Kim Kähäri

Assessment of hearing and hearing disorders in rock/jazz musicians: Evaluación de la audición y de los problemas auditivos en músicos de rock y jazz

The aim of this study was to assess hearing and hearing disorders among rock/jazz musicians. One hundred and thirty-nine (43 women and 96 men) musicians participated. The results are based on pure-tone audiometry and questionnaire responses. According to our definition of hearing loss, tinnitus, hyperacusis, distortion and/ or diplacusis as hearing disorders, we found disorders in 74% of the rock/jazz musicians studied. Hearing loss, tinnitus and hyperacusis were most common, and the latter two were found significantly more frequently than in different reference populations. The women showed bilateral, significantly better hearing thresholds at 3–6 kHz than the men. Hyperacusis, and the combination of both hyperacusis and tinnitus, were found to be significantly more frequent among women than among men. Hearing loss and tinnitus were significantly more common among men than among women. It is important to evaluate all kinds of hearing problems (other than hearing loss) in musicians, since they represent an occupational group especially dependent on optimal, functional hearing. On the basis of our results, we suggest that hearing problems such as tinnitus, hyperacusis, distortion and/ or diplacusis should, in addition to hearing loss, be defined as hearing disorders. El objetivo de este estudio fue evaluar la audición y los problemas auditivos entre músicos de rock y jazz. Participaron ciento treinta y nueve músicos (43 mujeres y 96 hombres). Los resultados se basan en una audiometría tonal y las respuestas a un cuestionario. De acuerdo con nuestra definición de hipoacusia, acúfeno, hiperacusia, distorsión y/o diploacusia, encontramos problemas en un 74% de los músicos de rock y jazz estudiados. Las entidades más comunes fueron la hipoacusia, el acúfeno y la hiperacusia y éstas últimas dos, se hallaron más frecuentes que en diferentes poblaciones de referencia. Se encontró que la audición en 3–6kHz fue significativamente mejor en mujeres que en hombres. Así mismo se encontró que la hiperacusia y la combinación de hiperacusia y acúfeno, son significativamente más frecuentes entre las mujeres que entre los hombres. En los hombres fue más común la hipoacusia y el acúfeno. Es importante evaluar todo tipo de problema auditivo (además de la hipoacusia) en los músicos, puesto que se trata de un grupo especialmente dependiente del Óptimo funcionamiento de la audición. Con base en nuestros resultados, sugerimos que además de la hipoacusia, se considere que el acúfeno, la hiperacusia, la distorsión y/o la diploacusia deben ser definidos como problemas auditivos.

The ICF Core Sets for hearing loss – researcher perspective. Part I: Systematic review of outcome measures identified in audiological research

Abstract Objective: To review the literature in order to identify outcome measures used in research on adults with hearing loss (HL) as part of the ICF Core Sets development project, and to describe study and population characteristics of the reviewed studies. Design: A systematic review methodology was applied using multiple databases. A comprehensive search was conducted and two search pools were created, pool I and pool II. Study sample: The study population included adults (≥ 18 years of age) with HL and oral language as the primary mode of communication. Results: 122 studies were included. Outcome measures were distinguished by ‘instrument type’, and 10 types were identified. In total, 246 (pool I) and 122 (pool II) different measures were identified, and only approximately 20% were extracted twice or more. Most measures were related to speech recognition. Fifty-one different questionnaires were identified. Many studies used small sample sizes, and the sex of participants was not revealed in several studies. Conclusion: The low prevalence of identified measures reflects a lack of consensus regarding the optimal outcome measures to use in audiology. Reflections and discussions are made in relation to small sample sizes and the lack of sex differentiation/descriptions within the included articles.

Preferred sound levels of portable music players and listening habits among adults: A field study

The main purpose of this descriptive field study was to explore music listening habits and preferred listening levels with portable music players (PMPs). We were also interested in seeing whether any exposure differences could be observed between the sexes. Data were collected during 12 hours at Stockholm Central Station, where people passing by were invited to measure their preferred PMP listening level by using a KEMAR manikin. People were also asked to answer a questionnaire about their listening habits. In all, 60 persons (41 men and 19 women) took part in the questionnaire study and 61 preferred PMP levels to be measured. Forty-one of these sound level measurements were valid to be reported after consideration was taken to acceptable measuring conditions. The women (31 years) and the men (33 years) started to use PMPs on a regular basis in their early 20s. Ear canal headphones/ear buds were the preferred headphone types. Fifty-seven percent of the whole study population used their PMP on a daily basis. The measured LAeq60 sec levels corrected for free field ranged between 73 and 102 dB, with a mean value of 83 dB. Sound levels for different types of headphones are also presented. The results of this study indicate that there are two groups of listeners: people who listen less frequently and at lower, safer sound levels, and people with excessive listening habits that may indeed damage their hearing sensory organ in time.

Implementing Internet-Based Aural Rehabilitation in a General Clinical Practice.

PURPOSE The purpose of this paper is to share the lessons that were learned about the process of implementing an Internet-based, randomized controlled trial (RCT) in general clinical practice (GCP) and to address some of the advantages of using the Internet as a tool to implement a RCT in GCP. The RCT implemented focused on investigating Internet-based aural rehabilitation (AR) in addition to hearing aid (HA)-fitting supplemented with telephone support, and it was applied in a clinical setting. The results of this RCT and the questionnaires chosen will be presented in an article elsewhere. PROCEDURE Here, the procedure of the implemented trial is presented, and the implementation challenges are presented and discussed. Specifically, we describe the trial research question, recruitment strategy, patient eligibility criteria, the questionnaires, clinician participation, funding and time (for the clinicians), and risks and benefits (for the participants). DISCUSSION The trial implementation showed that AR in addition to HA-fitting can be carried out in GCP using the Internet. Using an Internet-based RCT overcomes some of the challenges of implementing a trial in GCP.

Hearing Thresholds, tinnitus, and headphone listening habits in nine-year-old children

Abstract Objective: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. Design: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. Study sample: A total of 415 children aged nine years. Results: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones. Conclusion: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children’s hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

The impact of different background noises : Effects on cognitive performance and perceived disturbance in employees with aided hearing impairment and normal hearing

BACKGROUND Health care professionals frequently meet employees with hearing impairment (HI) who experience difficulties at work. There are indications that the majority of these difficulties might be related to the presence of background noise. Moreover, research has also shown that high-level noise has a more detrimental effect on cognitive performance and self-rated disturbance in individuals with HI than low-level noise. PURPOSE The purpose of this study was to examine the impact of different types of background noise on cognitive performance and perceived disturbance (PD) in employees with aided HI and normal hearing. RESEARCH DESIGN A mixed factorial design was conducted to examine the effect of noise in four experimental conditions. STUDY SAMPLE A total of 40 participants (21 men and 19 women) were recruited to take part in the study. The study sample consisted of employees with HI (n = 20) and normal hearing (n = 20). The group with HI had a mild-moderate sensorineural HI, and they were all frequent hearing-aid users. INTERVENTION The current study was conducted by using four general work-related tasks (mental arithmetic, orthographic decoding, phonological decoding, and serial recall) in four different background conditions: (1) quiet, (2) office noise at 56 dBA, (3) daycare noise at 73.5 dBA, and (4) traffic noise at 72.5 dBA. Reaction time and the proportion of correct answers in the working tasks were used as outcome measures of cognitive performance. The Borg CR-10 scale was used to assess PD. DATA COLLECTION AND ANALYSIS Data collection occurred on two separate sessions, completed within 4 wk of each other. All tasks and experimental conditions were used in a counterbalanced order. Two-way analysis of variance with repeated measures was performed to analyze the results. To examine interaction effects, pairwise t-tests were used. Pearson correlation coefficients between reaction time and proportion of correct answers, and cognitive performance and PD were also calculated to examine the possible correlation between the different variables. RESULTS No significant between-group or within-group differences in cognitive performance were observed across the four background conditions. Ratings of PD showed that both groups rated PD according to noise level, where higher noise level generated a higher PD. The present findings also demonstrated that the group with HI was more disturbed by higher than lower levels of noise (i.e., traffic and daycare setting compared with office setting). This pattern was observed consistently throughout four working tasks where the group with HI reported a significantly greater PD in the daycare and traffic settings compared with office noise. CONCLUSIONS The present results demonstrate that background noise does not impair cognitive performance in nonauditory tasks in employees with HI and normal hearing, but that PD is affected to a greater extent in employees with HI during higher levels of background noise exposure. In addition, this study also supports previous studies regarding the detrimental effects that high-level noise has on employees with HI. Therefore, we emphasize the need of both self-rated and cognitive measurements in hearing care and occupational health services for both employees with normal hearing and HI.

Headphone listening habits and hearing thresholds in swedish adolescents

Introduction: The aim of this study was to investigate self-reported hearing and portable music listening habits, measured hearing function and music exposure levels in Swedish adolescents. The study was divided into two parts. Materials and Methods: The first part included 280 adolescents, who were 17 years of age and focused on self-reported data on subjective hearing problems and listening habits regarding portable music players. From this group, 50 adolescents volunteered to participate in Part II of the study, which focused on audiological measurements and measured listening volume. Results: The results indicated that longer lifetime exposure in years and increased listening frequency were associated with poorer hearing thresholds and more self-reported hearing problems. A tendency was found for listening to louder volumes and poorer hearing thresholds. Women reported more subjective hearing problems compared with men but exhibited better hearing thresholds. In contrast, men reported more use of personal music devices, and they listen at higher volumes. Discussion: Additionally, the study shows that adolescents listening for ≥3 h at every occasion more likely had tinnitus. Those listening at ≥85 dB LAeq, FF and listening every day exhibited poorer mean hearing thresholds, reported more subjective hearing problems and listened more frequently in school and while sleeping. Conclusion: Although the vast majority listened at moderate sound levels and for shorter periods of time, the study also indicates that there is a subgroup (10%) that listens between 90 and 100 dB for longer periods of time, even during sleep. This group might be at risk for developing future noise-induced hearing impairments.

A Swedish cross-cultural adaptation and validation of the Tinnitus Functional Index

Abstract Objective: The Tinnitus Functional Index (TFI) is a recent self-report instrument for tinnitus with potential advantages over other existing instruments, including a demonstrated high responsiveness. The objectives of this study were to translate and cross-culturally adapt the TFI into Swedish and to investigate its validity and reliability. Design: The development of the Swedish version (TFI-SE) followed published guidelines on cross-cultural adaptation of health questionnaires. Validity and reliability was investigated by correlating responses on the TFI-SE with other tinnitus measures [Tinnitus Handicap Inventory (THI) and visual analogue scale (VAS)] and a scale measuring anxiety and depression (HADS). Study sample: Consecutively recruited tinnitus patients (n = 100) from four Swedish clinics completed the questionnaires. The mean age of the sample was 51 years (SD =17). Results: The internal consistency of the TFI-SE was good (α = 0.95) and the test–retest reliability was high (ICC =0.93). Our results supported the eight-factor structure proposed for the original TFI, and a high correlation between the TFI-SE and the THI (r = 0.8; p < 0.01) and lower correlations between the TFI-SE and the HADS-D (r = 0.60; p < 0.01) and HADS-A (r = 0.59; p < 0.01) confirmed satisfactory convergent and discriminant validity. Conclusions: We found that the Swedish translation and cross-cultural adaptation of the TFI is valid and reliable for use with adult tinnitus patients.

Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: a randomised controlled trial

Objective Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population. Outcome measures The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Communication Strategies Scale (CSS) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. All questionnaires were administered before and directly after the intervention and at 6 months postintervention. Methods We used a parallel group design (RCT). The data were collected in 2013–2014 at three different clinics. Seventy-four HA users were randomly assigned to receive either full internet-based AR (intervention group, n=37) or one element of the internet-based AR (control group, n=37). Results Data were analysed following the intention-to-treat principle. Each group showed improved HHIE scores over time and did not differ significantly from each other. The intervention group showed significantly greater improvement compared with the control group for the CSS total and the non-verbal subscale scores. The intervention group and control group were also subdivided into two age groups: 20–59 years and 60–80 years. Significantly better improvement on the CSS total and non-verbal subscale scores was found in the older group compared with the younger participants. Conclusions This study indicates that participants in an internet-based intervention applied in general clinical practice showed improved self-reported communication skills compared with a control group. Receiving a full intervention was not more effective in improving self-reported hearing problems than receiving just one element of the internet-based intervention. Trial registration number This trial is registered at ClinicalTrals.gov, NCT01837550; results.

Experiences of an Internet-based aural rehabilitation (IAR) program for hearing aid users: a qualitative study

Abstract Objective: Internet interventions for hearing aid (HA) users have been shown to be effective in helping persons with hearing problems. As earlier research refers to objective data on these effects, little is known about how participants experience the Internet interventions subjectively. The aim of the present study was to explore participants’ experiences of an Internet-based aural rehabilitation (IAR) program for HA-users, and to explore the possible subjective benefits of such a program. Design: A qualitative exploratory design was implemented involving semi-structured telephone interviews. The interviews were transcribed and analysed using content analysis. Study sample: Interviews were conducted with 20 participants (9 men and 11 women) who had completed an IAR program for HA-users. The participants were 57–81 years old and had used HAs for 2–25 years. Results: The results are organised in three main categories: general experiences associated with participating in the program, knowledge obtained from the program and perceived impact of taking part in the program. Conclusions: The overall results indicate positive experiences of the IAR program, and an overreaching theme of increased self-esteem was identified. The findings provide some valuable information for developers of future IAR programs.