Sherri L. Smith

Effects of hearing and vision impairments on the Montreal Cognitive Assessment.

Many standardized measures of cognition include items that must be seen or heard. Nevertheless, it is not uncommon to overlook the possible effects of sensory impairment(s) on test scores. In the current study, we investigated whether sensory impairments could affect performance on a widely used screening tool, the Montreal Cognitive Assessment (MoCA). Three hundred and one older adults (mean age = 71 years) completed the MoCA and also hearing and vision tests. Half of the participants had normal hearing and vision, 38% impaired hearing, 5% impaired vision, and 7% had dual-sensory impairment. More participants with normal sensory acuity passed the MoCA compared to those with sensory loss, even after modifying scores to adjust for sensory factors. The results suggest that cognitive abilities may be underestimated if sensory problems are not considered and that people with sensory loss are at greater risk of cognitive decline.

Prevalence and characteristics of dual sensory impairment (hearing and vision) in a veteran population.

With the increasing aging population, the number of veterans presenting with dual sensory impairment (DSI) (vision and hearing impairments) will increase. This study determined the prevalence and clinical characteristics of DSI in a veteran population receiving healthcare from the Department of Veterans Affairs (VA). A retrospective review was conducted on 400 charts randomly selected from a database of 1,472 unique veterans enrolled in the audiology and optometry outpatient clinics during a 1-year period. Depending on definition criteria, hearing impairment prevalence was 41.6% to 74.6%, vision impairment/blindness prevalence was 7.4%, and DSI prevalence was 5.0% to 7.4%. The vision impairment/blindness prevalence governed the DSI prevalence. By age, DSI prevalence ranged from 0% (among veterans <65 years) to >20% (among veterans 85+ years). The complexities encountered in defining DSI are discussed and suggestions are made for determining standardized definitions. More research is needed to determine the unique characteristics of individuals with DSI and their impact on VA resources.

Development of a hearing aid self-efficacy questionnaire

Discontinued hearing-aid use is caused by a number of factors, most of which may lead to low hearing-aid self-efficacy (i.e. low confidence in ones ability to B a successful hearing-aid user). This paper describes the development of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA), which was constructed in accordance with published recommendations for self-efficacy questionnaire development. The psychometric properties of the MARS-HA were evaluated with new and experienced hearing-aid users. The results revealed strong internal consistency and good test-retest reliability in both groups, with the following subscales identified both for the new users and the experienced users: (1) basic handling, (2) advanced handling, (3) adjustment to hearing aids, and (4) aided listening skills. Validity was established through the examination of expected differences based on group comparisons, training effects, and the impact of particular hearing aid features. The MARS-HA is a reliable and valid measure of hearing-aid self-efficacy and can be used to assist clinicians in identifying areas of low confidence that require additional audiologic training.

Word recognition for temporally and spectrally distorted materials: the effects of age and hearing loss.

Objectives: The purpose of Experiment 1 was to measure word recognition in younger adults with normal hearing when speech or babble was temporally or spectrally distorted. In Experiment 2, older listeners with near-normal hearing and with hearing loss (for pure tones) were tested to evaluate their susceptibility to changes in speech level and distortion types. The results across groups and listening conditions were compared to assess the extent to which the effects of the distortions on word recognition resembled the effects of age-related differences in auditory processing or pure-tone hearing loss. Design: In Experiment 1, word recognition was measured in 16 younger adults with normal hearing using Northwestern University Auditory Test No. 6 words in quiet and the Words-in-Noise test distorted by temporal jittering, spectral smearing, or combined jittering and smearing. Another 16 younger adults were evaluated in four conditions using the Words-in-Noise test in combinations of unaltered or jittered speech and unaltered or jittered babble. In Experiment 2, word recognition in quiet and in babble was measured in 72 older adults with near-normal hearing and 72 older adults with hearing loss in four conditions: unaltered, jittered, smeared, and combined jittering and smearing. Results: For the listeners in Experiment 1, word recognition was poorer in the distorted conditions compared with the unaltered condition. The signal to noise ratio at 50% correct word recognition was 4.6 dB for the unaltered condition, 6.3 dB for the jittered, 6.8 dB for the smeared, 6.9 dB for the double-jitter, and 8.2 dB for the combined jitter-smear conditions. Jittering both the babble and speech signals did not significantly reduce performance compared with jittering only the speech. In Experiment 2, the older listeners with near-normal hearing and hearing loss performed best in the unaltered condition, followed by the jitter and smear conditions, with the poorest performance in the combined jitter-smear condition in both quiet and noise. Overall, listeners with near-normal hearing performed better than listeners with hearing loss by ~30% in quiet and ~6 dB in noise. In the quiet distorted conditions, when the level of the speech was increased, performance improved for the hearing loss group, but decreased for the older group with near-normal hearing. Recognition performance of younger listeners in the jitter-smear condition and the performance of older listeners with near-normal hearing in the unaltered conditions were similar. Likewise, the performance of older listeners with near-normal hearing in the jitter-smear condition and the performance of older listeners with hearing loss in the unaltered conditions were similar. Conclusions: The present experiments advance our understanding regarding how spectral or temporal distortions of the fine structure of speech affect word recognition in older listeners with and without clinically significant hearing loss. The Speech Intelligibility Index was able to predict group differences, but not the effects of distortion. Individual differences in performance were similar across all distortion conditions with both age and hearing loss being implicated. The speech materials needed to be both spectrally and temporally distorted to mimic the effects of age-related differences in auditory processing and hearing loss.

Associations between speech understanding and auditory and visual tests of verbal working memory: effects of linguistic complexity, task, age, and hearing loss

Listeners with hearing loss commonly report having difficulty understanding speech, particularly in noisy environments. Their difficulties could be due to auditory and cognitive processing problems. Performance on speech-in-noise tests has been correlated with reading working memory span (RWMS), a measure often chosen to avoid the effects of hearing loss. If the goal is to assess the cognitive consequences of listeners’ auditory processing abilities, however, then listening working memory span (LWMS) could be a more informative measure. Some studies have examined the effects of different degrees and types of masking on working memory, but less is known about the demands placed on working memory depending on the linguistic complexity of the target speech or the task used to measure speech understanding in listeners with hearing loss. Compared to RWMS, LWMS measures using different speech targets and maskers may provide a more ecologically valid approach. To examine the contributions of RWMS and LWMS to speech understanding, we administered two working memory measures (a traditional RWMS measure and a new LWMS measure), and a battery of tests varying in the linguistic complexity of the speech materials, the presence of babble masking, and the task. Participants were a group of younger listeners with normal hearing and two groups of older listeners with hearing loss (n = 24 per group). There was a significant group difference and a wider range in performance on LWMS than on RWMS. There was a significant correlation between both working memory measures only for the oldest listeners with hearing loss. Notably, there were only few significant correlations among the working memory and speech understanding measures. These findings suggest that working memory measures reflect individual differences that are distinct from those tapped by these measures of speech understanding.

The Revised Speech Perception in Noise Test (R-SPIN) in a multiple signal-to-noise ratio paradigm.

BACKGROUND The Revised Speech Perception in Noise Test (R-SPIN; Bilger, 1984b) is composed of 200 target words distributed as the last words in 200 low-predictability (LP) and 200 high-predictability (HP) sentences. Four list pairs, each consisting of two 50-sentence lists, were constructed with the target word in a LP and HP sentence. Traditionally the R-SPIN is presented at a signal-to-noise ratio (SNR, S/N) of 8 dB with the listener task to repeat the last word in the sentence. PURPOSE The purpose was to determine the practicality of altering the R-SPIN format from a single SNR paradigm into a multiple SNR paradigm from which the 50% points for the HP and LP sentences can be calculated. RESEARCH DESIGN Three repeated measures experiments were conducted. STUDY SAMPLE Forty listeners with normal hearing and 184 older listeners with pure-tone hearing loss participated in the sequence of experiments. DATA COLLECTION AND ANALYSIS The R-SPIN sentences were edited digitally (1) to maintain the temporal relation between the sentences and babble, (2) to establish the SNRs, and (3) to mix the speech and noise signals to obtain SNRs between -1 and 23 dB. All materials were recorded on CD and were presented through an earphone with the responses recorded and analyzed at the token level. For reference purposes the Words-in-Noise Test (WIN) was included in the first experiment. RESULTS In Experiment 1, recognition performances by listeners with normal hearing were better than performances by listeners with hearing loss. For both groups, performances on the HP materials were better than performances on the LP materials. Performances on the LP materials and on the WIN were similar. Performances at 8 dB S/N were the same with the traditional fixed level presentation and the descending presentation level paradigms. The results from Experiment 2 demonstrated that the four list pairs of R-SPIN materials produced good first approximation psychometric functions over the -4 to 23 dB S/N range, but there were irregularities. The data from Experiment 2 were used in Experiment 3 to guide the selection of the words to be used at the various SNRs that would provide homogeneous performances at each SNR and would produce systematic psychometric functions. In Experiment 3, the 50% points were in good agreement for the LP and HP conditions within both groups of listeners. The psychometric functions for List Pairs 1 and 2, 3 and 4, and 5 and 6 had similar characteristics and maintained reasonable separations between the HP and LP functions, whereas the HP and LP functions for List Pair 7 and 8 bisected one another at the lower SNRs. CONCLUSIONS This study indicates that the R-SPIN can be configured into a multiple SNR paradigm. A more in-depth study with the R-SPIN materials is needed to develop lists that are systematic and reasonably equivalent for use on listeners with hearing loss. The approach should be based on the psychometric characteristics of the 200 HP and 200 LP sentences with the current R-SPIN lists discarded. Of importance is maintaining the synchrony between the sentences and their accompanying babble.

Development of the Listening Self-Efficacy Questionnaire (LSEQ).

Abstract Objective: Listening self-efficacy refers to the beliefs, or confidence, that listeners have in their capability to successfully listen in specific situations, which may influence audiologic rehabilitation outcomes. The objective of this study was to develop and validate the Listening Self-Efficacy Questionnaire (LSEQ), which quantifies listening self-efficacy in a variety of situations where the goal of the listener is to understand speech. Study Sample: Older listeners with hearing loss (N = 169) participated in the study. Design: A factor analysis showed that the LSEQ has three subscales, with beliefs about listening capabilities relating to the following situations: (1) dialogue in quiet, (2) focusing attention on a single source, and (3) complex auditory scenes. Internal consistency reliability was excellent (Chronbachs α > .80). Results: The validity of the LSEQ was demonstrated by comparing the LSEQ scores to audiologic measures, responses on questionnaires, and to the scores for reference groups of younger and older listeners with normal hearing. Conclusion: The findings indicate that the LSEQ is a valid and reliable measure of listening self-efficacy with good potential for use in clinical and research settings. Sumario Objetivo: La auto-eficacia para escuchar se refiere a la convicción o confianza que el sujeto tenga sobre su capacidad de escuchar exitosamente en situaciones específicas, las cuáles pueden influir los resultados de una rehabilitación audiológica. El propósito de este estudio fue desarrollar y validar un cuestionario de auto-eficacia para escuchar (LSEQ), que cuantifica la auto-eficacia para escuchar en una variedad de situaciones, donde la meta es entender lenguaje. Muestra del Estudio: Participaron en el estudio sujetos mayores con hipoacusia (n = 169). Diseño: Un análisis factorial mostró que el LSEQ tiene tres sub-escalas, con relación a capacidades para escuchar en la siguientes situaciones: (1) diálogo en silencio, (2) concentrando la atención en un fuente única, y (3) escenarios auditivos complejos. La confiabilidad y la consistencia interna fue excelente (Chronbach α > .80). Resultados: La validez del LSEQ fue demostrada comparando las puntuaciones con las mediciones audiológicas, con las respuestas de cuestionarios, y con las puntuaciones para grupos de referencia de personas jóvenes y viejas con audición normal. Conclusión: Los hallazgos indican que el LSEQ es una medida válida y confiable de auto-eficacia para escuchar con un buen potencial para utilizarse en el contexto clínico y de investigación.

A Randomized Control Trial: Supplementing Hearing Aid Use with Listening and Communication Enhancement (LACE) Auditory Training.

Objective: To examine the effectiveness of the Listening and Communication Enhancement (LACE) program as a supplement to standard-of-care hearing aid intervention in a Veteran population. Design: A multisite randomized controlled trial was conducted to compare outcomes following standard-of-care hearing aid intervention supplemented with (1) LACE training using the 10-session DVD format, (2) LACE training using the 20-session computer-based format, (3) placebo auditory training (AT) consisting of actively listening to 10 hr of digitized books on a computer, and (4) educational counseling—the control group. The study involved 3 VA sites and enrolled 279 veterans. Both new and experienced hearing aid users participated to determine if outcomes differed as a function of hearing aid user status. Data for five behavioral and two self-report measures were collected during three research visits: baseline, immediately following the intervention period, and at 6 months postintervention. The five behavioral measures were selected to determine whether the perceptual and cognitive skills targeted in LACE training generalized to untrained tasks that required similar underlying skills. The two self-report measures were completed to determine whether the training resulted in a lessening of activity limitations and participation restrictions. Outcomes were obtained from 263 participants immediately following the intervention period and from 243 participants 6 months postintervention. Analyses of covariance comparing performance on each outcome measure separately were conducted using intervention and hearing aid user status as between-subject factors, visit as a within-subject factor, and baseline performance as a covariate. Results: No statistically significant main effects or interactions were found for the use of LACE on any outcome measure. Conclusions: Findings from this randomized controlled trial show that LACE training does not result in improved outcomes over standard-of-care hearing aid intervention alone. Potential benefits of AT may be different than those assessed by the performance and self-report measures utilized here. Individual differences not assessed in this study should be examined to evaluate whether AT with LACE has any benefits for particular individuals. Clinically, these findings suggest that audiologists may want to temper the expectations of their patients who embark on LACE training.

Development of the self-efficacy for tinnitus management questionnaire.

BACKGROUND Self-efficacy refers to the beliefs (i.e., confidence) individuals have in their capabilities to perform skills needed to accomplish a specific goal or behavior. Research in the treatment of various health conditions such as chronic pain, balance disorders, and diabetes shows that self-efficacy beliefs play an important role in treatment outcomes and management of the condition. This article focuses on the application of self-efficacy to the management of tinnitus. The first step in formally incorporating self-efficacy in existing treatment regimens or developing a self-efficacy approach for tinnitus treatment is to have a valid and reliable measure available to assess the level of tinnitus self-efficacy. PURPOSE The objective of this study was to develop the Self-Efficacy for Tinnitus Management Questionnaire (SETMQ) and to obtain the psychometric properties of the questionnaire in a group of patients with tinnitus. RESEARCH DESIGN Observational study. STUDY SAMPLE A total of 199 patients who were enrolled in the Tinnitus Clinic at the James H. Quillen Veterans Affairs Medical Center participated in the current study. DATA COLLECTION AND ANALYSIS The SETMQ was mailed to patients enrolled in the Tinnitus Clinic. The participants who completed one copy of the SETMQ were mailed a second copy to complete approximately 2 weeks later. An exploratory factor analysis was conducted to identify the most coherent subscale structure of the SETMQ. The internal consistency and test-retest reliability for each of the subscales and the questionnaire as a whole were assessed. The validity of the SETMQ also was evaluated by investigating the relations between the SETMQ and other clinical measures related to tinnitus. RESULTS Five components emerged from the factor analysis that explained 75.8% of the variance related to the following areas: (1) routine tinnitus management, (2) emotional response to tinnitus, (3) internal thoughts and interaction with others, (4) tinnitus concepts, and (5) use of assistive devices. Four items failed to load on any factor and were discarded, resulting in 40 items on the final SETMQ. The internal consistency reliability of the overall questionnaire and for each subscale was good (Chronbachs α ranged from .74 to .98). Item-total correlations ranged from .47 to .86, indicating that each item on the SETMQ correlated at a moderate or marked level with the SETMQ aggregate score. Intraclass correlation coefficients were computed to determine the test-retest reliability of the SETMQ total scale and separately for each subscale, which were all above .80, indicating good test-retest reliability. Correlations among the SETMQ subscales and various tinnitus-related measures (e.g., Tinnitus Handicap Inventory, tinnitus loudness rating, tinnitus distress rating, etc.) were significant, albeit indicative of fair to good relations overall (range r = -.18 to -.53). CONCLUSIONS The results of the current study suggest that the SETMQ is a valid and reliable measure that may be an insightful instrument for clinicians and investigators who are interested in assessing tinnitus self-efficacy. Incorporating self-efficacy principles into tinnitus management would provide clinicians with another formalized treatment option. A self-efficacy approach to treating tinnitus may result in better outcomes compared with approaches not focusing on self-efficacy principles.

Development of the Word Auditory Recognition and Recall Measure: A Working Memory Test for Use in Rehabilitative Audiology.

Objectives: The purpose of this study was to develop the Word Auditory Recognition and Recall Measure (WARRM) and to conduct the inaugural evaluation of the performance of younger adults with normal hearing, older adults with normal to near-normal hearing, and older adults with pure-tone hearing loss on the WARRM. Design: The WARRM is a new test designed for concurrently assessing word recognition and auditory working memory performance in adults who may have pure-tone hearing loss. The test consists of 100 monosyllabic words based on widely used speech-recognition test materials. The 100 words are presented in recall set sizes of 2, 3, 4, 5, and 6 items, with 5 trials in each set size. The WARRM yields a word-recognition score and a recall score. The WARRM was administered to all participants in three listener groups under two processing conditions in a mixed model (between-subjects, repeated measures) design. The between-subjects factor was group, with 48 younger listeners with normal audiometric thresholds (younger listeners with normal hearing [YNH]), 48 older listeners with normal thresholds through 3000 Hz (older listeners with normal hearing [ONH]), and 48 older listeners with sensorineural hearing loss (older listeners with hearing loss [OHL]). The within-subjects factor was WARRM processing condition (no additional task or with an alphabet judgment task). The associations between results on the WARRM test and results on a battery of other auditory and memory measures were examined. Results: Word-recognition performance on the WARRM was not affected by processing condition or set size and was near ceiling for the YNH and ONH listeners (99 and 98%, respectively) with both groups performing significantly better than the OHL listeners (83%). The recall results were significantly better for the YNH, ONH, and OHL groups with no processing (93, 84, and 75%, respectively) than with the alphabet processing (86, 77, and 70%). In both processing conditions, recall was best for YNH, followed by ONH, and worst for OHL listeners. WARRM recall scores were significantly correlated with other memory measures. In addition, WARRM recall scores were correlated with results on the Words-In-Noise (WIN) test for the OHL listeners in the no processing condition and for ONH listeners in the alphabet processing condition. Differences in the WIN and recall scores of these groups are consistent with the interpretation that the OHL listeners found listening to be sufficiently demanding to affect recall even in the no processing condition, whereas the ONH group listeners did not find it so demanding until the additional alphabet processing task was added. Conclusions: These findings demonstrate the feasibility of incorporating an auditory memory test into a word-recognition test to obtain measures of both word recognition and working memory simultaneously. The correlation of WARRM recall with scores from other memory measures is evidence of construct validity. The observation of correlations between the WIN thresholds with each of the older groups and recall scores in certain processing conditions suggests that recall depends on listeners’ word-recognition abilities in noise in combination with the processing demands of the task. The recall score provides additional information beyond the pure-tone audiogram and word-recognition scores that may help rehabilitative audiologists assess the listening abilities of patients with hearing loss.