British journal of audiology最新文献

The Gothenburg Profile (GP) for measurement of experienced hearing disability and handicap was developed with content partly taken from the shortened Hearing Measurement Scale (HMS25). The GP consists of 20 items divided into two subscales. The first subscale measures Experienced Disability as to hearing speech (items 1-5) and sound localization (items 6-10). The second subscale targets the Experienced Handicap in social settings (items 11-15) and the personal reactions to the experienced handicap (items 16-20). In this study, data are presented for new hearing aid candidates (NewHA) (n=441) and for experienced hearing aid users (ExpHA) (n=476). Principal components factor analyses were conducted and a three-factor solution was obtained, supporting the two factors of the Experienced Disability subscale, but just confirming one factor in the Experienced Handicap subscale. The internal consistency reliability (coefficient alpha) was good (0.85 to 0.95) for the subscales as was the test-retest reliability. The ExpHA group expressed significantly greater disability (first subscale) as well as experienced handicap (second subscale). However, when controlling for hearing level the differences disappeared. The clinical use of the GP for assessment of rehabilitation needs is recommended.

This study examined the educational placements, before cochlear implantation, of 121 deaf children, and the educational placements, two years after implantation, of the 48 children who had reached that stage, looking at the influence of age at implantation and duration of deafness on the placement of these children. In addition, it compared the educational placements of those given implants prior to schooling, and those given implants when already in an educational setting. Categories used were pre-school, school for the deaf, unit or resource base within a mainstream school and full-time mainstream provision. Age at implantation and duration of deafness were found to be significant predictors of placement two years after implantation. The duration of deafness of children in schools for the deaf or units was twice that of children in mainstream education. Fifty-three per cent of children who were in pre-school at the time of implantation were in mainstream schools two years after implantation, whereas only 6% of those who were already in educational placements at the time of implantation were in mainstream education. This difference was statistically significant. The results indicate that children who are given implants early, before an educational decision has been made, are more likely to go to mainstream schools than those given implants when already in an educational setting.

Tinnitus retraining therapy (TRT) has been presented as a new approach to tinnitus management. In this paper a number of theoretical and practical problems with TRT are identified. These problems relate to the distinction between directive counselling and cognitive therapy, the adequacy of the cognitive therapy components, the nature of the outcome data which have been presented to date, the theoretical basis for the treatment, and the conceptual clarity of terms such as perception, attention and coping. The stated goal of removal of the perception of tinnitus may lead to confusion about the likely outcome of TRT for most patients. Methodological limitations in the research which has been published to date preclude any claims about the efficacy of TRT at the present time. It is suggested that randomized, controlled studies which include no-treatment and placebo conditions need to be undertaken. Studies are required in which the efficacy of the counselling and white noise components can be clearly isolated. Suggestions are made about the role of psychologists and non-psychologists in the provision of counselling and cognitive therapy services to tinnitus patients.

Noise from the measuring equipment and from environmental and physiological sources is inevitably present in records of evoked otoacoustic emissions. This paper considers the influence of noise on the power spectra of otoacoustic emissions as recorded with the Otodynamics ILO88 system. It is shown that if the noise has a normal distribution, the ratio of the power in the response spectrum to the power in the noise has an approximately log-normal distribution. It is also shown that the change in the level of the response spectrum that is observed when measurements are repeated is related through a t-distribution to the estimate of the noise-to-signal ratio that these measurements provide. The statistical analysis leads to simple significance tests that may be helpful in detecting the presence of an emission and that allow small changes in the spectrum to be identified.

Transient evoked otoacoustic emissions (TEOAE) have been evaluated as a means of monitoring cochlear function in patients receiving the chemotherapeutic agents cisplatin and carboplatin (-cis-diammine, 1,1-cyclobutane dicarboxylate (2) -0,0-platinum). Patients receiving these drugs were monitored prospectively with pure tone audiometry (PTA), tympanometry and TEOAE. Data was collected on 22 subjects receiving cisplatin and nine subjects receiving carboplatin. Significant deterioration in both PTA thresholds and TEOAE energy levels (with no change in tympanometry) were detected in the cisplatin group. No significant deterioration in audiological parameters occurred in the carboplatin group. It is indicated that cisplatin has a significant ototoxic effect in the majority of patients, whereas any ototoxic effect of carboplatin was undetectable. Our findings were different from previous studies in that the measurable changes in TEOAE occurred later than changes in the pure tone audiogram for the cisplatin group.

A useful alternative to the traditional water caloric is to use an air stimulus. However, the caloric test has not been standardized and a range of parameters are being used in different audiology clinics. The aim of this study was to determine cold air parameters that resulted in a similar slow-component eye velocity to that for water irrigation. Twelve normal subjects underwent caloric testing using air temperatures in the range 18-33 degrees C. The duration and air-flow rate were held constant at 60 s and 5 l/min. A water irrigation at 30 degrees C for 30 s and delivering 150 ml resulted in a mean slow-component eye velocity of 17 degrees/s. An equal response was obtained with an air temperature of 21.0 degrees C. Further work is required to find equivalent air and water responses for other combinations of parameters.

A recent study revealed that most patients were wearing National Health Service hearing aids that were capable of exceeding their uncomfortable loudness level (ULL) measured clinically (Munro et al., 1996). However, there is little evidence to show that these clinical measurements are a valid indicator of real-world auditory discomfort. The aim of this study was to investigate the relationship between ULL and real-world discomfort. The study involved 20 adult subjects, aged 41-92 years, who had been fitted monaurally with an NHS hearing aid. ULLs were measured using a probe-tube microphone situated close to the eardrum. Individual real ear to coupler differences were added to the SSPL90 in order to predict the maximum power output (MPO) of the hearing aid at the eardrum. Subjects completed a questionnaire designed to rate the loudness of different environmental sounds. The results show that the more the MPO value exceeded the ULL value, the more likely it was that the subjects reported loudness tolerance problems to environmental sounds of long duration. There was a statistically significant correlation between the ULL and discomfort ratings for sounds of longer duration, such as traffic and wind noise; but not for shorter-duration sounds, such as door banging. Subjects did not express real-world auditory discomfort when the MPO value matched the ULL value. These findings support the argument for setting hearing-aid MPO close to ULL.

A model for predicting loudness for people with cochlear hearing loss is applied to the problem of prescribing the frequency-gain characteristic of a linear hearing aid. It is argued that a reasonable goal is to make all frequency bands of speech equally loud while achieving a comfortable overall loudness; this can maximize the proportion of the speech spectrum that is above the absolute threshold for a given loudness. In terms of the model this means that the specific loudness pattern evoked by speech of a moderate level (65 dB SPL) should be reasonably flat (equal loudness per critical band), and the overall loudness should be similar to that evoked in a normal listener by 65 dB speech (about 23 sones). The model is used to develop a new formula - the 'Cambridge formula' - for prescribing insertion gain from audiometric thresholds. It is shown that, for a fixed overall loudness of 23 sones, the Cambridge formula leads to a higher calculated articulation index than three other commonly used prescriptive methods: NAL(R), FIG6 and DSL.

First time hearing aid candidates (N = 135) in a NHS setting were administered the Hearing Attitudes in Rehabilitation Questionnaire (HARQ) designed to assess attitudes to acquired hearing loss and hearing aids and 92% of them were followed up 3-9 months after fitting. Attitude scores, age, sex and sensory thresholds were related to six self-report outcome measures by use of logistic regression. The major findings were that patients who were least distressed by their hearing difficulties and reported not wanting or needing a hearing aid used their aids least frequently and evaluated them less highly in listening situations. An attitude that wearing a hearing aid was stigmatizing was not predictive of outcome except a report of more difficulty in handling the aid. There were some low but significant correlations between attitudes and sensory thresholds and thresholds also contributed to the prediction of outcome in a few instances.