Graham Naylor

Factors Influencing Help Seeking, Hearing Aid Uptake, Hearing Aid Use and Satisfaction With Hearing Aids: A Review of the Literature

Objectives: This descriptive summary of the literature provides an overview of the available studies (published between January 1980 and January 2009) on correlates of help-seeking behavior for hearing loss, hearing-aid uptake, hearing-aid use, and satisfaction with the device. Methods: Publications were identified by structured searches in Pubmed and Cinahl and by inspecting the reference lists of relevant articles. The articles covered different stages that a person with hearing impairment may go through: prior to hearing aid fitting, the period covering the fitting and the period post hearing aid fitting. Inclusion of articles occurred according to strict inclusion and exclusion criteria. Data were extracted by two independent researchers. Thirty-nine papers were included that identified 31 factors examined in relation to the four outcome measures. These covered personal factors (e.g., source of motivation, expectation, attitude), demographic factors (e.g., age, gender) and external factors (e.g., cost, counseling). Only two studies covered the actual fitting process. There was only one factor positively affecting all four outcome variables. This was self-reported hearing disability. The vast majority of studies showed no relationship of age and gender with any of the outcome domains. Discussion and conclusion: Whereas research of the last 28 years yielded valuable information regarding relevant and irrelevant factors in hearing aid health care, there are still many relevant issues that have never been investigated in controlled studies. These are discussed.

ODEON-Another hybrid room acoustical model

Abstract The ODEON room acoustics program is intended to be a base for research in objective and subjective room acoustics, and a useful tool for consultants. The program uses a hybrid method, in which an initial ray tracing is carried out to determine potential reflection sequences. These may later be tested for visibility at any number of receiver points. For the early part of the reflectogram, stringent visibility tests are made, and visible images are treated according to normal image source theory. The ray tracing data is also used to generate a plausible reverberent energy-time function with high reflection density, by assuming a homogeneous reverberant field. The energy of each of the reverberant images found is corrected to account for the difference between the number of images found and the number expected from theory. Details of the calculation principles are presented, including a number of optimisations which can be used in many types of model. The program version discussed here is 1·5.

Linear and nonlinear hearing aid fittings – 2. Patterns of candidature

We studied candidature for linear, slow-acting AVC hearing aids, and fast-acting WDRC hearing aids in a within-subject within-device crossover design of 50 listeners with SNHL. Candidature dimensions include HTLs, ULLs, spectro-temporal and masking abnormalities, cognitive capacity, and self-reports and acoustic measures of auditory ecology. Better performance with linear fittings is associated with flatter audiograms, wider dynamic range, and smaller differences in dynamic range between low and high frequencies, and also with more restricted auditory lifestyles. Better performance with all nonlinear fittings is associated with more sloping audiograms, more restricted dynamic ranges, greater differences in dynamic range between low and high frequencies, and more varied auditory lifestyles. Differential performance between WDRC and AVC fittings is associated with patterns of variation in auditory ecology (rapid versus slow changes) and cognitive (high versus low) capacity. Differential performance between WDRC in two channels, and a hybrid with WDRC in a low-frequency and AVC in a high-frequency channel is associated with psychoacoustic tests of cochlear function (high susceptibility to spectral and temporal smearing, and high susceptibility to upward spread of masking respectively). Patterns of candidature include measures beyond auditory function in the domains of cognitive capacity and auditory ecology. Sumario Estudiamos cincuenta sujetos con SNHL buscando criterios de selección para adaptar auxiliares auditivos lineales, con AVC de acción lenta, o con WDRC de acción rápida, en un diseño cruzado que juzgaba variaciones intra-sujeto y con respecto al mismo dispositivo. Los criterios bajo estudio fueron HTL y ULL, anormalidades del espectro temporal y de enmascaramiento, habilidad cognitiva, y auto-reportes y medidas acústicas de ecología auditiva. Se asoció un mejor desempeño al hacer las adaptaciones lineales en sujetos con audiogramas más planos, con rangos dinámicos más amplios y con pequeñas diferencias en el rango dinámico entre frecuencias graves y agudas, así como con estilos de vida auditiva más restringidos. Un mejor desempeño en todas las adaptaciones no lineales se asoció con audiogramas con pendiente, con rangos dinámicos más restringidos, con mayores diferencias en el rango dinámico entre frecuencias graves y agudas, y con estilos auditivos de vida más variados. El desempeño diferencial entre adaptaciones con WDRC y con AVC se asoció con patrones de variación en la ecología auditiva (cambios rápidos vs. lentos), y con habilidad cognitiva (alta vs. baja). El desempeño diferencial entre WDRC en dos canales y un híbrido que utilizaba WDRC en una frecuencia baja, con un AVC en un canal de alta frecuencia se asoció con pruebas psicoacústicas de función coclear (una alta susceptibilidad a la disminución en la nitidez espectral y temporal, y alta susceptibilidad a una diseminación ascendente del enmascaramiento, respectivamente). Los patrones para selección de candidatos incluyen mediciones más allá de la función auditiva en el ámbito de la capacidad cognitiva y de la ecología auditiva.

Hearing impairment and cognitive energy: the Framework for Understanding Effortful Listening (FUEL)

The Fifth Eriksholm Workshop on “Hearing Impairment and Cognitive Energy” was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to Titchener (1908) who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman’s seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener’s motivation to expend mental effort in the challenging situations of everyday life.

Linear and nonlinear hearing aid fittings – 1. Patterns of benefit

We evaluated the benefits of fast-acting WDRC, slow-acting AVC, and linear reference fittings for speech intelligibility and reported disability, in a within-subject within-device masked crossover design on 50 listeners with SNHL. Five hearing aid fittings were implemented having two compression channels and seven frequency bands. Each listener sequentially experienced each fitting for a 10-week period. Outcome measures included speech intelligibility under diverse conditions and self-reported disability. At a group level, each nonlinear fitting was superior to the linear references for benefits in listening comfort, listener satisfaction, reported intelligibility and speech intelligibility. Slow-acting AVC outperformed the fast-acting WDRC fittings for listening comfort, while for reported and measured speech intelligibility the converse was true. For listener satisfaction there were no group differences between the nonlinear fittings. Analysis in terms of fittings for individual listeners revealed subsets with definite divergences from the group data and hence a need for candidature criteria. There are systematic differences between the benefits of nonlinear and linear fittings, and also within nonlinear fittings with fast versus slow time constants. The patterns of benefit and individual optima depend on the domain of outcome being assessed. Sumario Evaluamos en cincuenta sujetos con SNHL los beneficios sobre la inteligibilidad del lenguaje de adaptaciones de auxiliares auditivos con WDRC de acción rápida, con AVC de acción lenta y con referencia lineal, así como la discapacidad reportada, con un diseño de enmascaramiento cruzado que permite juzgar las diferencias intra-sujeto y en función del propio dispositivo. Se implementaron cinco adaptaciones con dos canales de compresión y siete bandas de frecuencia. Cada sujeto utilizó secuencialmente las diferentes adaptaciones durante un período de diez semanas. Las medidas de resultado incluyeron inteligibilidad del lenguaje bajo diversas condiciones y la discapacidad auto-reportada. La adaptación con AVC de acción lenta superó la de WDRC de acción rápida en relación con la comodidad para escuchar, aunque para la inteligibilidad del lenguaje, tanto medida como reportada, ocurrió lo contrario. En relación con la satisfacción del sujeto, no existieron diferencias de grupo entre las adaptaciones no lineales. El análisis, en términos en adaptaciones para sujetos individuales, reveló sub-grupos con divergencias definitivas en relación a los datos grupales, y por tanto, la necesidad de establecer criterios para la selección de candidatos. Existen diferencias sistemáticas entre los beneficios de las adaptaciones lineales y no lineales, así como entre las adaptaciones no lineales y las constantes temporales rápidas versus las lentas. El patrón de beneficio y de optimización individual depende del ámbito de resultado bajo escrutinio.

Hearing help-seeking and rehabilitation Perspectives of adults with hearing impairment

Abstract Objective: This study investigated the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. Design: Individual semi-structured interviews were completed. Study sample: In total, 34 adults with hearing impairment in four countries (Australia, Denmark, UK, and USA) participated. Participants had a range of experience with hearing help-seeking and rehabilitation, from never having sought help to being satisfied hearing-aid users. Results: Qualitative content analysis identified four main categories (‘perceiving my hearing impairment’, ‘seeking hearing help’, ‘using my hearing aids’, and ‘perspectives and knowledge’) and, at the next level, 25 categories. This article reports on the densest categories: they are described, exemplified with interview quotes, and discussed. Conclusions: People largely described hearing help-seeking and rehabilitation in the context of their daily lives. Adults with hearing impairment rarely described clinical encounters towards hearing help-seeking and rehabilitation as a connected process. They portrayed interactions with clinicians as isolated events rather than chronologically-ordered steps relating to a common goal. Clinical implications of the findings are discussed.

Conducting qualitative research in audiology: A tutorial

Abstract Objective: Qualitative research methodologies are being used more frequently in audiology as it allows for a better understanding of the perspectives of people with hearing impairment. This article describes why and how international interdisciplinary qualitative research can be conducted. Design: This paper is based on a literature review and our recent experience with the conduction of an international interdisciplinary qualitative study in audiology. Results: We describe some available qualitative methods for sampling, data collection, and analysis and we discuss the rationale for choosing particular methods. The focus is on four approaches which have all previously been applied to audiologic research: grounded theory, interpretative phenomenological analysis, conversational analysis, and qualitative content analysis. Conclusions: This article provides a review of methodological issues useful for those designing qualitative research projects in audiology or needing assistance in the interpretation of qualitative literature.

A short form of the Speech, Spatial and Qualities of Hearing scale suitable for clinical use: the SSQ12.

Abstract Objective: To develop and evaluate a 12-item version of the Speech, Spatial and Qualities of Hearing scale for use in clinical research and rehabilitation settings, and provide a formula for converting scores between the full (SSQ49) and abbreviated (SSQ12) versions. Design: Items were selected independently at the three centres (Eriksholm Research Centre, MRC Institute of Hearing Research, University of New England) to be representative of the complete scale. A consensus was achieved after discussion. Study sample: The data set (n = 1220) used for a factor analysis (2, submitted) was re-analysed to compare original SSQ scores (SSQ49) with scores on the short version (SSQ12). Results: A scatter-plot of SSQ12 scores against SSQ49 scores showed that SSQ12 score was about 0.6 of a scale point lower than the SSQ49 (0–10 scale) in the re-analysis of the Akeroyd et al data. SSQ12 scores lay on a slightly steeper slope than scores on the SSQ49. Conclusions: The SSQ12 provides similar results to SSQ49 in a large clinical research sample. The slightly lower average SSQ12 score and the slightly steeper slope reflect the composition of this short form relative to the SSQ49.

A Taxonomy of Fatigue Concepts and Their Relation to Hearing Loss.

Fatigue is common in individuals with a variety of chronic health conditions and can have significant negative effects on quality of life. Although limited in scope, recent work suggests persons with hearing loss may be at increased risk for fatigue, in part due to effortful listening that is exacerbated by their hearing impairment. However, the mechanisms responsible for hearing loss-related fatigue, and the efficacy of audiologic interventions for reducing fatigue, remain unclear. To improve our understanding of hearing loss-related fatigue, as a field it is important to develop a common conceptual understanding of this construct. In this article, the broader fatigue literature is reviewed to identify and describe core constructs, consequences, and methods for assessing fatigue and related constructs. Finally, the current knowledge linking hearing loss and fatigue is described and may be summarized as follows: Hearing impairment may increase the risk of subjective fatigue and vigor deficits; adults with hearing loss require more time to recover from fatigue after work and have more work absences; sustained, effortful, listening can be fatiguing; optimal methods for eliciting and measuring fatigue in persons with hearing loss remain unclear and may vary with listening condition; and amplification may minimize decrements in cognitive processing speed during sustained effortful listening. Future research is needed to develop reliable measurement methods to quantify hearing loss-related fatigue, explore factors responsible for modulating fatigue in people with hearing loss, and identify and evaluate potential interventions for reducing hearing loss-related fatigue.

Technical and Audiological Factors in the Implementation and Use of Digital Signal Processing Hearing Aids

Fully digital hearing aids, to be worn behind or within the ear, are coming on to the market. The new possibilities and challenges of such aids are both technological and audiological in character. This paper describes some of the challenges, and one manufacturers approach to them. The signal processing structure in one current digital hearing aid is presented, and justified in audiological terms, as a background to discussions of (i) the relative urgency of further advances in technology and audiological knowledge, and (ii) the challenges to the practice of hearing aid dispensing. It is concluded that further advances in rehabilitative audiology are more pressing than further major technological progress, and that the potential client benefits of the new generation of digital hearing aids will only be realized if the challenges they present to software design and dispensing practice are recognized and met.