British journal of audiology最新文献

The purpose of this study was to describe the experiences of coping with demanding auditory situations in everyday life from the perspective of individuals with severe-profound hearing impairment. Seventeen individuals (11 women and 6 men), with post-lingual severe-profound hearing impairment participated in the study. All were patients at the Department of Audiology, Sahlgrenska University Hospital in Göteborg, Sweden. Inclusion criteria were a hearing impairment exceeding 70 dB HL at the frequency of 1 kHz in the better ear, and full-time employment. Data were assessed by in-depth interviews lasting about one hour. The interviews were transcribed verbatim and analysed line-by-in line in accordance with the grounded theory tradition. Six theoretical constructs, or categories, were grounded in the data. These categories were labelled 'coaching', 'belonging to two worlds', 'self-efficacy', 'hardiness' and 'directing coping strategies'. In a grounded theory the central phenomenon on which all the other categories are integrated is known as the 'core category'. The core category, which emerged in the present study, was labelled 'finding flow and entering a positive circle'. This was described as a condition necessary for successful coping with the demanding situation of being a profoundly hearing-impaired person working full-time. According to the core category, there is a small 'margin' within the positive circle (a space where smaller mistakes may occur). However, if mistakes are too severe, or too many, individuals will no longer find flow in the positive circle, rather they enter a negative circle. In the present study subjects' personalities were characterized by hardiness. It is suggested that coaching behaviour and the hearing-impaired individuals' personality dispositions of hardiness and self-efficacy function as resistance resources, buffering stressful events in everyday life.

According to epidemiological studies of tinnitus prevalence, 0.5-1% of respondents report that tinnitus severely affects their ability to lead a normal life. In the present investigation quality of life and its association with tinnitus-related factors: psychological, psychosomatic and audiological, was studied based on a sample of 122 patients, who attended the hearing clinic for distress due to tinnitus. A stepwise regression analysis was performed with quality of life as a dependent variable. Six of 13 variables included in the model proved to be significant regressors and to explain 65% of the variance. The six predictor variables were: impaired concentration, feeling depressed, perceived negative attitudes, hypersensitivity to sounds, average hearing level (best ear) and tinnitus duration (the shorter the duration of tinnitus the more negative impact on quality of life). The three most significant predictors were directly related to perceived psychological distress and explained most of the variance in quality of life in tinnitus patients included in this study. An unexpected finding was that fluctuations in tinnitus, vertigo, headache or perceived social support did not prove to belong to the significant regressors. The results are discussed in view of the construct of quality of life, depressive cognitions and social support in general, as well as in tinnitus-specific life circumstances.

This paper describes a laboratory-based comparison of the effectiveness of two formulae for fitting linear hearing aids, the NAL(R) formula and the Cambridge formula. The formulae prescribe the desired insertion gain as a function of frequency, based on the audiometric threshold. The two formulae have a similar rationale; both are based on the goal that, for speech with a moderate level, all frequency bands should be equally loud (equal loudness per critical band) over the frequency range important for speech (400-5000 Hz), and the overall loudness should be comfortable. However, the formulae differ; generally the Cambridge formula leads to slightly more high-frequency gain (above 2 kHz) and slightly less mid-frequency gain (between 500 Hz and 2000 Hz) than the NAL(R) formula. The two formulae were implemented using an experimental digital hearing aid whose frequency-gain characteristic could be controlled very precisely. A loudness model (Moore and Glasberg, 1997) was used to adjust the overall gains for each subject and each formula so that a speech-shaped noise with an overall level of 65 dB SPL would give the same loudness as for a normally hearing person (according to the model). The adjustments were, on average, smaller for the Cambridge than for the NAL(R) formula. A condition was also used with all insertion gains set to zero, simulating unaided listening. Evaluation was based on: (1) subjective ratings of the loudness, intelligibility and quality of continuous discourse presented in quiet at levels of 45, 55, 65 and 75 dB SPL and in babble at an 0-dB speech-to-babble ratio, using speech levels of 55, 65 and 75 dB SPL; (2) measures of the speech reception threshold (SRT) in background noise for two noise levels (65 and 75 dB SPL) and four types of background noise. Neither the subjective ratings nor the measures of the SRTs revealed any consistent difference between the results obtained using the two formulae, although both formulae led to lower (better) SRTs than for simulated unaided listening. It is concluded that the differences between the NAL(R) formula and the Cambridge formula are too small to have measurable effects, at least in a laboratory setting.

The purpose of this study was to estimate the hearing levels, at the mid-frequencies, of 233 ears with sensorineural hearing loss by classifying the corresponding transiently evoked otoacoustic emissions (TEOAE) recordings into three threshold groups. A classification algorithm was based upon a discriminant analysis of fast Fourier transform (FFT) data, evoked by non-linear click stimuli of 80 (+/-2) dB SPL per ear. To validate the efficiency of the proposed methodology TEOAE recordings were initially grouped by mean hearing level values of the 1 kHz and 2 kHz octaves into three threshold ranges according to two strategy schemes: in the first, TEOAE data were assigned into 10-19 dB HL, 20-39 dB HL or > or = 40 dB HL groups. In the second, TEOAE data were assigned into 10-29 > dB H >, 30-39 dB HL or > or = 40 dB HL groups. The most accurate prediction estimates were obtained from the second strategy scheme with a 90.9% accuracy in the 10-29 dB HL group, 82% in the 30-39 dB HL group and 71.4% in the > or = 40 dB HL group.

The aim of this study was to compare aspects of visual reinforcement audiometry (VRA) and the distraction test (DT), the two most commonly used behavioural tests of hearing for young children. The number of assessments completed, time taken, parental opinion and levels of minimum responses were compared in a group of 20 infants (mean age 17.7 months; SD 4.7 months; range 12-25 months) who had been selected from those referred from a local second-tier community audiology service. Each infant was assessed with each test following set protocols and a balanced design on two occasions separated by one week. Parental opinion was determined by application of two questionnaires, one after each session. There was no difference in the number of minimum response levels (MRLs) measured by the two tests. However, if a VRA protocol using three MRLs was assumed then the assessment was completed successfully in a significantly greater number of subjects with VRA. VRA took, on average, two minutes less than the DT to measure six MRLs. Most of the subject sample had normal hearing as defined by both tests. However, where MRLs were >30 dB HL for at least one of the tests, the DT elicited responses at significantly higher levels than VRA, suggesting that in these subjects the DT under-estimated hearing sensitivity. Seventy per cent of parents selected VRA when asked to choose between the tests.

Some health authorities in the UK are discontinuing hearing screening at school entry, mainly because the pure tone sweep test is under-specific (i.e. fails too many children) and thus leads to unnecessary and costly, but unproductive, follow-up assessment. A screening method with different properties such as a questionnaire could be a more cost-effective method of mass screening children. The MRC Institute of Hearing Research has developed and evaluated through several stages such a screening questionnaire (the Childhood Middle Ear Disease and Hearing Questionnaire (CMEDHQ), containing 11 scored questions under two broad headings: history and presentation of the disease, and consultation/treatment history. In a service-based evaluation, 2860 mainstream reception-year school children from two consecutive years, attending schools in south west Cumbria in the North-West Regional Health Authority received the sweep test and the CMEDHQ. (Although predominantly designed to detect middle ear problems, the questionnaire also has some potential to detect permanent hearing loss; thus providing a useful backstop for detection of permanent losses either missed or not present in earlier infancy.) The screening CMEDHQ obtained a very high response rate (90%). Follow-up included 235 control cases as well as all pure tone sweep test failures. Analysis, by use of a definition of cases conservative with respect to the sensitivity of the questionnaire, showed that the CMEDHQ has better specificity, but slightly lower sensitivity, than the pure tone sweep test for composite system decision (where 'case' = treated at ENT; 'non-case' = pass at whatever stage was reached before discharge). Follow-up indicated that the limited method available for assessing sensitivity might give an over-favourable view of the pure tone sweep test. Possible improvement of questionnaire sensitivity by further refinements is under examination. The findings show that it is worth conducting a fully parallel multi-district cost-effectiveness comparison of the pure tone sweep test versus the CMEDHQ.

The aim of this study was to investigate the use of speech pattern audiometry (SPA) in assessing speech perception abilities of a group of 25 children with sensorineural hearing loss, and to compare their aided performance on SPA tests of four different phoneme contrasts with scores achieved on recorded Manchester Junior Word Lists (MJWL) at their most comfortable listening level (MCLL). The listeners were 25 children, 19 with congenital and six with acquired hearing loss aged between eight and 14 years. They were classified into three groups according to the severity of the hearing loss in the better hearing ear (20-60 dB HL, 61-80 dB HL and >81 dB HL). The SPA tests evaluated listeners' ability to identify word-initial plosives differing in the phonetic features of voicing and place of articulation. The main outcome measures were the SPA gradient measures, the SPA labelling function configuration and MJWL scores. The group with the most severe hearing loss (>81 dB HL) showed significantly poorer performance on the SPA tests and MJWL tests than the groups with mild (20-60 dB HL) to moderate (61-80 dB HL) hearing losses. There was significantly better performance on the two plosive voicing contrast tests than the two plosive place contrasts. For the MJWL, the performance of the group with the more severe hearing loss was also significantly different from the mild and moderate hearing loss groups. A MJWL score of up to 75% was associated with the random labelling configuration on all four SPA tests, emphasizing the different aspects of speech perception that were being examined with each type of test. This study suggests that there is a place for SPA as part of the test battery for speech perception testing in hearing-impaired children.