K. Jonas Brännström

Quality and readability of English-language internet information for adults with hearing impairment and their significant others

Abstract Objective: This study evaluated the quality and readability of English-language internet information for adults with hearing impairment and their significant others. Design: Two keyword pairs (hearing loss and hearing aids) were entered into five country-specific versions of the most commonly used internet search engine in May 2011. Sample: For each of the 10 searches, the first 10 relevant websites were included. After removing duplicates, a total of 66 websites were assessed. Their origin (commercial, non-profit organization, or government), date of last update, quality (Health On the Net (HON) certification and DISCERN scores), and readability (Flesch Reading Ease Score, Flesch-Kincaid Grade Level Formula, and Simple Measure Of Gobbledygook) were assessed. Results: Most websites were of commercial origin and had been updated within the last 18 months. Their quality and readability was highly variable. Only 14% of the websites had HON certification. Websites that were of non-profit organization origin had significantly higher DISCERN scores. Readability measures show that on average, only people with at least 11–12 years of education could read and understand the internet information presented. Conclusions: Based on these results, this article provides a list of recommendations for website developers and clinicians wishing to incorporate internet information into their practice.

Hearing aid fitting outcome: clinical application and psychometric properties of a Swedish translation of the international outcome inventory for hearing aids (IOI-HA).

BACKGROUND The International Outcome Inventory for Hearing Aids (IOI-HA) is a seven-item hearing-specific questionnaire. It was developed with the purpose of evaluating the efficacy of hearing aid rehabilitation. Few psychometric properties have been presented for a Swedish translation of the IOI-HA. Furthermore, previous studies have examined the IOI-HA in mainly sensorineural hearing losses, and we do not know how the type of hearing loss affects the outcome. PURPOSE To evaluate the hearing aid fitting outcome measured in a clinical setting using a Swedish translation of the International Outcome Inventory for Hearing Aids (IOI-HA), to determine the psychometric properties of the translation, and to examine how a number of demographic variables such as type of hearing loss affect the outcome. RESEARCH DESIGN A descriptive and correlational study in a retrospective sample. STUDY SAMPLE Two hundred and twenty-four (107 females and 117 males; ages 27-94 yr with an average of 66.1 yr) first-time hearing aid users. INTERVENTION Mostly digital hearing aids (97.8%) were fitted monaurally (60%) or binaurally (40%) between 2007 and 2009. DATA COLLECTION AND ANALYSIS The subjects were mailed the IOI-HA questionnaire six months after their final appointment, and the completed questionnaire was returned by mail to the clinic. The psychometric properties were evaluated and compared to previous studies using the IOI-HA. The associations between the outcome scores and a number of demographic variables (age, gender, degree of hearing loss, type of hearing loss, number of hearing aids, and type of hearing aids) were examined. Based on the pure tone audiograms, the subjects were divided into three groups; those with conductive hearing losses, sensorineural hearing losses, and mixed hearing losses. For these groups, the differences in outcome measured as IOI-HA were examined. RESULTS The psychometric properties of the present translation of the IOI-HA showed resemblance in many aspects to previous reports. Furthermore, the type of hearing loss seems to affect the IOI-HA outcome. Hearing loss increases with increasing age, and hearing aid use increases with increasing degree of hearing loss. Subjects with sensorineural hearing losses show significantly poorer scores on items concerning introspective aspects of the outcome in comparison to subjects with mixed hearing losses and subjects with conductive hearing losses. Monaurally fitted subjects tend to report lower scores on average, but monaural or binaural hearing aid fitting do not significantly affect the subjective outcome. CONCLUSIONS The psychometric properties of the present Swedish translation of the IOI-HA show resemblance in many aspects to previous reports, but the differences observed could be due to differences in the study populations. Overall, the demographic variables examined could not be used as predictors for the hearing aid fitting outcome, and more reliable predictors need to be identified.

Acceptable noise level with Danish, Swedish, and non-semantic speech materials.

Abstract Objective: Acceptable noise level (ANL) has been established as a method to quantify the acceptance of background noise while listening to speech presented at the most comfortable level. The aim of the present study was to generate Danish, Swedish, and a non-semantic version of the ANL test and investigate normal-hearing Danish and Swedish subjects’ performance on these tests. Design: ANL was measured using Danish and Swedish running speech with two different noises: Speech-weighted amplitude-modulated noise, and multitalker speech babble. ANL was also measured using the non-semantic international speech test signal (ISTS) as speech signal together with the speech-weighted amplitude-modulated noise. The latter condition was identical in both populations. Study sample: Forty Danish and 40 Swedish normal-hearing subjects. Results: In both populations ANL results were similar to previously reported results from American studies. Generally, significant differences were seen between test conditions using different types of noise within ears in each population. Significant differences were seen for ANL across populations, also when the non-semantic ISTS was used as speech signal. Conclusions: The present findings indicate that there are extrinsic factors, such as instructions, affecting the ANL results.

Acceptable noise level (ANL) with Danish and non-semantic speech materials in adult hearing-aid users

Abstract Objective: The acceptable noise level (ANL) test is used for quantification of the amount of background noise subjects accept when listening to speech. This study investigates Danish hearing-aid users’ ANL performance using Danish and non-semantic speech signals, the repeatability of ANL, and the association between ANL and outcome of the international outcome inventory for hearing aids (IOI-HA). Design: ANL was measured in three conditions in both ears at two test sessions. Subjects completed the IOI-HA and the ANL questionnaire. Study sample: Sixty-three Danish hearing-aid users; fifty-seven subjects were full time users and 6 were part time/non users of hearing aids according to the ANL questionnaire. Results: ANLs were similar to results with American English speech material. The coefficient of repeatability (CR) was 6.5–8.8 dB. IOI-HA scores were not associated to ANL. Conclusions: Danish and non-semantic ANL versions yield results similar to the American English version. The magnitude of the CR indicates that ANL with Danish and non-semantic speech materials is not suitable for prediction of individual patterns of future hearing-aid use or evaluation of individual benefit from hearing-aid features. The ANL with Danish and non-semantic speech materials is not related to IOI-HA outcome.

Does the acceptable noise level (ANL) predict hearing-aid use?

Abstract Objective: It has been suggested that individuals have an inherent acceptance of noise in the presence of speech, and that different acceptance of noise results in different hearing-aid (HA) use. The acceptable noise level (ANL) has been proposed for measurement of this property. It has been claimed that the ANL magnitude can predict hearing-aid use patterns. Many papers have been published reporting on different aspects of ANL, but none have challenged the predictive power of ANL. The purpose of this study was to discuss whether ANL can predict HA use and how more reliable ANL results can be obtained. Design: Relevant literature regarding the ANL was found on Medline, Embase, and Google Scholar. Additional information was found as references in the included papers and through personal contacts, for instance when attending audiology conferences. Study sample: Forty-five papers published in peer reviewed journals as well as a number of papers from trade journals, posters and oral presentations from audiology conventions. Conclusions: An inherent acceptance of noise in the presence of speech may exist, but no method for precise measurement of ANL is available. The ANL model for prediction of HA use has yet to be proven valid.

Acceptable noise level: Repeatability with Danish and non-semantic speech materials for adults with normal hearing

Objective: The acceptable noise level (ANL) is used to quantify the amount of background noise that subjects can accept while listening to speech, and is suggested for prediction of individual hearing-aid use. The aim of this study was to assess the repeatability of the ANL measured in normal-hearing subjects using running Danish and non-semantic speech materials as stimuli and modulated speech-spectrum and multi-talker babble noises as competing stimuli. Design: ANL was measured in both ears at two test sessions separated by a period ranging from 12 to 77 days. At each session the measurements at the first and the second ear were separated in time by 15–30 minutes. Bland-Altman plots and calculation of the coefficient of repeatability (CR) were used to estimate the repeatability. Study sample: Thirty nine normal-hearing subjects. Results: The ANL CR was 6.0–8.9 dB for repeated tests separated by about 15–30 minutes and 7.2–10.2 dB for repeated tests separated by 12 days or more. Conclusions: The ANL test has poor repeatability when assessed with Danish and non-semantic speech materials on normal-hearing subjects. The same CR among hearing-impaired subjects would imply too poor repeatability to predict individual patterns of future hearing-aid use.

Children's Subjective Ratings and Opinions of Typical and Dysphonic Voice After Performing a Language Comprehension Task in Background Noise

OBJECTIVE Previous studies suggest that dysphonic voices are perceived more negatively than typical voices, and it is possible that vocal perception influences academic achievement and comprehension. This study assessed childrens subjective ratings and opinions of a typical and dysphonic voice after performing a language comprehension task in background noise. It also explored if subjective ratings were related to performance in the comprehension task. STUDY DESIGN Ninety-three 8-year-old children participated and were randomly allocated to two groups. METHODS A digital version of the Test for Reception of Grammar, version 2 (TROG-2) was used. In TROG-2, the child listens to a sentence and then, out of four possible pictures, selects the picture that corresponds to the sentence content. Each sentence assesses a specific grammatical construction. Test instructions were recorded using one speaker with two different voice qualities (typical voice and provoked dysphonic voice). One group of children performed TROG-2 with the typical voice and the other with the dysphonic voice, both presented in a multitalker babble noise using earphones. All children rated their subjective perception of the voice. RESULTS The dysphonic voice received poorer ratings than the typical voice. Children making more positive ratings of the voice performed better on earlier blocks in TROG-2, but only in the typical voice group. CONCLUSIONS Children perceived the dysphonic voice more negatively even when listening to the same speaker. Performance is related to the perception of the voice, but only when the perceptual load of the task-relevant stimuli is sufficiently low.

The acceptable noise level: the effect of repeated measurements.

Abstract Objective: This study explores if increasing number of repetitions might improve the precision of the acceptable noise level (ANL) test. Design: We measured twelve ANL repetitions, i.e. four complete ANL tests (4 × 3 repetitions), at one session using diotic presentation and a non-semantic ANL version. Study sample: Thirty-two normal-hearing adults. Results: Small order and fatigue effects were seen. We used the coefficient of repeatability (CR) to assess the repeatability; CRs ranged between 3.9 and 7.6 dB for the four ANL tests. Using the twelve ANL repetitions we removed the variability of the ANL across subjects by normalizing the data to the individual mean ANL for the twelve repetitions. The mean normalized ANL across the subjects rapidly approached the ANL normalized to the individual mean for the 12 repetitions (0 dB), and after three repetitions the SD seemed to be stable at about 3 dB. Conclusions: The findings suggest that both order and fatigue affect the ANL. The findings also suggest that it may be more accurate to speak of an acceptable noise range than ANL. These findings have large implications for how we understand acceptable noise and it would explain a large part of the variability seen among normal-hearing and perhaps hearing-impaired subjects.

Interaural attenuation for Sennheiser HDA 200 circumaural earphones.

Abstract Interaural attenuation (IA) was evaluated for pure tones (frequency range 125 to 16000 Hz) using Sennheiser HDA 200 circumaural earphones and Telephonics TDH-39P earphones in nine unilaterally deaf subjects. Audiometry was conducted in 1-dB steps using the manual ascending technique in accordance with ISO 8253-1. For all subjects and for all tested frequencies, the lowest IA value for HDA 200 was 42 dB. The present IA values for TDH-39P earphones closely resemble previously reported data. The findings show that the HDA 200 earphones provide more IA than the TDH-39P, especially at lower frequencies (≤500 Hz). It is concluded that contralateral masking should be applied during pure-tone audiometry with the HDA 200 earphones when the level at the test ear is more than 40 dB above the threshold of the non-test ear. Sumario Se evaluó la atenuación interaural (AI) con tonos puros (rango de frecuencia 125-16000 Hz) usando auriculares circumaurales Sennheiser HAD 200 y auriculares Telephonics TDH-39P, en nueve sordos unilaterales. La audiometría se practicó en pasos de 1-dB usando la técnica manual ascendente de acuerdo con ISO 8253-1. En todos los sujetos y en todas las frecuencias el valor de AI más bajo para HDA 200 fue de 42 dB. Los valores actuales de AI para los auriculares TDH-39P se asemejan mucho a los datos previamente reportados. Los hallazgos muestran que los auriculares HDA 200 proporcionan mayor AI que los TDH-39P, especialmente en las frecuencias bajas (≤ 500Hz). Se concluye que el enmascaramiento contralateral debe aplicarse en la audiometría tonal con auriculares HDA 200, cuando el nivel en el oído evaluado sea mayor a 40 dB sobre el umbral del oído no evaluado.

Clinical application of long-term intensity and pitch matches in fluctuating low-frequency hearing loss

The purpose of this study was to measure changes in intensity and pitch matches to better assess disease activity in fluctuating hearing loss. Long-term suprathreshold audiometry was carried out at home on a subject with a unilateral fluctuating low-frequency hearing loss during a period when the subject demonstrated no symptoms and a period when the subject reported hearing loss, aural pressure, and tinnitus. Daily measurements of binaural intensity and pitch matches were made. Day-to-day fluctuations were clearly accentuated during the period when the subject experienced symptoms. Specifically, deviations from the reference tone were only observed for binaural pitch matches at 1 kHz during the period without symptoms; however, highly fluctuating binaural intensity and pitch matches were observed at 0.25 kHz during the period with symptoms. These fluctuations were not observed in a normal-hearing group. The results suggest that long-term measurements of binaural intensity and pitch matches can be used to monitor disease activity in fluctuating low-frequency hearing loss.