Kathleen M. Cienkowski

Auditory-visual speech perception and aging

Objective This experiment was designed to assess the integration of auditory and visual information for speech perception in older adults. The integration of place and voicing information was assessed across modalities using the McGurk effect. The following questions were addressed: 1) Are older adults as successful as younger adults at integrating auditory and visual information for speech perception? 2) Is successful integration of this information related to lipreading performance? Design The performance of three groups of participants was compared: young adults with normal hearing and vision, older adults with normal to near-normal hearing and vision, and young controls, whose hearing thresholds were shifted with noise to match the older adults. Each participant completed a lipreading test and auditory and auditory-plus-visual identification of syllables with conflicting auditory and visual cues. Results The results show that on average older adults are as successful as young adults at integrating auditory and visual information for speech perception at the syllable level. The number of fused responses did not differ for the CV tokens across the ages tested. Although there were no significant differences between groups for integration at the syllable level, there were differences in the response alternatives chosen. Young adults with normal peripheral sensitivity often chose an auditory alternative whereas, older adults and control participants leaned toward visual alternatives. In additions, older adults demonstrated poorer lipreading performance than their younger counterparts. This was not related to successful integration of information at the syllable level. Conclusions Based on the findings of this study, when auditory and visual integration of speech information fails to occur, producing a nonfused response, participants select an alternative response from the modality with the least ambiguous signal.

Refinement and psychometric evaluation of the Attitudes Toward Loss of Hearing Questionnaire

Objective: To refine and statistically validate the Attitudes Toward Loss of Hearing Questionnaire (ALHQ) so that it will be appropriate for clinical application and to understand some of the personality attributes underlying attitudes toward hearing loss. Design: An American‐English version of an ALHQ, originally designed byBrooks (1989), was completed by 226 men; a subset of 80 also completed personality questionnaires. All subjects underwent pure‐tone testing and speech audiometry. Factor analysis was used to extract scales from the ALHQ. Reliability analyses using Cronbachs α were carried out on each scale. Test‐retest reliability was evaluated from questionnaires completed 6 to 18 mo after initial administration. Multiple regression analysis was used to examine the audiometric and personality determinants of attitudes. Results: Five reliable scales were extracted from a 24‐question version of the ALHQ: 1) Social and Emotional Impact of Hearing Loss, 2) Acceptance/Adjustment to Hearing Loss, 3) Perceived Support from Significant Others, 4) Hearing Aid Stigma, and 5) Awareness of Hearing Loss. Audiometric data explained little of the variance in attitude scores; age and other demographic factors did not correlate with attitudes either. The personality traits of extroversion, self‐esteem, and anxiety/neuroticism played a larger role in determining attitude. Conclusions: The ALHQ is psychometrically acceptable and is a potentially useful clinical tool. It is quick and easy to complete and to score and could be used as a basis for counseling and for following attitude change in patients over time.

The impact of health literacy on patient understanding of counseling and education materials

Abstract Low health literacy is reported to have negative consequences on patient understanding of health-related information; however, there is a dearth of research regarding health literacy in an audiology-specific context. This study examines the grade level of language used in verbal and written communication samples during routine hearing aid orientation appointments. Patient counseling sessions were videotaped and transcribed; hearing aid instruction guides used during counseling sessions were also transcribed. The Flesch-Kincaid grade level formula was used to determine the approximate United States grade level equivalent of the counseling sessions, hearing aid instruction guides, and to predict patient health literacy. The results indicate that patient predicted health literacy likely impacts understanding of both one-on-one counseling and hearing aid instruction guides. Sumario Los bajos conocimientos en salud se reportan como causantes de consecuencias negativas en la comprensión de la información relacionada con la salud; no obstante, son escasas las investigaciones dirigidas a los conocimientos en salud en el contexto audiológico específico. Este estudio examina el nivel de lenguaje usado en muestras de comunicación verbal y escrita obtenidas durante citas rutinarias de orientación sobre auxiliares auditivos. Las sesiones de asesoría a pacientes se videograbaron y transcribieron; las guías de instrucción sobre auxiliares auditivos usadas en estas sesiones, también fueron transcritas. Se usó la fórmula de niveles de Flesch-Kincaid para determinar el equivalente aproximado en los Estados Unidos, de las sesiones de asesoría y las guías de instrucción de auxiliares auditivos y para predecir los conocimientos en salud de los pacientes. Los resultados indican que los conocimientos sobre salud que en ellos se pueden predecir, impactan la comprensión tanto de la asesoría personal, como de las guías de instrucción de auxiliares auditivos.

A computer method for assessing satisfaction with hearing aids

The purpose of this study was to evaluate a new clinical assessment, the Dynamic Assessment of Hearing Aids (DAHA), for a large clinical population. Unlike traditional questionnaire methods, the DAHA has patients use an intuitive graphical computer interface to record visual analogue ratings of satisfaction with various features of their hearing aids (e.g. clarity, cost, appearance). Data were collected from 191 participants.A subset of participants returned for retest. The DAHA items assess satisfaction with hearing aids within four domains: communication, physical features, sound quality, and personal reactions. The concurrent validity was determined by comparing DAHA results to those obtained with the satisfaction with amplification in daily life (SADL). Ratings for personal reactions to hearing aids indicate the most satisfaction, and ratings for communication (especially group conversations and phone use) indicate the least satisfaction. The DAHA total score was found to have good test/retest and high internal consistency. Concurrent validity was supported by a strong correlation between total scores on the DAHA and the SADL. Results suggest the DAHA maybe an effective tool for clinical use. Sumario El objetivo de este estudio fue valorar un nuevo instrumento clínico, la “Evaluación dinámica de Auxiliares Auditivos” (DAHA), en una amplia población. A diferencia de los cuestionarios tradicionales, con el DAHA los pacientes utilizan una interfase gráfica intuitiva para grabar apreciaciones de satisfacción análogas visuales de varios atributos de sus auxiliares auditivos (p.ej. claridad, costo, apariencia). Se colectaron datos de 191 participantes. Un subgrupo de participantes regresó para una re-evaluación. Los ítem del DAHA evalúan la satisfacción que proporcionan los auxiliares auditivos en cuatro áreas: comunicación, características físicas, calidad de sonido y reacciones personales. La validez concomitante se determinó comparando los resultados del DAHA con los obtenidos en el de “Satisfacción con Amplificación en la Vida Diaria” (SADL). Los índices de reacciones personales a los auxiliares indicaron la mayor satisfacción y los índices de comunicación (especialmente conversación grupal y uso de teléfono) indicaron la menor satisfacción. Se encontró que la calificación total del DAHA tiene una alta consistencia interna y una buena calificación test/re-test. Hubo una alta correlación entre la calificación final en el DAHA y la de SADL. Los resultados sugieren que el DAHA puede ser una herramienta de uso clínico efectiva.

Auditory-visual speech perception in an adult with aphasia

The evaluation of auditory-visual speech perception is not typically undertaken in the assessment of aphasia; however, treatment approaches utilise bimodal presentations. Research demonstrates that auditory and visual information are integrated for speech perception. The strongest evidence of this cross-modal integration is the McGurk effect. This indirect measure of integration shows that presentation of conflicting tokens may change perception (e.g. auditory /bi/ + visual /gi/ = /di/). The purpose of this study was to investigate the ability of a person with mild aphasia to identify tokens presented in auditory-only, visual-only and auditory-visual conditions. It was hypothesized that performance would be best in the bimodal condition and that presence of the McGurk effect would demonstrate integration of speech information. Findings did not support the hypotheses. It is suspected that successful integration of AV speech information was limited by a perseverative response pattern. This case study suggests the use of bisensory speech information may be impaired in adults with aphasia.

Client-attitude questionnaire provides data that can help shape counseling strategies

Recent advances in technology have changed the face of hearing aid fitting. Digital signal processing, non-linear amplification, and directional microphones are available at the click of a mouse button. Despite this, acceptance of hearing aids remains poor. Only 20.4% of hearingimpaired adults own hearing aids1 and 16.2% of owners do not actually use their hearing instrument(s).1 Only a little over half (54.5%) of owners are satisfied with their hearing aids while 19.4% are dissatisfied.1 Hearing impairment is widespread. It is estimated that 27.2 million Americans have a hearing loss.1 Approximately 30% of people over the age of 65 are affected by hearing impairment, with the figure rising to 35% in those over 75 years.2,3 Psychosocial issues play a major role in the hearingimpaired person’s decision not to purchase hearing aids. The most commonly cited reasons are: “Hearing instruments have a stigma attached to them,” “Hearing aids are expensive and/or do not work,” “My loss is not serious enough to warrant a hearing aid,” and “Only old people wear hearing aids.”4 It therefore seems likely that if some of the psychosocial issues underlying the refusal to acquire hearing aids could be elucidated and altered via counseling, then a greater number of hearing-impaired persons could be expected to wear hearing aids. Recent studies confirm that hearing aid use has notable advantages. For instance, the National Council on the Aging found that older adults with hearing loss who do not use amplification are more likely to report feelings of sadness, depression, anxiety, and emotional turmoil.5 In contrast, the council found, their aided counterparts experience an overall improvement in quality of life, relationships, and feelings about themselves following acquisition of hearing aids. In 1996, we published a paper describing the development of the Attitudes Toward Hearing Loss Questionnaire (ALHQ).6 This 24-item questionnaire consisted of five subscales that evaluated some of the psychosocial factors involved in the use and acquisition of hearing aids. Three of the five subscales were considered to be statistically reliable, but two were not. The aim of the study reported here was to revise the questionnaire to improve its statistical reliability, while at the same time investigating the possibility of adding or replacing subscales. This paper describes the outcome of the refinement of the ALHQ, and reports some of the relationships seen between ALHQ subscales and other subjective measures of hearing aid satisfaction/benefit.

Talker variability effects in auditory‐visual speech perception

Talker variability effects have been demonstrated for many aspects of syllable, word, and sentence recognition for stimuli presented in the auditory‐only modality. In the current investigation, talker variability effects were examined in multiple modalities—visual‐only, auditory‐only, and auditory‐visual. Auditory‐visual presentations were of two types: consonant [auditory and visual were of the same token—/visual bi and auditory bi/] or disparate [/visual gi and auditory bi or visual bi and auditory gi/]. The disparate condition has elicited ‘‘the McGurk effect,’’ in which listeners may report a fused response that is neither the auditory or the visual component of the stimulus. Eleven talkers (five male and six female) of varying cultural backgrounds were videotaped. Their productions of CV syllables were presented to adult listeners who reported their percepts. Individual talkers elicited different degrees of syllable fusion among listeners, despite their equivalent auditory intelligibility. In additio...

Are reports of temporary threshold shift-like symptoms by humans with normal hearing associated with hidden hearing loss?

Forty-six subjects with normal hearing, mean age 20.2 years, were selected from 451 volunteers completing a questionnaire concerning hearing, exposure to noise, experiencing TTS-like symptoms, and speech understanding. Metrics quantifying reports of TTS-like symptoms were constructed from responses to questions concerning hearing immediately after noise exposure. Statistically significant deteriorations in scores on the Speech, Spatial and Qualities of Hearing Scale (SSQ) (Gatehouse & Noble, Int J Audiol 43, 85-99 (2004)) were found with increasing values of TTS metrics for all SSQ questions. Groups reporting TTS-like symptoms (“exposed”), and “controls” (with little / no noise exposure and no reports of TTS-like symptoms), were formed from the subject pool with mean hearing levels differing <2 dB from 250Hz—8kHz. There was no difference in mean word scores between groups in a Modified Rhyme test conducted in speech-spectrum shaped noise. However, the exposed group exhibited a statistically significant de...

Minimizing occlusion: An evaluation of open‐fit versus deep‐canal fit hearing aids

Individuals with good low‐frequency hearing and poor high‐frequency hearing may complain that when wearing hearing aids, their voice sounds boomy or hollow [B. C. Grover and M. C. Martin, Audiology 18, 335–350 (1979)]. This is known as the occlusion effect. This effect occurs due to an improvement of bone‐conduction responses when the ear canal is covered or blocked [D. P. Goldstein and C. S. Hayes, J. Speech Hear. Res. 8, 137–148 (1965)]. The purpose of this study was to determine the degree of measured and self‐rated occlusion for hearing aids that attempt to minimize occlusion by utilizing open‐fit or deep‐canal fit designs. Measured occlusion was calculated from aided and unaided real ear responses obtained while subjects vocalized [i]. Self‐ratings were acquired using an occlusion effect scale. Results showed that open‐fit and deep‐canal fit hearing aids differ in degree of measured and self‐rated occlusion. Hearing aids with open‐canal characteristics had less measured occlusion, according to real e...

Multiple talker effects in auditory–visual speech perception among older adults

Talker variability effects have been shown for speech stimuli presented auditorily to young adult and older adult participants. Recent investigations suggest that similar variability is seen among young adults for auditory–visual congruent and discrepant stimuli. Older adults are reported to be at a disadvantage for processing information spoken by multiple talkers. Some investigators have suggested that perceptually demanding conditions, such as listening in noise may be more difficult for older listeners. In the current investigation, talker variability effects for CV syllables were examined in multiple modalities visual‐only, auditory‐only, and auditory–visual for older listeners. Auditory–visual presentations were of two types: congruent [auditory and visual were of the same token —/visual bi and auditory bi/] or disparate [/visual gi and auditory bi/]. The disparate condition has elicited the McGurk effect, in which listeners may report a fused response that is neither the auditory or the visual comp...