Margaret F. Cheesman

Factors in Client–Clinician Interaction That Influence Hearing Aid Adoption

The influence of client–clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider–patient interaction on health outcomes. The purpose of this study was to identify factors in the client–clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client–clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client–clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction.

Comparison of growth of masking functions and speech discrimination abilities in younger and older adults.

This study examined the possibility that age-related differences in speech discrimination abilities may reflect individual differences in the amount of masking and in the rate of growth of on- and off-frequency masking. Young (mean age = 26 years) and older (mean age = 60 years) adult listeners were selected, all of whom had hearing thresholds equal to or better than 30 dB HL at audiometric frequencies < or = 2000 Hz and equal or better than 40 dB HL at audiometric frequencies from 3000 to 6000 Hz. Listeners were tested on a consonant identification task in which nonsense words were presented in quiet, high-pass-filtered, low-pass-filtered and in wide-band noise. Despite their good hearing thresholds, the older listeners made significantly more errors in all four test conditions. Masked thresholds and growth of masking functions were obtained for all listeners at signal frequencies of 750, 1000, and 1500 Hz, in the presence of a one-third-octave band of noise centred at 1000 Hz, with four noise levels from 50 to 80 dB SPL. The older listeners had higher masked thresholds overall, when compared to younger listeners, even though their audiometric thresholds at these frequencies were within normal limits. However, the slope of the growth of masking functions at and above the masker frequency did not differ with age. These results show that older listeners show reduced speech discrimination abilities both in difficult listening conditions and in quiet, even when their pure-tone thresholds are within normal limits. Moreover, these effects cannot be attributed to differences in masked thresholds or in the rate of growth of masking.

Evaluation of speech intelligibility and sound localization abilities with hearing aids using binaural wireless technology

Wireless synchronization of the digital signal processing (DSP) features between two hearing aids in a bilateral hearing aid fitting is a fairly new technology. This technology is expected to preserve the differences in time and intensity between the two ears by co-ordinating the bilateral DSP features such as multichannel compression, noise reduction, and adaptive directionality. The purpose of this study was to evaluate the benefits of wireless communication as implemented in two commercially available hearing aids. More specifically, this study measured speech intelligibility and sound localization abilities of normal hearing and hearing impaired listeners using bilateral hearing aids with wireless synchronization of multichannel Wide Dynamic Range Compression (WDRC). Twenty subjects participated; 8 had normal hearing and 12 had bilaterally symmetrical sensorineural hearing loss. Each individual completed the Hearing in Noise Test (HINT) and a sound localization test with two types of stimuli. No specific benefit from wireless WDRC synchronization was observed for the HINT; however, hearing impaired listeners had better localization with the wireless synchronization. Binaural wireless technology in hearing aids may improve localization abilities although the possible effect appears to be small at the initial fitting. With adaptation, the hearing aids with synchronized signal processing may lead to an improvement in localization and speech intelligibility. Further research is required to demonstrate the effect of adaptation to the hearing aids with synchronized signal processing on different aspects of auditory performance.

Towards a comprehensive approach for managing transitions of older workers with hearing loss

Demographic and legislative trends suggest that many older workers may remain at work past the traditional retirement age. This extended work trajectory poses new challenges and opportunities for workers with acquired hearing loss as they age. Workplaces require a new approach to enable transitions of older workers with hearing loss to remain safe and productive. A review of the literature on older workers, those with hearing loss, and strategies used to accommodate them suggests that individualized and piecemeal approaches are predominant. While universal design represents a fresh ideology that may help create more accessible and usable products and environments, its application to improve workplaces for older workers with hearing loss is limited. This paper proposes that occupational science be integrated with knowledge in hearing sciences, accessibility, and usability to assist with the transitions faced by older workers with hearing loss. A more comprehensive approach including the following three key components will be posited to examine the nexus of aging, hearing loss and work: (1) the use of an occupational perspective, along with concepts in hearing sciences to examine hearing demands and improve hearing access; (2) the use of contextual processes to promote physical and social change, and (3) the inclusion of Universal Design for Hearing (UDH) considerations as stakeholders develop more hearing friendly workplaces.

Psychometric properties of the self-efficacy for situational communication management questionnaire (SESMQ)

Objectives: Perceived self-efficacy (PSE) is one’s beliefs in one’s capabilities to organize and execute the courses of action required to manage prospective situations. In audiologic rehabilitation, PSE could influence a person with hearing loss’ activity limitations, participation restrictions, and response to audiologic rehabilitation. This article reports the psychometric properties of the Self-Efficacy for Situational Communication Management Questionnaire (SESMQ), developed to measure PSE for managing communication in adults with acquired hearing loss. Design: The SESMQ contains 20 situations that are rated on two scales (hearing ability and PSE). Respondents rate how well they can hear from 0 (not well at all) to 10 (very well) and their degree of confidence in managing communication in the situation, or PSE, from 0 (not confident at all) to 10 (very confident). Total scores on each scale can range from 0 to 200, with higher scores indicating greater hearing ability or PSE. Psychometric properties were determined using data collected from The National Centre for Audiology (London, Canada) and the Communication Disability Centre at The University of Queensland (Brisbane, Australia). Participants were 338 adults aged 50 to 93 years with an average high-frequency pure-tone hearing loss in the better ear of 46 dB HL; 157 of the participants owned hearing aids. Results: A two-factor solution was found to be optimal for the SESMQ, with hearing ability accounting for 46.4% of the variation and confidence accounting for 11.6% of the variation in SESMQ scores. Test–retest reliability on a subset of 40 participants resulted in intraclass correlation coefficients of 0.94 for the SESMQ, 0.93 for the hearing ability scale, and 0.94 for the confidence scale, The SESMQ and its scales exhibited high internal consistency, with Cronbach’s &agr; of 0.94 for the SESMQ, 0.93 for the hearing ability scale, and 0.94 for the confidence scale. Participants scored lower on the hearing scale items (92.6, SD = 37.1), on average, than on the PSE scale items (123.0, SD = 37.9). SESMQ hearing ability scores were significantly associated with duration of hearing loss, and duration of hearing aid ownership. Only the hearing ability scale of the SESMQ was negatively associated with hearing loss when controlling for age. SESMQ hearing ability and confidence scores were negatively associated with consequences of hearing loss and negative beliefs and attitudes toward hearing loss and its consequences. Conclusions: The results support the SESMQ as an informative measure of PSE specific to communication for adults with hearing loss. The SESMQ may prove useful in both research and clinical practice.

The relation between loudness and intensity difference limens for tones in quiet and noise backgrounds

Recent studies of the relation between loudness and intensity difference limens (DLs) suggest that, if two tones of the same frequency are equally loud, they will have equal relative DLs [R. S. Schlauch and C.C. Wier, J. Speech Hear. Res. 30, 13-20 (1987); J.J. Zwislocki and H.N. Jordan, J. Acoust. Soc. Am. 79, 772-780 (1986)]. To test this hypothesis, loudness matches and intensity DLs for a 1000-Hz pure tone in quiet and in a 40-dB SPL spectrum level broadband noise were obtained for four subjects with normal hearing. The DLs were obtained in both gated- and continuous-pedestal conditions. Contrary to previous reports, equally loud tones do not yield equal relative DLs at several midintensities in the gated condition and at many intensities in the continuous condition. While the equal-loudness, equal-relative-DL hypothesis is not supported by the data, the relation between loudness and intensity discrimination appears to be well described by a model reported by Houtsma et al. [J. Acoust. Soc. Am. 68, 807-813 (1980)].

Selective adaptation by context‐conditioned fricatives

The role of vowel context and consonant labeling in the selective adaptation of voiceless fricatives was examined in three experiments. This approach was designed to determine whether selective adaptation effects occurred with voiceless fricative stimuli and to determine whether any such effects had a linguistic basis as opposed to a purely auditory basis. Two synthetic fricative‐vowel continua were used; one ranged from [si] to [∫i] and the other from [su] to [∫u]. Identification of the consonant portion of the syllables in these continua, as either [s] or [∫], depended on both the frequency of the friction noise and on the vowel quality. In experiment 1, the end points of the continua were used as adaptors, and the identification boundary shifted toward the adapting stimulus. In experiment 2, an ambiguous frication noise (that was identified as [s] before [u] and as [∫] before [i]) adapted the identification boundary in opposite directions, depending on which of the two vowels followed the noise. Thus t...

Representations of workers with hearing loss in Canadian newspapers: a thematic analysis

Abstract Objective: Participation in the labour force with a hearing impairment presents a number of challenges. This study describes how Canadian newspapers represent workers with hearing loss. Design: Taking a critical framing theory approach, thematic analysis was performed through coding relevant articles, abstracting and hierarchically categorising themes. Study sample: Seven English-language Canadian newspapers were searched for publications between 1995 and 2016. Twenty-six articles met our criteria: discussing paid workers with hearing loss who used English rather than sign language on the job and making reference to workers’ competence. Results: We identified a global theme, Focussing on a good worklife or focussing on a limited worklife, composed of three organising themes (1) Prominent individuals struggle, take action, and continue despite hearing loss, (2) Workers with hearing loss in the community create their best day themselves, and (3) Workers with hearing loss, as a generalised whole, are portrayed as either competent or limited. Conclusions: The dominant framing portrays individual workers as ingenious, determined, and successful. Negative framings were predominantly generalisations to these workers as a group. To generate more positive framings, professionals can build relationships with consumer groups and, when contacted by the media, direct journalists to interview workers with hearing loss.

Assessing communication accessibility in the university classroom: Towards a goal of universal hearing accessibility

Measures of accessibility typically focus on the physical environment and aspects relating to getting into and out of spaces. The transient sound environment is less well characterized in typical accessibility measures. Hearing accessibility measures can be based upon physical indices or functional assessment. The physical measures are indices that use signal-to-noise ratios to evaluate audibility while the functional assessment tool adopts universal design for hearing (UDH) principles derived from principles of universal design. The UDH principles include (1) Optimization of the hearing environment for all; (2) Optimization of interactions between persons and objects to promote better hearing in an environment; (3) Optimization of opportunities for people to have multiple choices of interactions with one another; (4) Optimization of opportunities for people to perform different activities in and across environments; (5) Optimization of opportunities for people to have safe, private, and secure use of the environment while minimizing distraction, interference, or cognitive loading; and (6) Optimization of opportunities for people to use the environment without extra steps for hearing access during preparatory, use and/or after use phases. This paper compares the two approaches using case examples from post-secondary classrooms in order to describe the potential advantages and limitations of each.

Objective and subjective measures of self‐reported hearing deterioration in older hearing‐impaired adults

A small proportion of hearing‐impaired older adults reports hearing deterioration during their annual otologic examination without exhibiting any concomitant changes in audiometric or otologic results. This study examined the ability of a self‐report questionnaire and a battery of speech perception tests to distinguish these subjects from a set of matched subjects who had no reported hearing deterioration. The Communication Profile for the Hearing Impaired (CPHI) and three performance‐based speech perception measures [objective and subjective speech reception threshold tests (SRT) and a suprathreshold nonsense word task] were included in the test battery. Responses to some specific items of the CPHI and the difference between the subjective and objective SRTs in noise differed between listeners with reported hearing deterioration and those without. Those who reported deterioration underestimated their hearing ability to hear in noise more than the control group. They were also more aware of their communic...