Joost M. Festen

Factors in Subjective Hearing Disability

This report describes an approach to identify different factors in hearing disability. On the basis of interviews and case studies, the Amsterdam Inventory for Auditory Disability and Handicap was developed. It consists of 30 questions, dealing with a variety of everyday listening situations. Reports of 274 hearing-impaired subjects are presented. Item and factor analysis on the questions resulted in five factors, interpreted as five basic auditory disabilities: distinction of sounds, intelligibility in noise, auditory localization, intelligibility in quiet and detection of sounds. Investigation of one excluded item showed that intolerance of noise may be a sixth aspect.

International Outcome Inventory for Hearing Aids (IOI-HA): results from The Netherlands

This paper presents data on the Dutch translation of the International Outcome Inventory for Hearing Aids (IOI-HA). The inventory was used as an additional postal tool in a nationwide study on the benefits of bilateral hearing aid fitting. Responses of 505 hearing aid users were analysed. Descriptive statistics and inter-item correlations are reported. Factor analysis resulted in the extraction of two factors. Cronbachs alpha coefficients and corrected item total correlations showed high internal consistency of the scales. Significant correlations were found between IOI Factor 2 and the Hearing Handicap and Disability Inventory and subscales of the Amsterdam Invcntory for Hearing Disability and Handicap. Sumario Este trabajo presenta los datos de la traducciócute;n al holandés del Inventario Internacional de Resultados para Auxiliares Auditivos (IOI-HA). El inventario fue usado como un instrumento postal adicional en un estudio nacional acerca de los beneficios de la adaptatiócute;n bilateral de auxiliares auditivos. Se analizaron las respuestas de 505 usuarios de auxiliares auditivos. Se reportan los datos estadisticos descriptivos y las correlaciones entre los items. El factor de analisis finalìzócute; en la extractiócute;n de dos factores. Los coeficientes alpha de Cronbach y las correlaciones totales de los items corregidos mostraron una alta consistencia interna de las escalas. Se encontraron correlaciones significativas entre el factor2 IOI, el Inventario de desventaja y discapacidad auditiva y las subescalas del Inventario Amsterdam para discapacidad y desventaja auditiva.This paper presents data on the Dutch translation of the International Outcome Inventory for Hearing Aids (IOI-HA). The inventory was used as an additional postal tool in a nationwide study on the benefits of bilateral hearing aid fitting. Responses of 505 hearing aid users were analysed. Descriptive statistics and inter-item correlations are reported. Factor analysis resulted in the extraction of two factors. Cronbachs alpha coefficients and corrected item total correlations showed high internal consistency of the scales. Significant correlations were found between IOI Factor 2 and the Hearing Handicap and Disability Inventory and subscales of the Amsterdam Inventory for Hearing Disability and Handicap.

The Self-reported Handicapping Effect of Hearing Disabilities

This study investigates the extent to which individuals see themselves as being handicapped by a hearing disability. Self-reports were obtained with the Amsterdam Inventory for Auditory Disability and Handicap which distinguishes five basic disabilities: intelligibility in noise, intelligibility in quiet, localization of sounds, distinction of sounds and detection of sounds. Responses of 239 hearing-impaired people with varying types of hearing loss have been examined. The occurrence of the five disabilities in the population as well as the self-reported limiting and annoying effect per disability has been examined. This study shows that the handicapping effects of the disabilities do not have equal weights. Handicap resulting from the inability to understand speech in noise is most strongly felt. This paper argues that the type of disability jointly determines the severity of a persons handicap.

Assessing Aspects of Auditory Handicap by Means of Pupil Dilatation

The demand on extra effort and concentration during listening are notorious handicapping effects of hearing impairment as is shown by self-assessment studies. In an attempt to explore new ways of assessing hearing handicap, the present study focuses on an objective measure of mental effort during listening. Pupil dilatation is used as the index of mental effort. Results for 14 hearing-impaired and 14 normal hearing listeners show a relation between pupil dilatation and difficulty in speech reception in noise, as manipulated by the speech-to-noise ratio. In addition the study shows that, with regard to effort and concentration, hearing-impaired subjects benefit less than normals from easier listening situations (e.g. at 5 dB above the individual speech-reception threshold). The results show a significant correlation between self-rated handicap and pupil dilatation.

The Relationships between Self-reported Hearing Disability and Measures of Auditory Disability

Although required for many practical purposes, adequate measures of hearing disability are not yet available. In an attempt to identify a set of performance tests for predicting hearing disability in daily life the relationship between self-reported disability scores and measures of auditory disability was examined. The Amsterdam Inventory was completed by 51 respondents aged 30 to 70 years who also performed on various tests. Earlier factor analysis of the inventory scores resulted in the distinction of five aspects of auditory disability. Stepwise multiple regression analysis in the present study shows that the tests describe and differentiate quite well between these five aspects. Multiple correlation coefficients range from R = 0.60 to R = 0.74.

Deviant vocal fold vibration as observed during videokymography : the effect on voice quality

Videokymographic images of deviant or irregular vocal fold vibration, including diplophonia, the transition from falsetto to modal voice, irregular vibration onset and offset, and phonation following partial laryngectomy were compared with the synchronously recorded acoustic speech signals. A clear relation was shown between videokymographic image sequences and acoustic speech signals, and the effect of irregular or incomplete vocal fold vibration patterns was recognized in the amount of perceived breathiness and roughness and by the harmonics-to-noise ratio in the speech signal. Mechanisms causing roughness are the presence of mucus, phase differences between the left and right vocal fold, and short-term frequency and amplitude modulation. It can be concluded that the use of simultaneously recorded videokymographic image sequences and speech signals contributes to the understanding of the effect of irregular vocal fold vibration on voice quality.

Alternative Voice After Laryngectomy Using a Sound-Producing Voice Prosthesis

Objective To improve the voice quality of female laryngectomees and/or laryngectomees with a hypotonic pharyngoesophageal (PE) segment by means of a pneumatic artificial source of voice incorporated in a regular tracheoesophageal (TE) shunt valve.

Female-pitched sound-producing voice prostheses - initial experimental and clinical results

Abstract In order to improve voice quality in female laryngectomees and/or laryngectomees with a hypotonic pharyngo-oesophageal segment, a sound-producing voice prosthesis was designed. The new source of voice consists of either one or two bent silicone lips which perform an oscillatory movement driven by the expired pulmonary air that flows along the outward-striking lips through the tracheo-oesophageal shunt valve. Four different prototypes of this pneumatic sound source were evaluated in vitro and in two female laryngectomees, testing the feasibility and characteristics of this new mechanism for alternative alaryngeal voice production. In vivo evaluation included acoustic analyses of both sustained vowels and read-aloud prose, videofluoroscopy, speech rate, and registration of tracheal phonatory pressure and vocal intensity. The mechanism proved feasible and did not result in unacceptable airflow resistance. The average pitch of voice increased and clarity improved in female laryngectomees. Pitch regulation of this prosthetic voice is possible with sufficient modulation to avoid monotony. The quality of voice attained through the sound-producing voice prostheses depends on a patient’s ability to let pulmonary air flow easily through the pharyngo-oesophageal segment without evoking the low-frequency mucosal vibrations that form the regular tracheo-oesophageal shunt voice. These initial experimental and clinical results provide directions for the future development of sound-producing voice prostheses. A single relatively long lip in a container with a rectangular lumen that hardly protrudes from the voice prosthesis may have the most promising characteristics.

Assessment of alaryngeal speech using a sound‐producing voice prosthesis in relation to sex and pharyngoesophageal segment tonicity

A pneumatic artificial sound source incorporated in a regular tracheoesophageal shunt valve may improve alaryngeal voice quality.

Analysis of failure of voice production by a sound-producing voice prosthesis

OBJECTIVEnTo analyse the cause of failing voice production by a sound-producing voice prosthesis (SPVP).nnnMETHODSnThe functioning of a prototype SPVP is described in a female laryngectomee before and after its sound-producing mechanism was impeded by tracheal phlegm. This assessment included: perceptual voice evaluation of read-aloud prose by an expert listener; inspection of the malfunctioning SPVP; and aero-acoustical in vivo registrations using a computer-based data acquisition system.nnnRESULTSnSound-producing voice prosthesis speech is higher pitched, stronger, contains less aperiodic noise and requires a lower airflow rate than the patients regular tracheoesophageal (TE) shunt speech. Tracheal phlegm caused malfunction of the vibrating silicone lip of the SPVP by causing it to stick to its stainless steel container in an opened position, thereby reducing the SPVP to no more than a regular TE shunt valve from a functional point of view. Tracheal phonatory pressure and dynamic vocal intensity range were not affected by the functional status of the SPVP.nnnCONCLUSIONSnTo exploit the advantages an SPVP could offer female laryngectomees with an atonic or severely hypotonic pharyngoesophageal segment, the sound-producing mechanism of the SPVP needs to be less vulnerable to tracheal phlegm.