoked potentials from 11 young normal adults were collected after monaural tone burst stimuli of 250, 1000, and 4000 Hz. Results demonstrated that N1e amplitudes after stimulation at 250 Hz were significantly larger than those obtained after stimulation at 1000 or 4000 Hz. These frequency-specific differences existed for latency as well. Responses obtained after stimulation at 250 Hz were, on the average, 13 msec longer than those obtained after stimulation at 1000 or 4000 Hz. Also, contralateral latencies were significantly shorter than ipsilateral latencies. Although the significant frequency-specific amplitude results support the findings of previous investigators, the frequency-related latency differences have not been described. An explanation of these differences may exist in the spatial differences in the reception areas for low- and high-frequency tones in the primary auditory cortex.

Relationships among psychoacoustic judgments, speech understanding ability and self-perceived handicap in tinnitus subjects.

Tinnitus is often a disturbing symptom which affects 6-20% of the population. Relationships among tinnitus pitch and loudness judgments, audiometric speech understanding measures and self-perceived handicap were evaluated in a sample of subjects with tinnitus and hearing loss (THL). Data obtained from the THL sample on the audiometric speech measures were compared to the performance of an age-matched hearing loss only (HL) group. Both groups had normal hearing through 1 kHz with a sloping configuration of < or = 20 dB/octave between 2-12 kHz. The THL subjects performed more poorly on the low predictability items of the Speech Perception in Noise Test, suggesting that tinnitus may interfere with the perception of speech signals having reduced linguistic redundancy. The THL subjects rated their tinnitus as annoying at relatively low sensation levels using the pitch-match frequency as the reference tone. Further, significant relationships were found between loudness judgment measures and self-rated annoyance. No predictable relationships were observed between the audiometric speech measures and perceived handicap using the Tinnitus Handicap Questionnaire. These findings support the use of self-report measures in tinnitus patients in that audiometric speech tests alone may be insufficient in describing an individuals reaction to his/her communication breakdowns.

Auditory evoked cortical magnetic field (M100—M200) measurements in tinnitus and normal groups

Recently, Hoke et al. (1989) and Pantev et al. (1989) demonstrated that the auditory evoked cortical magnetic field (AECMF) M100 component was larger, and M200 was smaller and occurred later in subjects with unilateral tinnitus compared with normal subjects. These group amplitude differences resulted in an M200/M100 amplitude ratio that was smaller for the subjects with tinnitus. The purposes of the present investigation were to: 1) extend the observations of Hoke et al. (1989), and, 2) determine whether contralateral AECMF differences existed following stimulation of the non-tinnitus and tinnitus ears of patients with tinnitus. Neuromagnetic AECMF recordings were recorded from 25 young normal hearing and 14 patients with unilateral tinnitus and hearing loss. The results failed to support the findings of Hoke et al. (1989). Specifically, there is no evidence suggesting that the M100 amplitude is larger, the M200 latency later, or, the M200/M100 amplitude ratios smaller, when the two samples are compared. Additionally, there were no differences in the amplitudes or latencies of M100 or M200 when results from stimulation of the tinnitus and non-tinnitus ears of tinnitus subjects were compared.