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  • 1.
    Andersson, Ulf
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning.
    Lidestam, Björn
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning.
    Bottom-up driven speechreading in a speechreading expert: The case of AA (JK023)2005In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 26, no 2, p. 214-224Article in journal (Refereed)
    Abstract [en]

    Objective: This case study tested the threshold hypothesis (Rönnberg et al., 1998), which states that superior speechreading skill is possible only if high-order cognitive functions, such as capacious verbal working memory, enable efficient strategies. Design: In a case study, a speechreading expert (AA) was tested on a number of speechreading and cognitive tasks and compared with control groups (z scores). Sentence-based speechreading tests, a word-decoding test, and a phoneme identification task were used to assess speechreading skill at different analytical levels. The cognitive test battery used included tasks of working memory (e.g., reading span), inference-making, phonological processing (e.g., rhyme-judgment), and central-executive functions (verbal fluency, Stroop task). Results: Contrary to previous cases of extreme speechreading skill, AA excels on both low-order (phoneme identification: z = +2.83) and high-order (sentence-based: z = +8.12 and word-decoding: z = +4.21) speechreading tasks. AA does not display superior verbal inference-making ability (sentence-completion task: z = -0.36). Neither does he possess a superior working memory (reading span: z = +0.80). However, AA outperforms the controls on two measures of executive retrieval functions, the semantic (z = +3.77) and phonological verbal fluency tasks (z = +3.55). Conclusions: The performance profile is inconsistent with the threshold hypothesis. Extreme speechreading accuracy can be obtained in ways other than via well-developed high-order cognitive functions. It is suggested that AA's extreme speechreading skill, which capitalizes on low-order functions in combination with efficient central executive functions, is due to early onset of hearing impairment. Copyright © 2005 by Lippincott Williams & Wilkins.

  • 2.
    Andersson, Ulf
    et al.
    Linköping University, Department of Behavioural Sciences, Cognitive Psychology. Linköping University, Faculty of Arts and Sciences.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Arts and Sciences.
    Bottom-Up Driven Speechreading in a Speechreading Expert: The Case of AA.2005In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, p. 214-224Article in journal (Refereed)
  • 3.
    Arehart, Kathryn H.
    et al.
    University of Colorado Boulder, Speech, Language, and Hearing Sciences.
    Souza, Pamela
    Northwestern University, Evanston, Communication Sciences and Disorders.
    Kates, James M.
    University of Colorado Boulder, Speech, Language, and Hearing Sciences.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Snekkersten, Oticon A/S, Eriksholm Research Centre,Denmark.
    Pedersen, Michael Syskind
    Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark.
    Relationship between distortion, hearing loss and working memory for digital noise reduction2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 5, p. 505-516Article in journal (Refereed)
    Abstract [en]

    Objectives: This study considered speech modified by additive babble combined with noise-suppression processing. The purpose was to determine the relative importance of the signal modifications, individual peripheral hearing loss, and individual cognitive capacity on speech intelligibility and speech quality.

    Design: The participant group consisted of 31 individuals with moderate high-frequency hearing loss ranging in age from 51 to 89 years (mean = 69.6 years). Speech intelligibility and speech quality were measured using low-context sentences presented in babble at several signal-to-noise ratios. Speech stimuli were processed with a binary mask noise-suppression strategy with systematic manipulations of two parameters (error rate and attenuation values). The cumulative effects of signal modification produced by babble and signal processing were quantified using an envelope-distortion metric. Working memory capacity was assessed with a reading span test. Analysis of variance was used to determine the effects of signal processing parameters on perceptual scores. Hierarchical linear modeling was used to determine the role of degree of hearing loss and working memory capacity in individual listener response to the processed noisy speech. The model also considered improvements in envelope fidelity caused by the binary mask and the degradations to envelope caused by error and noise.

    Results: The participants showed significant benefits in terms of intelligibility scores and quality ratings for noisy speech processed by the ideal binary mask noise-suppression strategy. This benefit was observed across a range of signal-to-noise ratios and persisted when up to a 30% error rate was introduced into the processing. Average intelligibility scores and average quality ratings were well predicted by an objective metric of envelope fidelity. Degree of hearing loss and working memory capacity were significant factors in explaining individual listener’s intelligibility scores for binary mask processing applied to speech in babble. Degree of hearing loss and working memory capacity did not predict listeners’ quality ratings.

    Conclusions: The results indicate that envelope fidelity is a primary factor in determining the combined effects of noise and binary mask processing for intelligibility and quality of speech presented in babble noise. Degree of hearing loss and working memory capacity are significant factors in explaining variability in listeners’ speech intelligibility scores but not in quality ratings.

  • 4.
    Arehart, Kathryn
    et al.
    University of Colorado, CO 80309 USA.
    Souza, Pamela
    Northwestern University, IL USA.
    Kates, James
    University of Colorado, CO 80309 USA.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Oticon AS, Denmark.
    Syskind Pedersen, Michael
    Oticon AS, Denmark.
    Relationship Among Signal Fidelity, Hearing Loss, and Working Memory for Digital Noise Suppression2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 5, p. 505-516Article in journal (Refereed)
    Abstract [en]

    Objectives: This study considered speech modified by additive babble combined with noise-suppression processing. The purpose was to determine the relative importance of the signal modifications, individual peripheral hearing loss, and individual cognitive capacity on speech intelligibility and speech quality. Design: The participant group consisted of 31 individuals with moderate high-frequency hearing loss ranging in age from 51 to 89 years (mean = 69.6 years). Speech intelligibility and speech quality were measured using low-context sentences presented in babble at several signal-to-noise ratios. Speech stimuli were processed with a binary mask noise-suppression strategy with systematic manipulations of two parameters (error rate and attenuation values). The cumulative effects of signal modification produced by babble and signal processing were quantified using an envelope-distortion metric. Working memory capacity was assessed with a reading span test. Analysis of variance was used to determine the effects of signal processing parameters on perceptual scores. Hierarchical linear modeling was used to determine the role of degree of hearing loss and working memory capacity in individual listener response to the processed noisy speech. The model also considered improvements in envelope fidelity caused by the binary mask and the degradations to envelope caused by error and noise. Results: The participants showed significant benefits in terms of intelligibility scores and quality ratings for noisy speech processed by the ideal binary mask noise-suppression strategy. This benefit was observed across a range of signal-to-noise ratios and persisted when up to a 30% error rate was introduced into the processing. Average intelligibility scores and average quality ratings were well predicted by an objective metric of envelope fidelity. Degree of hearing loss and working memory capacity were significant factors in explaining individual listeners intelligibility scores for binary mask processing applied to speech in babble. Degree of hearing loss and working memory capacity did not predict listeners quality ratings. Conclusions: The results indicate that envelope fidelity is a primary factor in determining the combined effects of noise and binary mask processing for intelligibility and quality of speech presented in babble noise. Degree of hearing loss and working memory capacity are significant factors in explaining variability in listeners speech intelligibility scores but not in quality ratings.

  • 5.
    Arlinger, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Can we establish internationally equivalent outcome measures in audiological rehabilitation?2000In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 21, no 4 SUPPL.Article in journal (Refereed)
    Abstract [en]

    Objective: This paper intends to discuss issues related to cultural, ethnic, and other nonaudiological variables that may affect the response when trying to determine outcome of audiological rehabilitation in different countries. Design: The ideal measure for the determination of outcome of audiological rehabilitation would be sensitive to changes in disability as well as handicap. Further, it would allow unforeseen effects to be identified and not be limited by language borders or cultural and ethnic differences. A variety of critical factors are discussed that are related to culture, social traditions, ethnic factors, etc. that may affect outcome measures and thus make international equivalence difficult. Conclusions: With careful consideration of the factors discussed, a basic set of questions could be formulated and agreed on, calibrated on suitable populations in different countries, and thereafter used as a bridge across borders to allow comparison of different procedures or meta-analyses of studies performed by different laboratories.

  • 6.
    Bennett, Rebecca J.
    et al.
    Ear Sci Inst Australia, Australia; Univ Western Australia, Australia.
    Laplante-Lévesque, Ariane
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Eriksholm Res Ctr, Denmark.
    Meyer, Carly J.
    Univ Queensland, Australia.
    Eikelboom, Robert H.
    Ear Sci Inst Australia, Australia; Univ Western Australia, Australia; Univ Pretoria, South Africa.
    Exploring Hearing Aid Problems: Perspectives of Hearing Aid Owners and Clinicians2018In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 39, no 1, p. 172-187Article in journal (Refereed)
    Abstract [en]

    Objectives: To gather perspectives of hearing aid owners and hearing healthcare clinicians with regard to problems that arise after hearing aid fitting and use these perspectives to generate a conceptual framework to gain a better understanding of these problems. Design: Participants included a group of 17 hearing aid owners and a group of 21 hearing healthcare clinicians; data collection occurred separately for each group. Participants each attended two group sessions in Perth, Western Australia, wherein they: (1) generated statements describing the problems associated with hearing aids and (2) grouped and rated the statements to identify key themes. Concept mapping was used to generate a conceptual framework. Results: Participants identified four concepts regarding hearing aid problems as follows: (1) hearing aid management; (2) hearing aid sound quality and performance; (3) feelings, thoughts, and behaviors; and (4) information and training. While hearing aid owners and clinicians generated similar results regarding the concepts derived, the clinicians reported that the problems identified had a greater negative impact on hearing aid success than did hearing aid owners. Conclusions: The magnitude and diversity of hearing aid problems identified in this study highlight the ongoing challenges that hearing aid owners face and suggest that current processes for hearing aid fitting can be improved. Problems relating to hearing aid management were most often deemed to have the greatest impact on hearing aid success and be the most preventable/solvable, and thus are a good starting point when addressing hearing aid-related problems.

  • 7.
    Besser, Jana
    et al.
    Vrije University of Amsterdam Medical Centre, Netherlands; Vrije University of Amsterdam Medical Centre, Netherlands.
    Festen, Joost M.
    Vrije University of Amsterdam Medical Centre, Netherlands; Vrije University of Amsterdam Medical Centre, Netherlands.
    Theo Goverts, S.
    Vrije University of Amsterdam Medical Centre, Netherlands; Vrije University of Amsterdam Medical Centre, Netherlands.
    Kramer, Sophia E.
    Vrije University of Amsterdam Medical Centre, Netherlands; Vrije University of Amsterdam Medical Centre, Netherlands.
    Pichora-Fuller, Kathleen
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. University of Toronto, Canada; Toronto Rehabil Institute, Canada; Rotman Research Institute, Canada.
    Speech-in-Speech Listening on the LiSN-S Test by Older Adults With Good Audiograms Depends on Cognition and Hearing Acuity at High Frequencies2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 1, p. 24-41Article in journal (Refereed)
    Abstract [en]

    Objectives: The main objective was to investigate age-related differences on the listening in spatialized noise-sentences (LiSN-S) test in adults with normal audiometric thresholds in most of the speech range. A second objective was to examine the contributions of auditory, cognitive, and linguistic abilities to LiSN-S outcomes. Design: The LiSN-S test was administered to participants in an older group (M-Age = 72.0, SD = 4.3 years) and a younger group (M-Age = 21.7, SD = 2.6 years) with N = 26 per group. All the participants had clinically normal audiometric thresholds at frequencies up to and including 3000 Hz. The LiSN-S test yields a speech reception threshold (SRT) in each of the four speech-in-speech listening conditions that differ in the availability of voice difference cues and/or spatial separation cues. Based on these four SRTs, the scores were calculated for the talker advantage, the spatial advantage, and the total advantage as a result of both the types of cues. Additionally, the participants completed four auditory temporal-processing tests, a cognitive screening test, a vocabulary test, and tests of linguistic closure for high-and low-context sentences. The contributions of these predictor variables and measures of pure-tone hearing acuity to LiSN-S outcomes were analyzed for both the groups using regression analyses. Results: Younger listeners outperformed the older listeners on all four LiSN-S SRTs and all the three LiSN-S advantage measures. Age-related differences were larger for conditions involving the use of spatial cues. For the younger group, all LiSN-S SRTs were predicted by the measure of linguistic closure in low-context sentences; in addition, the SRT for the condition with voice difference cues but without spatial separation cues was predicted by vocabulary, and the SRT for the condition with both voice difference cues and spatial separation cues was predicted by temporal resolution at low frequencies. Vocabulary also contributed to the talker advantage in the younger group, whereas the spatial advantage was predicted by high-frequency pure-tone hearing acuity in the range 6,000 to 10,000 Hz (pure-tone average [ PTA] HIGH). For the older group, the LiSN-S SRT in the condition with neither voice difference cues nor spatial separation cues was predicted by age; their other three LiSN-S SRTs and all advantage measures were predicted by PTA HIGH. In addition, for the older group, cognition predicted LiSN-S SRT outcomes in three of the four conditions. Measures of auditory temporal processing, linguistic abilities, or hearing acuity up to and including 4000 Hz did not predict LiSN-S outcomes in this group. Conclusions: LiSN-S outcomes were poorer for adults aged 65 years or older, even those with good audiograms, compared with younger adults and also compared with people up to the age of 60 years from a previous study. In the present study, regardless of the types of cues, auditory and cognitive interactions were reflected by the combined influences on LiSN-S outcomes of high-frequency hearing acuity and measures of linguistic and cognitive processing. The data also suggest a hierarchy in the deployment of processing resources, which would account for the observed shift from linguistic abilities in the younger group to general cognitive abilities in the older group.

  • 8.
    Boisvert, Isabelle
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    McMahon, Catherine M
    Macquarie University.
    Tremblay, Genevieve
    Institute Readaptat Deficience Phys Quebec.
    Lyxell, Björn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Relative Importance of Monaural Sound Deprivation and Bilateral Significant Hearing Loss in Predicting Cochlear Implantation Outcomes2011In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 32, no 6, p. 758-766Article in journal (Refereed)
    Abstract [en]

    Objectives: Making evidence-based recommendations to prospective unilateral cochlear implant recipients on the potential benefits of implanting one or the other ear is challenging for cochlear implant teams. This particularly occurs in cases where a hearing aid has only been used in one ear for many years (referred to here as the "hearing ear"), and the contralateral ear has, in essence, been sound-deprived. In such cases, research to date is inconclusive, and little anecdotal evidence exists to inform the debate and support best clinical practice. less thanbrgreater than less thanbrgreater thanDesign: Retrospective data on speech recognition outcomes of 16 adult participants who received a cochlear implant in an ear deprived of sound for a minimum of 15 yr were analyzed. All subjects were implanted through the Quebec Cochlear Implant Program and were provided with personalized intensive rehabilitation services. Data obtained from clinical records included demographic data and speech recognition scores measured after implantation with the sentences of a multimedia auditory test battery in the auditory-only condition. Speech recognition outcomes were compared with the duration of auditory deprivation in the implanted ear, bilateral significant hearing loss, and auditory stimulation before bilateral significant hearing loss. less thanbrgreater than less thanbrgreater thanResults: Using nonparametric correlation analyses, a strong negative correlation was demonstrated between speech recognition scores and the duration of bilateral significant hearing loss and with the duration of auditory stimulation before bilateral significant hearing loss. No significant correlation with the duration of auditory deprivation or with the duration of prior auditory stimulation in the implanted ear was found. less thanbrgreater than less thanbrgreater thanConclusions: These findings suggest that functional outcomes of cochlear implantation for unilateral sound deprivation may be more strongly influenced by central processes than peripheral effects stemming from the deprivation per se. This indicates the relevance of considering the clients history of binaural hearing rather than the hearing in each ear individually when discussing possible outcomes with a cochlear implant.

  • 9.
    Conrad, Isabell
    et al.
    Johannes Gutenberg University of Mainz, Germany.
    Kleinstaeuber, Maria
    University of Marburg, Germany.
    Jasper, Kristine
    Johannes Gutenberg University of Mainz, Germany.
    Hiller, Wolfgang
    Johannes Gutenberg University of Mainz, Germany.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Weise, Cornelia
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. University of Marburg, Germany.
    The Role of Dysfunctional Cognitions in Patients With Chronic Tinnitus2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 5, p. E279-E289Article in journal (Refereed)
    Abstract [en]

    Objectives: The present study investigates the role of dysfunctional cognitions in patients with chronic tinnitus. To explore different dimensions of tinnitus-related thoughts, a 22-item self-report measure, the Tinnitus Cognitions Scale (T-Cog), is presented. Furthermore, dysfunctional cognitions are examined as a possible mediator of the relation between tinnitus distress and depression. Design: The present study analyzes the cross-sectional data of 373 patients with chronic tinnitus. Parallel analysis and principal axis factoring are used to identify the factor structure of the T-Cog. Assumed mediating effects are tested using the asymptotic and resampling procedure. Results: Factor analysis reveals two factors interpreted as tinnitus-related catastrophic thinking and tinnitus-related avoidance cognitions. Internal consistency is sufficient with a Cronbachs of 0.88 for the total scale and 0.74 and 0.87 for the subscales. The authors find high associations between the T-Cog and other measures of tinnitus distress, depression, anxiety, and tinnitus acceptance, indicating convergent validity. With the exception of neuroticism, low correlations with personality factors are found, indicating discriminant validity. Patients with moderate or severe tinnitus distress report significantly higher scores of dysfunctional cognitions than patients with mild tinnitus distress. Tinnitus-related catastrophic thinking and tinnitus-related avoidance cognitions partially mediate the relation between tinnitus distress and depression. Conclusions: Dysfunctional cognitions can play an important role in the degree of tinnitus distress. Catastrophic and avoidant thoughts contribute to the explanation of depression among tinnitus patients. The T-Cog is a reliable and valid questionnaire for the assessment of different dimensions of cognitions. Its use could provide information for identifying tinnitus patients who are particularly suitable for cognitive-behavioral therapy.

  • 10. Cox, Robyn
    et al.
    Hyde, Martyn
    Arlinger, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Optimal outcome measures, research priorities, and international cooperation.2000In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 21, p. 106-115Article in journal (Refereed)
  • 11.
    Ellis, Rachel
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Molander, Peter
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Lyxell, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark..
    Predicting Speech-in-Noise Recognition from Performance on the Trail Making Test: Results from a Large-Scale Internet Study2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, no 1, p. 73-79Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to investigate the utility of an internet-based version of the trail making test (TMT) to predict performance on a speech-in-noise perception task.

    Design: Data were taken from a sample of 1509 listeners aged between 18 and 91 years old. Participants completed computerized versions of the TMT and an adaptive speech-in-noise recognition test. All testing was conducted via the internet.

    Results: The results indicate that better performance on both the simple and complex subtests of the TMT are associated with better speech-in-noise recognition scores. Thirty-eight percent of the participants had scores on the speech-in-noise test that indicated the presence of a hearing loss.

    Conclusions: The findings suggest that the TMT may be a useful tool in the assessment, and possibly the treatment, of speech-recognition difficulties. The results indicate that the relation between speech-in-noise recognition and TMT performance relates both to the capacity of the TMT to index processing speed and to the more complex cognitive abilities also implicated in TMT performance.

  • 12.
    Feeney, Patrick
    et al.
    Oregon Health and Science University, Portland, Oregon, USA.
    Hunter, Lisa
    Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
    Kei, Joseph
    University of Queensland, Queensland, Australia.
    Lilly, David
    Oregon Health and Science University, Portland, Oregon, USA.
    Margolis, Robert
    University of Minnesota, Minneapolis, Minnesota, USA.
    Nakajima, Heidi
    Harvard Medical School, Boston, Massachusetts, USA.
    Neely, Stephen
    Boys Town National Research Hospital, Omaha, Nebraska, USA.
    Prieve, Beth
    Syracuse University, Syracuse, New York, USA.
    Rosowski, John
    Harvard Medical School, Boston, Massachusetts, USA.
    Sanford, Chris
    Idaho State University, Pocatello, Idaho, USA.
    Schairer, Kim
    James H. Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee, USA.
    Shahnaz, Navid
    University of British Columbia, Vancouver, Canada.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Voss, Susan
    Smith College, Northampton, Massachusetts, USA.
    Consensus statement: Eriksholm workshop on wideband absorbance measures of the middle ear2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no Supplement 1, p. 78s-79sArticle in journal (Refereed)
    Abstract [en]

    The participants in the Eriksholm Workshop on Wideband Absorbance Measures of the Middle Ear developed statements for this consensus article on the final morning of the Workshop. The presentations of the first 2 days of the Workshop motivated the discussion on that day. The article is divided into three general areas: terminology; research needs; and clinical application.The varied terminology in the area was seen as potentially confusing, and there was consensus on adopting an organizational structure that grouped the family of measures into the term wideband acoustic immittance (WAI), and dropped the term transmittance in favor of absorbance. There is clearly still a need to conduct research on WAI measurements. Several areas of research were emphasized, including the establishment of a greater WAI normative database, especially developmental norms, and more data on a variety of disorders; increased research on the temporal aspects of WAI; and methods to ensure the validity of test data. The area of clinical application will require training of clinicians in WAI technology. The clinical implementation of WAI would be facilitated by developing feature detectors for various pathologies that, for example, might combine data across ear-canal pressures or probe frequencies.

  • 13.
    Grenness, Caitlin
    et al.
    HEARing CRC, Australia; University of Melbourne, Australia.
    Hickson, Louise
    HEARing CRC, Australia; University of Queensland, Australia.
    Laplante-Lévesque, Ariane
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Eriksholm Research Center, Oticon AS, Denmark.
    Meyer, Carly
    HEARing CRC, Australia; University of Queensland, Australia.
    Davidson, Bronwyn
    University of Melbourne, Australia.
    Communication Patterns in Audiologic Rehabilitation History-Taking: Audiologists, Patients, and Their Companions2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 2, p. 191-204Article in journal (Refereed)
    Abstract [en]

    Objectives: The nature of communication between patient and practitioner influences patient outcomes. Specifically, the history-taking phase of a consultation plays a role in the development of a relationship and in the success of subsequent shared decision making. There is limited research investigating patient-centered communication in audiology, and this study may be the first to investigate verbal communication in an adult audiologic rehabilitation context. This research aimed, first, to describe the nature of verbal communication involving audiologists, patients, and companions in the history-taking phase of initial audiology consultations and, second, to determine factors associated with communication dynamics. Design: Sixty-three initial audiology consultations involving patients over the age of 55, their companions when present, and audiologists were audio-video recorded. Consultations were coded using the Roter Interaction Analysis System and divided into three consultation phases: history, examination, and counseling. This study analyzed only the history-taking phase in terms of opening structure, communication profiles of each speaker, and communication dynamics. Associations between communication dynamics (verbal dominance, content balance, and communication control) and 11 variables were evaluated using Linear Mixed Model methods. Results: The mean length of the history-taking phase was 8.8 min (range 1.7 to 22.6). A companion was present in 27% of consultations. Results were grouped into three areas of communication: opening structure, information exchange, and relationship building. Examination of the history opening structure revealed audiologists tendency to control the agenda by initiating consultations with a closed-ended question 62% of the time, followed by interruption of patient talk after 21.3 sec, on average. The aforementioned behaviors were associated with increased verbal dominance throughout the history and increased control over the content of questions. For the remainder of the history, audiologists asked 97% of the questions and did so primarily in closed-ended form. This resulted in the audiologist talking as much as the patient and much more than the companions when they were present. Questions asked by the audiologist were balanced in topic: biomedical and psychosocial/lifestyle; however, few emotionally focused utterances were observed from any speaker (less than 5% of utter ances). Conclusions: Analysis of verbal communication involving audiologists, patients, and companions in the history-taking phase in 63 initial audiology consultations revealed a communicative exchange that was audiologist-controlled and structured, but covered both medical and lifestyle content. Audiologists often attempted to create a relationship with their patients; however, little emotional relationship building occurred, which may have implications later in the consultation when management decisions are being made. These results are not in line with patient-centered communication principles. Further research and changes to clinical practice are warranted to transform patient-centered communication from an ideal to a reality.

  • 14.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Bånkestad, Ellinor
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Acceptance of Tinnitus As an Independent Correlate of Tinnitus Severity2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 4, p. e176-e182Article in journal (Refereed)
    Abstract [en]

    Objectives: Tinnitus is the experience of sounds without an identified external source, and for some the experience is associated with significant severity (i.e., perceived negative affect, activity limitation, and participation restriction due to tinnitus). Acceptance of tinnitus has recently been proposed to play an important role in explaining heterogeneity in tinnitus severity. The purpose of the present study was to extend previous investigations of acceptance in relation to tinnitus by examining the unique contribution of acceptance in accounting for tinnitus severity, beyond anxiety and depression symptoms. Design: In a cross-sectional study, 362 participants with tinnitus attending an ENT clinic in Sweden completed a standard set of psychometrically examined measures of acceptance of tinnitus, tinnitus severity, and anxiety and depression symptoms. Participants also completed a background form on which they provided information about the experience of tinnitus (loudness, localization, sound characteristics), other auditory-related problems (hearing problems and sound sensitivity), and personal characteristics. Results: Correlational analyses showed that acceptance was strongly and inversely related to tinnitus severity and anxiety and depression symptoms. Multivariate regression analysis, in which relevant patient characteristics were controlled, revealed that acceptance accounted for unique variance beyond anxiety and depression symptoms. Acceptance accounted for more of the variance than anxiety and depression symptoms combined. In addition, mediation analysis revealed that acceptance of tinnitus mediated the direct association between self-rated loudness and tinnitus severity, even after anxiety and depression symptoms were taken into account. Conclusions: Findings add to the growing body of work, supporting the unique and important role of acceptance in tinnitus severity. The utility of the concept is discussed in relation to the development of new psychological models and interventions for tinnitus severity.

  • 15.
    Keidser, Gitte
    et al.
    National Acoust Labs, Australia.
    Rudner, Mary
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Seeto, Mark
    National Acoust Labs, Australia.
    Hygge, Staffan
    University of Gavle, Sweden.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    The Effect of Functional Hearing and Hearing Aid Usage on Verbal Reasoning in a Large Community-Dwelling Population2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, no 1, p. e26-e36Article in journal (Refereed)
    Abstract [en]

    Objectives: Verbal reasoning performance is an indicator of the ability to think constructively in everyday life and relies on both crystallized and fluid intelligence. This study aimed to determine the effect of functional hearing on verbal reasoning when controlling for age, gender, and education. In addition, the study investigated whether hearing aid usage mitigated the effect and examined different routes from hearing to verbal reasoning. Design: Cross-sectional data on 40- to 70-year-old community-dwelling participants from the UK Biobank resource were accessed. Data consisted of behavioral and subjective measures of functional hearing, assessments of numerical and linguistic verbal reasoning, measures of executive function, and demographic and lifestyle information. Data on 119,093 participants who had completed hearing and verbal reasoning tests were submitted to multiple regression analyses, and data on 61,688 of these participants, who had completed additional cognitive tests and provided relevant lifestyle information, were submitted to structural equation modeling. Results: Poorer performance on the behavioral measure of functional hearing was significantly associated with poorer verbal reasoning in both the numerical and linguistic domains (p < 0.001). There was no association between the subjective measure of functional hearing and verbal reasoning. Functional hearing significantly interacted with education (p < 0.002), showing a trend for functional hearing to have a greater impact on verbal reasoning among those with a higher level of formal education. Among those with poor hearing, hearing aid usage had a significant positive, but not necessarily causal, effect on both numerical and linguistic verbal reasoning (p < 0.005). The estimated effect of hearing aid usage was less than the effect of poor functional hearing. Structural equation modeling analyses confirmed that controlling for education reduced the effect of functional hearing on verbal reasoning and showed that controlling for executive function eliminated the effect. However, when computer usage was controlled for, the eliminating effect of executive function was weakened. Conclusions: Poor functional hearing was associated with poor verbal reasoning in a 40- to 70-year-old community-dwelling population after controlling for age, gender, and education. The effect of functional hearing on verbal reasoning was significantly reduced among hearing aid users and completely overcome by good executive function skills, which may be enhanced by playing computer games.

  • 16.
    Koelewijn, Thomas
    et al.
    VU University Medical Centre.
    Zekveld, Adriana
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Festen, Joost M
    VU University Medical Centre.
    Kramer, Sophia E
    VU University Medical Centre.
    Pupil Dilation Uncovers Extra Listening Effort in the Presence of a Single-Talker Masker2012In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 33, no 2, p. 291-300Article in journal (Refereed)
    Abstract [en]

    Objectives: Recent research has demonstrated that pupil dilation, a measure of mental effort (cognitive processing load), is sensitive to differences in speech intelligibility. The present study extends this outcome by examining the effects of masker type and age on the speech reception threshold (SRT) and mental effort. less thanbrgreater than less thanbrgreater thanDesign: In young and middle-aged adults, pupil dilation was measured while they performed an SRT task, in which spoken sentences were presented in stationary noise, fluctuating noise, or together with a single-talker masker. The masker levels were adjusted to achieve 50% or 84% sentence intelligibility. less thanbrgreater than less thanbrgreater thanResults: The results show better SRTs for fluctuating noise and a single-talker masker compared with stationary noise, which replicates results of previous studies. The peak pupil dilation, reflecting mental effort, was larger in the single-interfering speaker condition compared with the other masker conditions. Remarkably, in contrast to the thresholds, no differences in peak dilation were observed between fluctuating noise and stationary noise. This effect was independent of the intelligibility level and age. less thanbrgreater than less thanbrgreater thanConclusions: To maintain similar intelligibility levels, participants needed more mental effort for speech perception in the presence of a single-talker masker and then with the two other types of maskers. This suggests an additive interfering effect of speech information from the single-talker masker. The dissociation between these performance and mental effort measures underlines the importance of including measurements of pupil dilation as an independent index of mental effort during speech processing in different types of noisy environments and at different intelligibility levels.

  • 17.
    Kramer, Sophia E.
    et al.
    Vrije University of Amsterdam Medical Centre, Netherlands.
    Teunissen, Charlotte E.
    Vrije University of Amsterdam Medical Centre, Netherlands.
    Zekveld, Adriana
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. Vrije University of Amsterdam Medical Centre, Netherlands.
    Cortisol, Chromogranin A, and Pupillary Responses Evoked by Speech Recognition Tasks in Normally Hearing and Hard-of-Hearing Listeners: A Pilot Study2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, p. 126S-135SArticle in journal (Refereed)
    Abstract [en]

    Pupillometry is one method that has been used to measure processing load expended during speech understanding. Notably, speech perception (in noise) tasks can evoke a pupil response. It is not known if there is concurrent activation of the sympathetic nervous system as indexed by salivary cortisol and chromogranin A (CgA) and whether such activation differs between normally hearing (NH) and hard-of-hearing (HH) adults. Ten NH and 10 adults with mild-to-moderate hearing loss (mean age 52 years) participated. Two speech perception tests were administered in random order: one in quiet targeting 100% correct performance and one in noise targeting 50% correct performance. Pupil responses and salivary samples for cortisol and CgA analyses were collected four times: before testing, after the two speech perception tests, and at the end of the session. Participants rated their perceived accuracy, effort, and motivation. Effects were examined using repeated-measures analyses of variance. Correlations between outcomes were calculated. HH listeners had smaller peak pupil dilations (PPDs) than NH listeners in the speech in noise condition only. No group or condition effects were observed for the cortisol data, but HH listeners tended to have higher cortisol levels across conditions. CgA levels were larger at the pretesting time than at the three other test times. Hearing impairment did not affect CgA. Self-rated motivation correlated most often with cortisol or PPD values. The three physiological indicators of cognitive load and stress (PPD, cortisol, and CgA) are not equally affected by speech testing or hearing impairment. Each of them seem to capture a different dimension of sympathetic nervous system activity.

  • 18.
    Laplante-Lévesque, Ariane
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Oticon AS, Denmark.
    Brannstrom, Jonas K.
    Lund University, Sweden.
    Ingo, Elisabeth
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. Oticon AS, Denmark.
    Stages of Change in Adults Who Have Failed an Online Hearing Screening2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 1, p. 92-101Article in journal (Refereed)
    Abstract [en]

    Objectives: Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. Design: In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. Results: A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. Conclusions: The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

  • 19.
    Laplante-Lévesque, Ariane
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Dons Jensen, Lisbeth
    Eriksholm Research Centre, Denmark .
    Dawes, Piers
    University of Manchester, England .
    Nielsen, Claus
    Eriksholm Research Centre, Denmark .
    Optimal Hearing Aid Use: Focus Groups With Hearing Aid Clients and Audiologists2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no 2, p. 193-202Article in journal (Refereed)
    Abstract [en]

    Objectives: This study explored the meaning and determinants of optimal hearing aid use from the perspectives of hearing aid clients and audiologists. An additional objective was to contrast the perspectives of the clients and audiologists. less thanbrgreater than less thanbrgreater thanDesign: Four focus groups were conducted: (1) clients (n = 7) in Denmark, (2) clients (n = 10) in the United Kingdom, (3) audiologists (n = 6) in Denmark, and (4) audiologists (n = 7) in the United Kingdom. Clients owned hearing aids and audiologists had regular contact with clients. The focus group facilitators used a topic guide to generate the participants views on optimal hearing aid use. The focus groups were audio-recorded, transcribed verbatim, translated into English if conducted in Danish, and qualitatively analyzed with content analysis. less thanbrgreater than less thanbrgreater thanResults: Both clients and audiologists described optimal hearing aid use as being frequent and regular and driven by the individual needs of the clients. When describing determinants of optimal hearing aid use, both clients and audiologists mentioned the role of the client (e. g., adjustment to hearing aids), the role of the audiologist (e. g., audiologic practice and profession), and the role of the hearing aid (e. g., benefits and limitations of the hearing aid). They both highlighted the importance of client access to information. However, how clients and audiologists described the influence of these determinants varied somewhat. Clients emphasized the role of the hearing aid in achieving optimal hearing aid use. From a client perspective, hearing aids that performed well and had relevant features were most central. In contrast, audiologists emphasized the role of a good client-audiologist relationship in achieving optimal hearing aid use. From the audiologists perspective, audiologists who were able to understand the needs of the clients and to instruct clients appropriately were most central. less thanbrgreater than less thanbrgreater thanConclusions: This study highlights similarities and differences in how clients and audiologists describe optimal hearing aid use and its determinants. It is commendable that audiologists acknowledge the importance of the client-audiologist relationship, but given clients focus on hearing aids, audiologists might wish to describe more explicitly to their clients how their intervention can extend beyond provision of the optimal hearing aid. (Ear andamp; Hearing 2013;34;193-202)

  • 20.
    Laplante-Lévesque, Ariane
    et al.
    University of Queensland, Australia and Eriksholm Research Centre, Oticon, Denmark.
    Hickson, Louise
    University of Queensland, Australia.
    Worrall, Linda
    University of Queensland, Australia.
    Stages of change in adults with acquired hearing impairment seeking help for the first time: application of the transtheoretical model in audiologic rehabilitation2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no 4, p. 447-457Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    This study investigated the application of the transtheoretical (stages-of-change) model in audiologic rehabilitation. More specifically, it described the University of Rhode Island Change Assessment (URICA) scores of adults with acquired hearing impairment. It reported the psychometric properties (construct, concurrent, and predictive validity) of the stages-of-change model in this population.

    DESIGN:

    At baseline, 153 adults with acquired hearing impairment seeking help for the first time completed the URICA as well as measures of degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Participants were subsequently offered intervention options: hearing aids, communication programs, and no intervention. Their intervention uptake and adherence were assessed 6 months later and their intervention outcomes were assessed 3 months after intervention completion. First, the stages-of-change construct validity was evaluated by investigating the URICA factor structure (principal component analysis), internal consistency, and correlations between stage scores. The URICA scores were reported in terms of the scores for each stage of change, composite scores, stages with highest scores, and stage clusters (cluster analysis). Second, the concurrent validity was assessed by examining associations between stages of change and degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Third, the predictive validity was evaluated by investigating associations between stages of change and intervention uptake, adherence, and outcomes.

    RESULTS:

    First, in terms of construct validity, the principal component analysis identified four instead of three stages (precontemplation, contemplation, preparation, and action) for which the internal consistency was good. Most of the sample was in the action stage. Correlations between stage scores supported the model. Cluster analysis identified four stages-of-change clusters, which the authors named active change, initiation, disengagement, and ambivalence. In terms of concurrent validity, participants who reported a more advanced stage of change had a more severe hearing impairment, reported greater hearing disability, and had a hearing impairment for a longer period of time. In terms of predictive validity, participants who reported a more advanced stage of change were more likely to take up an intervention and to report successful intervention outcomes. However, stages of change did not predict intervention adherence.

    CONCLUSIONS:

    The majority of the sample was in the action stage. The construct, concurrent, and predictive validity of the stages-of-change model were good. The stages-of-change model has some validity in the rehabilitation of adults with hearing impairment. The data support that change might be better represented on a continuum rather than by movement from one step to the next. Of all the measures, the precontemplation stage score had the best concurrent and predictive validity. Therefore, further research should focus on addressing the precontemplation stage with a measure suitable for clinical use.

  • 21.
    Laplante-Lévesque, Ariane
    et al.
    University of Queensland, Brisbane, Australia and Eriksholm Research Centre, Oticon, Snekkersten, Denmark.
    Hickson, Louise
    University of Queensland, Brisbane, Australia.
    Worrall, Linda
    University of Queensland, Brisbane, Australia.
    What makes adults with hearing impairment take up hearing AIDS or communication programs and achieve successful outcomes?2012In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 33, no 1, p. 79-93Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    Client involvement in health decision making, or shared decision making, is increasingly being advocated. For example, rehabilitation interventions such as hearing aids and communication programs can be presented as options to adults with hearing impairment seeking help for the first time. Our previous research focused on the predictors of intervention decisions when options were presented with a decision aid. However, not all participants took up the intervention they initially decided upon. Although it is interesting to understand what informs adults with hearing impairment's intervention decisions, it is their intervention uptake and outcomes which best represent the ultimate end result of the rehabilitation process. This prospective study investigated the predictors of uptake and of successful outcomes of hearing aids and communication programs in middle-aged and older adults with hearing impairment seeking help for the first time.

    DESIGN:

    Using shared decision making, 153 participants with hearing impairment (average of air conduction thresholds at 0.5, 1, 2, and 4 kHz greater than 25 dB HL in at least one ear) aged 50 yr and older were presented with intervention options: hearing aids, communication programs (group or individual), and no intervention. Each participant received a decision aid and had at least 1 wk to consider intervention options before the intervention decision was made. Outcome measures for both hearing aids and communication programs at 3 mo after intervention completion were benefit (measured with the Client-Oriented Scale of Improvement), composite outcomes (measured with the International Outcome Inventory), and reduction in self-reported hearing disability (measured with the Hearing Handicap Questionnaire). Multivariate analysis (logistic and linear regression) identified predictors of intervention uptake and of successful outcomes when all other variables were held constant.

    RESULTS:

    Almost a quarter of the 153 participants (24%) did not take up the intervention they initially decided upon: 6 mo after making their intervention decision, 66 participants (43%) obtained hearing aids, 28 participants (18%) completed communication programs, and 59 participants (39%) did not complete an intervention. Seven intervention uptake predictors were identified: (1) application for subsidized hearing services (participants more likely to obtain hearing aids and less likely to complete no intervention); (2) higher socioeconomic status (no intervention less likely); (3) greater communication self-efficacy (hearing aids less likely); (4) greater contemplation stage of change (no intervention less likely); (5) greater hearing disability perceived by others and self (communication programs less likely); (6) greater perceived communication program effectiveness (communication programs more likely); and (7) greater perceived suitability of individual communication program (hearing aids less likely and communication programs more likely). Six predictors of successful intervention outcomes were identified: (1) higher socioeconomic status; (2) greater initial self-reported hearing disability; (3) lower precontemplation stage of change; (4) greater action stage of change; (5) lower chance locus of control; and (6) greater hearing disability perceived by others and self.

    CONCLUSIONS:

    Self-reported hearing disability and stages of change are the two most robust predictors of intervention uptake and successful outcomes. Clinicians should offer intervention options and should discuss these predictors when helping adults with hearing impairment make optimal decisions.

  • 22.
    Lunner, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Hellgren, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Arlinger, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Elberling, Claus
    A digital filterbank hearing aid: Predicting user preference and performance for two signal processing algorithms1997In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 18, p. 12-25Article in journal (Refereed)
  • 23.
    Lunner, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Hellgren, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Arlinger, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Elberling, Claus
    A digital filterbank hearing aid: Three digital signal processing algorithms-User preference and performance1997In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 18, p. 373-387Article in journal (Refereed)
    Abstract [en]

        

  • 24.
    Lunner, Thomas
    et al.
    Eriksholm Research Centre, Snekkersten, Denmark.
    Hietkamp, Renskje
    Eriksholm Research Centre, Snekkersten, Denmark.
    Andersen, Martin R
    Eriksholm Research Centre, Snekkersten, Denmark.
    Hopkins, Kathryn
    Department of Experimental Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom.
    Moore, Brian C
    Department of Experimental Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom.
    Effect of speech material on the benefit of temporal fine structure information in speech for young normal-hearing and older hearing-impaired participants2012In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 33, no 3, p. 377-388Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The purpose of this study was to investigate the influence of the type of speech material on the benefit obtained from temporal fine structure (TFS) information in speech for young normal-hearing (YNH) and older hearing-impaired (OHI) participants.

    DESIGN:

    The design was based on the work of . They measured the speech reception thresholds for a target talker in a background talker as a function of the frequency range over which TFS information was available. The signal was split into 32 channels, each with a bandwidth equal to the equivalent rectangular bandwidth of the "normal" auditory filter at the same center frequency. Above a cutoff (CO) channel, channels were vocoded and contained only temporal envelope information. Channels up to and including CO were not processed. Hopkins et al. found that, as CO was increased, speech reception thresholds decreased more for normal-hearing participants than for participants with cochlear hearing loss, suggesting that the latter were less able to use TFS information. We used the same design, but compared results when the target speech materials were open-set sentences, as used by Hopkins et al., and when they were more predictable sentences with a closed word set (Danish Dantale 2).

    RESULTS:

    With the open-set material, YNH listeners benefited more from TFS information than OHI listeners, replicating . For the YNH participants, the benefit of adding TFS was greater for the open-set material than for the closed-set material, while no difference in TFS benefit across speech materials was found for the OHI participants.

    CONCLUSIONS:

    The choice of speech material is important when assessing the benefit of TFS. Several factors may facilitate recognition in the absence of TFS cues, including small set size, predictable temporal structure of the target speech, and contextual effects. We speculate that TFS information is useful for reducing informational masking, by providing cues for the perceptual segregation of the target and background. When the target speech is highly predictable, informational masking may be minimal, rendering TFS cues unnecessary.

  • 25.
    Lunner, Thomas
    et al.
    Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark.
    Hietkamp, Renskje K.
    Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark.
    Andersen, Martin R.
    Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark.
    Hopkins, Kathryn
    University of Manchester, United Kingdom.
    Moore, Brian C. J.
    University of Cambridge, United Kingdom.
    Effect of Speech Material on the Benefit of Temporal Fine Structure Information in Speech for Normal-Hearing and Hearing-Impaired Participants2012In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 33, no 3, p. 377-388Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The purpose of this study was to investigate the influence of the type of speech material on the benefit obtained from temporal fine structure (TFS) information in speech for young normal-hearing (YNH) and older hearing-impaired (OHI) participants.

    DESIGN:

    The design was based on the work of . They measured the speech reception thresholds for a target talker in a background talker as a function of the frequency range over which TFS information was available. The signal was split into 32 channels, each with a bandwidth equal to the equivalent rectangular bandwidth of the "normal" auditory filter at the same center frequency. Above a cutoff (CO) channel, channels were vocoded and contained only temporal envelope information. Channels up to and including CO were not processed. Hopkins et al. found that, as CO was increased, speech reception thresholds decreased more for normal-hearing participants than for participants with cochlear hearing loss, suggesting that the latter were less able to use TFS information. We used the same design, but compared results when the target speech materials were open-set sentences, as used by Hopkins et al., and when they were more predictable sentences with a closed word set (Danish Dantale 2).

    RESULTS:

    With the open-set material, YNH listeners benefited more from TFS information than OHI listeners, replicating . For the YNH participants, the benefit of adding TFS was greater for the open-set material than for the closed-set material, while no difference in TFS benefit across speech materials was found for the OHI participants.

    CONCLUSIONS:

    The choice of speech material is important when assessing the benefit of TFS. Several factors may facilitate recognition in the absence of TFS cues, including small set size, predictable temporal structure of the target speech, and contextual effects. We speculate that TFS information is useful for reducing informational masking, by providing cues for the perceptual segregation of the target and background. When the target speech is highly predictable, informational masking may be minimal, rendering TFS cues unnecessary.

  • 26.
    Lunner, Thomas
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Snekkersten, Oticon A/S, Eriksholm Research Centre.
    Rudner, Mary
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Rosenbom, Tove
    Oticon Medical, Göteborg, Sweden.
    Ågren, Jessica
    Oticon Medical, Göteborg, Sweden.
    Ning Ng, Elaine Hoi
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Using Speech Recall in Hearing Aid Fitting and Outcome Evaluation Under Ecological Test Conditions2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, no 1, p. 145S-154SArticle in journal (Refereed)
    Abstract [en]

    In adaptive Speech Reception Threshold (SRT) tests used in the audiological clinic, speech is presented at signal to noise ratios (SNRs) that are lower than those generally encountered in real-life communication situations. At higher, ecologically valid SNRs, however, SRTs are insensitive to changes in hearing aid signal processing that may be of benefit to listeners who are hard of hearing. Previous studies conducted in Swedish using the Sentence-final Word Identification and Recall test (SWIR) have indicated that at such SNRs, the ability to recall spoken words may be a more informative measure. In the present study, a Danish version of SWIR, known as the Sentence-final Word Identification and Recall Test in a New Language (SWIRL) was introduced and evaluated in two experiments. The objective of experiment 1 was to determine if the Swedish results demonstrating benefit from noise reduction signal processing for hearing aid wearers could be replicated in 25 Danish participants with mild to moderate symmetrical sensorineural hearing loss. The objective of experiment 2 was to compare direct-drive and skin-drive transmission in 16 Danish users of bone-anchored hearing aids with conductive hearing loss or mixed sensorineural and conductive hearing loss. In experiment 1, performance on SWIRL improved when hearing aid noise reduction was used, replicating the Swedish results and generalizing them across languages. In experiment 2, performance on SWIRL was better for direct-drive compared with skin-drive transmission conditions. These findings indicate that spoken word recall can be used to identify benefits from hearing aid signal processing at ecologically valid, positive SNRs where SRTs are insensitive.

  • 27.
    Naylor, Graham
    et al.
    Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark.
    Öberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Wänström, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark.
    Exploring the Effects of the Narrative Embodied in the Hearing Aid Fitting Process on Treatment Outcomes2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 5, p. 517-526Article in journal (Refereed)
    Abstract [en]

    Objectives: There is strong evidence from other fields of health, and growing evidence in audiology, that characteristics of the process of intervention as perceived by the client (embodied narratives) can have significant effects on treatment outcomes, independent of the technical properties of the intervention itself. This phenomenon deserves examination because studies of technical interventions that fail to take account of it may reach erroneous conclusions and because clinical practice can put such effects to therapeutic use. The aim of this study was to test the idea that embodied narratives might affect outcomes in hearing aid fitting. This was achieved by carrying out experiments in which technical (acoustic) differences between alternative hearing aid fittings were absent, while providing test subjects with a strong contrast between the processes apparently applied to derive the fittings being compared. Thus, any effects of contrasting narratives could be observed, free of acoustical confounds. The hypothesis was that narrative effects would be observed. Design: A balanced crossover design was used, in which subjects received and evaluated two bilateral hearing aid fittings in succession. Subjects were deceived as to the true identical content of the hearing aid fittings being compared, but encouraged to believe that one fitting process was interactive and the other was diagnostic in character. Two almost identical experiments were undertaken: one with 24 experienced adult hearing aid users and another with 16 adult first-time users. Each hearing aid fitting was worn at home for 2 weeks, after which self-report outcome measures (Hearing Aid Performance Questionnaire, Hearing Handicap Inventory for the Elderly, and International Outcome Inventory for Hearing Aids) were administered. After the second test period, a short preference questionnaire was also completed. Results: Twenty of the 24 experienced users showed a clear preference for one or the other fitting, and their self-report scores reflected these preferences. Effect sizes were comparable with those typically observed for true acoustical contrasts. No order effect was seen in this group. In contrast, 13 of the 16 first-time users preferred the second fitting. Trends in the self-report measures were similar for this group but weaker than for the experienced users. In both groups, the reasons given for subjects preference were predominantly related to sound, despite there being no acoustical differences. Conclusions: This study suggests that the narrative embodied in a given fitting process can have a substantial effect on the perceived benefit of the treatment, independent of any acoustical differences, at least for experienced users. For first-time users, acclimatization seems to overshadow the purely narrative effect of any fitting process. In the future, research study designs should include steps to avoid narrative effects when technical parameters of hearing aids are the intended object of study. In clinical practice, the narrative is part of the therapeutic context, and one may design it for maximum beneficial effect.

  • 28.
    Neely, Stephen
    et al.
    Boys Town National Research Hospital, Omaha, Nebraska, USA.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Schairer, Kim
    Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee, USA.
    Alternative ear-canal measures related to absorbance2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no Supplement 1, p. 72s-77sArticle in journal (Refereed)
    Abstract [en]

    Several alternative ear-canal measures are similar to absorbance in their requirement for prior determination of a Thévenin-equivalent sound source. Examples are (1) sound intensity level, (2) forward pressure level, (3) time-domain ear-canal reflectance, and (4) cochlear reflectance. These four related measures are similar to absorbance in their utilization of wideband stimuli and their focus on recording ear-canal sound pressure. The related measures differ from absorbance in how the ear-canal pressure is analyzed and in the type of information that is extracted from the recorded response. Sound intensity level and forward pressure level have both been shown to be better as measures of sound level in the ear canal compared with sound pressure level because they reduced calibration errors due to standing waves in studies of behavioral thresholds and otoacoustic emissions. Time-domain ear-canal reflectance may be used to estimate ear-canal geometry and may have the potential to assess middle ear pathology. Cochlear reflectance reveals information about the inner ear that is similar to what is provided by other types of otoacoustic emissions, and may have theoretical advantages that strengthen its interpretation.

  • 29.
    Ng, Hoi Ning, Elaine
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Rudner, Mary
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Lunner, Thomas
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Noise reduction improves memory for target language speech in competing native but not foreign language speech2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 1, p. 82-91Article in journal (Refereed)
    Abstract [en]

    Objectives: A hearing aid noise reduction (NR) algorithm reduces the adverse effect of competing speech on memory for target speech for individuals with hearing impairment with high working memory capacity. In the present study, we investigated whether the positive effect of NR could be extended to individuals with low working memory capacity, as well as how NR influences recall performance for target native speech when the masker language is non-native.

    Design: A sentence-final word identification and recall (SWIR) test was administered to 26 experienced hearing aid users. In this test, target spoken native language (Swedish) sentence lists were presented in competing native (Swedish) or foreign (Cantonese) speech with or without binary masking NR algorithm. After each sentence list, free recall of sentence final words was prompted. Working memory capacity was measured using a reading span (RS) test.

    Results: Recall performance was associated with RS. However, the benefit obtained from NR was not associated with RS. Recall performance was more disrupted by native than foreign speech babble and NR improved recall performance in native but not foreign competing speech.

    Conclusions: Noise reduction improved memory for speech heard in competing speech for hearing aid users. Memory for native speech was more disrupted by native babble than foreign babble, but the disruptive effect of native speech babble was reduced to that of foreign babble when there was NR.

  • 30.
    Ohlenforst, Barbara
    et al.
    Vrije University of Amsterdam Medical Centre, Netherlands; Amsterdam Public Health Research Institute, Netherlands; Oticon AS, Denmark.
    Zekveld, Adriana
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. Vrije University of Amsterdam Medical Centre, Netherlands; Amsterdam Public Health Research Institute, Netherlands.
    Jansma, Elise P.
    Vrije University of Amsterdam, Netherlands.
    Wang, Yang
    Vrije University of Amsterdam Medical Centre, Netherlands; Amsterdam Public Health Research Institute, Netherlands; Oticon AS, Denmark.
    Naylor, Graham
    MRC CSO Institute Hearing Research, Scotland.
    Lorens, Artur
    Int Centre Hearing and Speech, Poland.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Oticon AS, Denmark.
    Kramer, Sophia E.
    Vrije University of Amsterdam Medical Centre, Netherlands; Amsterdam Public Health Research Institute, Netherlands.
    Effects of Hearing Impairment and Hearing Aid Amplification on Listening Effort: A Systematic Review2017In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 38, no 3, p. 267-281Article, review/survey (Refereed)
    Abstract [en]

    Objectives: To undertake a systematic review of available evidence on the effect of hearing impairment and hearing aid amplification on listening effort. Two research questions were addressed: Q1) does hearing impairment affect listening effort? and Q2) can hearing aid amplification affect listening effort during speech comprehension? Design: English language articles were identified through systematic searches in PubMed, EMBASE, Cinahl, the Cochrane Library, and PsyclNFO from inception to August 2014. References of eligible studies were checked. The Population, Intervention, Control, Outcomes, and Study design strategy was used to create inclusion criteria for relevance. It was not feasible to apply a meta-analysis of the results from comparable studies. For the articles identified as relevant, a quality rating, based on the 2011 Grading of Recommendations Assessment, Development, and Evaluation Working Group guidelines, was carried out to judge the reliability and confidence of the estimated effects. Results: The primary search produced 7017 unique hits using the keywords: hearing aids OR hearing impairment AND listening effort OR perceptual effort OR ease of listening. Of these, 41 articles fulfilled the Population, Intervention, Control, Outcomes, and Study design selection criteria of: experimental work on hearing impairment OR hearing aid technologies AND listening effort OR fatigue during speech perception. The methods applied in those articles were categorized into subjective, behavioral, and physiological assessment of listening effort. For each study, the statistical analysis addressing research question Q1 and/or Q2 was extracted. In seven articles more than one measure of listening effort was provided. Evidence relating to Q1 was provided by 21 articles that reported 41 relevant findings. Evidence relating to Q2 was provided by 27 articles that reported 56 relevant findings. The quality of evidence on both research questions (Q1 and Q2) was very low, according to the Grading of Recommendations Assessment, Development, and Evaluation Working Group guidelines. We tested the statistical evidence across studies with nonparametric tests. The testing revealed only one consistent effect across studies, namely that listening effort was higher for hearing-impaired listeners compared with normal-hearing listeners (Q1) as measured by electroencephalographic measures. For all other studies, the evidence across studies failed to reveal consistent effects on listening effort. Conclusion: In summary, we could only identify scientific evidence from physiological measurement methods, suggesting that hearing impairment increases listening effort during speech perception (Q1). There was no scientific, finding across studies indicating that hearing aid amplification decreases listening effort (Q2). In general, there were large differences in the study population, the control groups and conditions, and the outcome measures applied between the studies included in this review. The results of this review indicate that published listening effort studies lack consistency, lack standardization across studies, and have insufficient statistical power. The findings underline the need for a common conceptual framework for listening effort to address the current shortcomings.

  • 31.
    Pichora-Fuller, Kathleen M.
    et al.
    University of Toronto, Canada.
    Kramer, Sophia E.
    Vrije University of Amsterdam Medical Centre, Netherlands.
    Eckert, Mark A.
    Medical University of South Carolina, SC USA.
    Edwards, Brent
    EarLens Corp, CA USA.
    Hornsby, Benjamin W. Y.
    Vanderbilt University, TN 37212 USA.
    Humes, Larry E.
    Indiana University, IN 47405 USA.
    Lemke, Ulrike
    Phonak AG, Switzerland.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Oticon AS, Denmark.
    Matthen, Mohan
    University of Toronto, Canada.
    Mackersie, Carol L.
    San Diego State University, CA 92182 USA.
    Naylor, Graham
    MRC CSO Institute Hearing Research, Scotland.
    Phillips, Natalie A.
    Concordia University, Canada.
    Richter, Michael
    Liverpool John Moores University, England.
    Rudner, Mary
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Sommers, Mitchell S.
    Washington University, MO 63130 USA.
    Tremblay, Kelly L.
    University of Washington, WA 98195 USA.
    Wingfield, Arthur
    Brandeis University, MA USA.
    Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL)2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, p. 5S-27SArticle in journal (Refereed)
    Abstract [en]

    The Fifth Eriksholm Workshop on "Hearing Impairment and Cognitive Energy" was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to Titchener (1908) who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahnemans seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listeners motivation to expend mental effort in the challenging situations of everyday life.

  • 32.
    Pichora-Fuller, Kathy
    et al.
    University of Toronto in Mississauga, Department of Psychology.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Snekkersten, Oticon A/S, Eriksholm Research Centre.
    Consensus on a Framework for Understanding Effortful Listening (FUEL)In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667Article in journal (Refereed)
  • 33.
    Preminger, Jill E.
    et al.
    University of Louisville, Kentucky, USA.
    Laplante-Lévesque, Ariane
    Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark.
    Perceptions of age and brain in relation to hearing help seeking and rehabilitation2014In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 35, no 1, p. 19-29Article in journal (Refereed)
    Abstract [en]

    Objectives:

    This study used a qualitative approach to explore the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. Two superordinate themes, Age and Brain, emerged from prior analyses and are investigated in the present article.

    Design:

    In-depth semistructured interviews were completed in four countries with 34 adults (aged 26 to 96 years) with hearing impairment. Participants were asked to “Tell the story of your hearing.” Participants included individuals with different levels of experiences in hearing help-seeking and rehabilitation. The themes of Age and Brain emerged from the data based on qualitative content analysis. These major themes were analyzed further using interpretative phenomenology to create models of themes and subthemes as they related to hearing help-seeking and rehabilitation expectations and experience.

    Results:

    Age was discussed by 68% of the 34 participants. The data were sorted into three themes: Expectations, Self-Image, and Ways of Coping. Brain was discussed by 50% of the participants. The data were sorted into three themes: Cognitive Operations, Plasticity, and Mental Effort.

    Conclusions:

    Adults with hearing impairment think of their age and their brain as contributing to their hearing impairment, disability, help-seeking, and rehabilitation. Although hearing impairment associated with older age was typically construed as a stigma, not all perceptions of aging and hearing impairment were negative. Some participants viewed older age and its influence on relationships or priorities as a reason for seeking out hearing health care or as the determining factor in deciding to wear hearing aids (HAs). Some expected hearing impairment with older age, thus they found it easier to accept wearing HAs than they may have at a younger age. They discussed the brain in terms of the cognitive operations that may either inhibit or improve speech communication. Participants believed that they could train their brains to improve their communication (and sometimes avoid the need for HAs) or to increase their HA benefit. Age and Brain interconnected in a number of ways. Participants believed that older age led to cognitive decline, which resulted in decreased speech understanding. Participants also believed that the cognitive decline that accompanies older age may limit HA benefit. Hearing healthcare providers may wish to clarify negative messages about age and brain with their patients and provide information about how older brains are capable of changing and benefiting from HA use and comprehensive audiologic rehabilitation programs.

  • 34.
    Prieve, Beth
    et al.
    Syracuse University, Syracuse, New York, USA.
    Feeney, Patrick
    Oregon Health and Science University, Portland, Oregon, USA.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Shahnaz, Navid
    University of British Columbia, Vancouver, Canada.
    Prediction of conductive hearing loss using wideband acoustic immittance2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no Supplement 1, p. 54s-59sArticle in journal (Refereed)
    Abstract [en]

    The purpose of this article was to review the effectiveness of wideband acoustic immittance (WAI) and tympanometry in detecting conductive hearing loss (CHL). Eight studies were included that measured CHL through air-and bone-conducted thresholds in at least a portion of their participants. One study included infants, three studies included children, one study included older children and adults, and three studies included adults. WAI identified CHL well in all populations. In infants and children, WAI in several single-frequency bands identified CHL with equal accuracy to measures of middle ear admittance using clinical tympanometry with a single probe tone (1000 Hz for infants; 226 Hz for children and adults). When WAI was combined across frequency bands, it identified CHL superior to traditional, single-frequency tympanometry. Only two studies used WAI tympanometry, which assesses the outer/middle ear across both frequency and introduced air pressure, and differing results were reported as to whether introducing pressure into the ear canal provides better identification of CHL. In general, WAI appears to be a promising clinical tool, and further investigation is warranted.

  • 35.
    Rosowski, John
    et al.
    Harvard Medical School, Boston, Massachusetts, USA.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Lilly, David
    Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
    An overview of wideband immittance measurements techniques and terminology: you say absorbance, I say reflectance2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no Supplement 1, p. 9s-16sArticle in journal (Refereed)
    Abstract [en]

    This article reviews the relationships among different acoustic measurements of the mobility of the tympanic membrane, including impedance, admittance, reflectance, and absorbance, which the authors group under the rubric of immittance measures. Each of these quantities is defined and related to the others. The relationship is most easily grasped in terms of a straight rigid ear canal of uniform area terminated by a uniform middle ear immittance placed perpendicular to the long axis of the ear canal. Complications due to variations from this geometry are discussed. Different methods for measuring these quantities are described, and the assumptions inherent within each method are made explicit. The benefits of wideband measurements of these quantities are described, as are the benefits and limitations of different components of immittance and reflectance/absorbance. While power reflectance (the square of the magnitude of pressure reflectance) is relatively invariant along the length of the ear canal, it has the disadvantage that it ignores phase information that may be useful in assessing the presence of acoustic leaks in ear-canal measurements and identifying other potential error sources. A combination of reflectance and impedance magnitude and angle give a more complete description of the middle ear from measurements in the ear canal.

  • 36.
    Rudner, Mary
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, The Swedish Institute for Disability Research.
    Cognitive spare capacity as an index of listening effort2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, p. 69S-76SArticle in journal (Refereed)
  • 37.
    Rudner, Mary
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Linköping University, Linnaeus Centre HEAD.
    Foo, Catharina
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Snekkersten, Oticon A/S, Eriksholm Research Centre.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Linköping University, Linnaeus Centre HEAD.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Snekkersten, Oticon A/S, Eriksholm Research Centre.
    Phonological mismatch makes aided speech recognition in noise cognitively taxing2007In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 28, p. 879-892Article in journal (Refereed)
    Abstract [en]

    Objectives: The working memory framework for Ease of Language Understanding predicts that speech processing becomes more effortful, thus requiring more explicit cognitive resources, when there is mismatch between speech input and phonological representations in long-term memory. To test this prediction, we changed the compression release settings in the hearing instruments of experienced users and allowed them to train for 9 weeks with the new settings. After training, aided speech recognition in noise was tested with both the trained settings and orthogonal settings. We postulated that training would lead to acclimatization to the trained setting, which in turn would involve establishment of new phonological representations in long-term memory. Further, we postulated that after training, testing with orthogonal settings would give rise to phonological mismatch, associated with more explicit cognitive processing.

    Design: Thirty-two participants (mean = 70.3 years, SD = 7.7) with bilateral sensorineural hearing loss (pure-tone average = 46.0 dB HL, SD = 6.5), bilaterally fitted for more than 1 year with digital, two-channel, nonlinear signal processing hearing instruments and chosen from the patient population at the Linkooping University Hospital were randomly assigned to 9 weeks training with new, fast (40 ms) or slow (640 ms), compression release settings in both channels. Aided speech recognition in noise performance was tested according to a design with three within-group factors: test occasion (T1, T2), test setting (fast, slow), and type of noise (unmodulated, modulated) and one between-group factor: experience setting (fast, slow) for two types of speech materials-the highly constrained Hagerman sentences and the less-predictable Hearing in Noise Test (HINT). Complex cognitive capacity was measured using the reading span and letter monitoring tests.

    Prediction: We predicted that speech recognition in noise at T2 with mismatched experience and test settings would be associated with more explicit cognitive processing and thus stronger correlations with complex cognitive measures, as well as poorer performance if complex cognitive capacity was exceeded.

    Results: Under mismatch conditions, stronger correlations were found between performance on speech recognition with the Hagerman sentences and reading span, along with poorer speech recognition for participants with low reading span scores. No consistent mismatch effect was found with HINT.

    Conclusions: The mismatch prediction generated by the working memory framework for Ease of Language Understanding is supported for speech recognition in noise with the highly constrained Hagerman sentences but not the less-predictable HINT.

  • 38.
    Rudner, Mary
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Keidser, Gitte
    National Acoustic Laboratories, Australia.
    Hygge, Staffan
    University of Gävle, Sweden.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Better visuospatial working memory in adults who report profound deafness compared to those with normal or poor hearing: data from the UK Biobank resource2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, no 5, p. 620-622Article in journal (Refereed)
    Abstract [en]

    Experimental work has shown better visuospatial working memory (VSWM) in profoundly deaf individuals compared to those with normal hearing. Other data, including the UK Biobank resource shows poorer VSWM in individuals with poorer hearing. Using the same database, the authors investigated VSWM in individuals who reported profound deafness. Included in this study were 112 participants who were profoundly deaf, 1310 with poor hearing and 74,635 with normal hearing. All participants performed a card-pair matching task as a test of VSWM. Although variance in VSWM performance was large among profoundly deaf participants, at group level it was superior to that of participants with both normal and poor hearing. VSWM in adults is related to hearing status but the association is not linear. Future study should investigate the mechanism behind enhanced VSWM in profoundly deaf adults.

  • 39. Samuelsson, A-K
    et al.
    Hydén, Dag
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Roberg, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Skogh, Thomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Evaluation of anti-hsp70 antibody screening in sudden deafness2003In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 24, no 3, p. 233-235Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the diagnostic utility of anti-hsp70 antibody screening in sudden deafness. Design: Sera from 27 patients with sudden deafness and 100 healthy blood donors were analyzed by Western blotting (WB) for the presence of antibodies against 68 kD heat shock protein (anti-hsp70). Results: 19% of the patient sera and 14% of the control sera turned out positive, which was not significantly different. Conclusions: The anti-hsp70 WB test lacks clinical utility for diagnostic screening in patients with sudden deafness.

  • 40.
    Saunders, Gabrielle H.
    et al.
    Portland VA Medical Centre, OR USA; Oregon Health and Science University, OR 97201 USA.
    Frederick, Melissa T.
    Portland VA Medical Centre, OR USA.
    Silverman, ShienPei C.
    Portland VA Medical Centre, OR USA.
    Nielsen, Claus
    Oticon AS, Denmark.
    Laplante-Lévesque, Ariane
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Oticon AS, Denmark.
    Description of Adults Seeking Hearing Help for the First Time According to Two Health Behavior Change Approaches: Transtheoretical Model (Stages of Change) and Health Belief Model2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, no 3, p. 324-333Article in journal (Refereed)
    Abstract [en]

    Objectives: Several models of health behavior change are commonly used in health psychology. This study applied the constructs delineated by two models-the transtheoretical model (in which readiness for health behavior change can be described with the stages of precontemplation, contemplation and action) and the health belief model (in which susceptibility, severity, benefits, barriers, self-efficacy, and cues to action are thought to determine likelihood of health behavior change)-to adults seeking hearing help for the first time. Design: One hundred eighty-two participants (mean age: 69.5 years) were recruited following an initial hearing assessment by an audiologist. Participants mean four-frequency pure-tone average was 35.4 dB HL, with 25.8% having no hearing impairment, 50.5% having a slight impairment, and 23.1% having a moderate or severe impairment using the World Health Organization definition of hearing loss. Participants hearing-related attitudes and beliefs toward hearing health behaviors were examined using the University of Rhode Island Change Assessment (URICA) and the health beliefs questionnaire (HBQ), which assess the constructs of the transtheoretical model and the health belief model, respectively. Participants also provided demographic information, and completed the hearing handicap inventory (HHI) to assess participation restrictions, and the psychosocial impact of hearing loss (PIHL) to assess the extent to which hearing impacts competence, self-esteem, and adaptability. Results: Degree of hearing impairment was associated with participation restrictions, perceived competence, self-esteem and adaptability, and attitudes and beliefs measured by the URICA and the HBQ. As degree of impairment increased, participation restrictions measured by the HHI, and impacts of hearing loss, as measured by the PIHL, increased. The majority of first-time help seekers in this study were in the action stage of change. Furthermore, relative to individuals with less hearing impairment, individuals with more hearing impairment were at more advanced stages of change as measured by the URICA (i.e., higher contemplation and action scores relative to their precontemplation score), and they perceived fewer barriers and more susceptibility, severity, benefits and cues to action as measured by the HBQ. Multiple regression analyses showed participation restrictions (HHI scores) to be a highly significant predictor of stages of change explaining 30% to 37% of the variance, as were duration of hearing difficulty, and perceived benefits, severity, self-efficacy and cues to action assessed by the HBQ. Conclusions: The main predictors of stages of change in first-time help seekers were reported participation restrictions and duration of hearing difficulty, with constructs from the health belief model also explaining some of the variance in stages of change scores. The transtheoretical model and the health belief model are valuable for understanding hearing health behaviors and can be applied when developing interventions to promote help seeking.

  • 41.
    Singh, Gurjit
    et al.
    University of Toronto, Canada and Toronto Rehabil Institute, Canada .
    Pichora-Fuller, Kathleen M
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Hayes, Donald
    Unitron Hearing Ltd., Kitchener, Canada.
    von Schroeder, Herbert P.
    University of Toronto, Canada .
    Carnahan, Heather
    University of Toronto, Canada and Womens College Hospital, Toronto, Canada .
    The Aging Hand and the Ergonomics of Hearing Aid Controls2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no 1, p. E1-E13Article in journal (Refereed)
    Abstract [en]

    Objectives: The authors investigated the effects of hand function and aging on the ability to manipulate different hearing instrument controls. Over the past quarter century, hearing aids and hearing aid controls have become increasingly miniaturized. It is important to investigate the aging hand and hearing aid ergonomics because most hearing aid wearers are adults aged 65 years and above, who may have difficulty handling these devices. less thanbrgreater than less thanbrgreater thanDesign: In Experiment 1, the effect of age on the ability to manipulate two different open-fit behind-the-ear style hearing aids was investigated by comparing the performance of 20 younger (18-25 years of age), 20 young-old (60-70 years of age), and 20 older adults (71-80 years of age). In Experiment 2, ability to manipulate 11 different hearing instrument controls was investigated in 28 older adults who self-reported having arthritis in their hand, wrist, or finger and 28 older adults who did not report arthritis. For both experiments, the relationship between performance on the measures of ability to manipulate the devices and performance on a battery of tests to assess hand function was investigated. less thanbrgreater than less thanbrgreater thanResults: In Experiment 1, age-related differences in performance were observed in all the tasks assessing hand function and in the tasks assessing ability to manipulate a hearing aid. In Experiment 2, although minimal differences were observed between the two groups, significant differences were observed depending on the type of hearing instrument control. Performance on several of the objective tests of hand function was associated with the ability to manipulate hearing instruments. less thanbrgreater than less thanbrgreater thanConclusions: The overall pattern of findings suggest that haptic (touch) sensitivity in the fingertips and manual dexterity, as well as disability, pain, and joint stiffness of the hand, all contribute to the successful operation of a hearing instrument. However, although aging is associated with declining hand function and co-occurring declines in ability to manipulate a hearing instrument, for the sample of individuals in this study, including those who self-reported having arthritis, only minimal declines were observed.

  • 42.
    Smith, Sherri L.
    et al.
    Vet Affairs Medical Centre, TN USA; East Tennessee State University, TN 37614 USA.
    Pichora-Fuller, Kathleen
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. University of Toronto, Canada; University of Health Network, Canada; Baycrest Hospital, Canada.
    Alexander, Genevieve
    Vet Affairs Medical Centre, TN USA.
    Development of the Word Auditory Recognition and Recall Measure: A Working Memory Test for Use in Rehabilitative Audiology2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, no 6, p. E360-E376Article in journal (Refereed)
    Abstract [en]

    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.

  • 43.
    Smith, Sherri L
    et al.
    East Tennessee State University, USA.
    Pichora-Fuller, Kathleen
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Wilson, Richard H
    East Tennessee State University, USA.
    MacDonald, Ewen N
    Technical University of Denmark, Lyngby.
    Word Recognition for Temporally and Spectrally Distorted Materials: The Effects of Age and Hearing Loss2012In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 33, no 3, p. 349-366Article in journal (Refereed)
    Abstract [en]

    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. less thanbrgreater than less thanbrgreater thanDesign: 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. less thanbrgreater than less thanbrgreater thanResults: 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 similar to 30% in quiet and similar to 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. less thanbrgreater than less thanbrgreater thanConclusions: 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.

  • 44.
    Voss, Susan
    et al.
    Smith College, Northampton, Massachusetts, USA.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Neely, Stephen
    Boys Town National Research Hospital, Omaha, Nebraska, USA.
    Rosowski, John
    Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
    Factors that introduce intrasubject variability into ear-canal absorbance measurements2013In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 34, no Supplement 1, p. 60s-64sArticle in journal (Refereed)
    Abstract [en]

    Wideband immittance measures can be useful in analyzing acoustic sound flow through the ear and also have diagnostic potential for the identification of conductive hearing loss as well as causes of conductive hearing loss. To interpret individual measurements, the variability in test–retest data must be described and quantified. Contributors to variability in ear-canal absorbance–based measurements are described in this article. These include assumptions related to methodologies and issues related to the probe fit within the ear and potential acoustic leaks. Evidence suggests that variations in ear-canal cross-sectional area or measurement location are small relative to variability within a population. Data are shown to suggest that the determination of the Thévenin equivalent of the ER-10C probe introduces minimal variability and is independent of the foam ear tip itself. It is suggested that acoustic leaks in the coupling of the ear tip to the ear canal lead to substantial variations and that this issue needs further work in terms of potential criteria to identify an acoustic leak. In addition, test–retest data from the literature are reviewed.

  • 45.
    Wendt, Dorothea
    et al.
    Eriksholm Res Ctr, Denmark; Tech Univ Denmark, Denmark.
    Hietkamp, Renskje K.
    Eriksholm Res Ctr, Denmark.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Eriksholm Res Ctr, Denmark; Tech Univ Denmark, Denmark.
    Impact of Noise and Noise Reduction on Processing Effort: A Pupillometry Study2017In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 38, no 6, p. 690-700Article in journal (Refereed)
    Abstract [en]

    Objectives: Speech perception in adverse listening situations can be exhausting. Hearing loss particularly affects processing demands, as it requires increased effort for successful speech perception in background noise. Signal processing in hearing aids and noise reduction (NR) schemes aim to counteract the effect of noise and reduce the effort required for speech recognition in adverse listening situations. The present study examined the benefit of NR schemes, applying a combination of a digital NR and directional microphones, for reducing the processing effort during speech recognition. Design: The effect of noise (intelligibility level) and different NR schemes on effort were evaluated by measuring the pupil dilation of listeners. In 2 different experiments, performance accuracy and peak pupil dilation (PPD) were measured in 24 listeners with hearing impairment while they performed a speech recognition task. The listeners were tested at 2 different signal to noise ratios corresponding to either the individual 50% correct (L50) or the 95% correct (L95) performance level in a 4-talker babble condition with and without the use of a NR scheme. Results: In experiment 1, the PPD differed in response to both changes in the speech intelligibility level (L50 versus L95) and NR scheme. The PPD increased with decreasing intelligibility, indicating higher processing effort under the L50 condition compared with the L95 condition. Moreover, the PPD decreased when the NR scheme was applied, suggesting that the processing effort was reduced. In experiment 2, 2 hearing aids using different NR schemes (fast-acting and slow-acting) were compared. Processing effort changed as indicated by the PPD depending on the hearing aids and therefore on the NR scheme. Larger PPDs were measured for the slow-acting NR scheme. Conclusions: The benefit of applying an NR scheme was demonstrated for both L50 and L95, that is, a situation at which the performance level was at a ceiling. This opens the opportunity for new means of evaluating hearing aids in situations in which traditional speech reception measures are shown not to be sensitive.

    The full text will be freely available from 2018-11-01 15:54
  • 46.
    Zeitooni, Mehrnaz
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Mäki-Torkko, Elina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Binaural Hearing Ability With Bilateral Bone Conduction Stimulation in Subjects With Normal Hearing: Implications for Bone Conduction Hearing Aids.2016In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, no 6, p. 690-702Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of this study is to evaluate binaural hearing ability in adults with normal hearing when bone conduction (BC) stimulation is bilaterally applied at the bone conduction hearing aid (BCHA) implant position as well as at the audiometric position on the mastoid. The results with BC stimulation are compared with bilateral air conduction (AC) stimulation through earphones.

    DESIGN: Binaural hearing ability is investigated with tests of spatial release from masking and binaural intelligibility level difference using sentence material, binaural masking level difference with tonal chirp stimulation, and precedence effect using noise stimulus.

    RESULTS: In all tests, results with bilateral BC stimulation at the BCHA position illustrate an ability to extract binaural cues similar to BC stimulation at the mastoid position. The binaural benefit is overall greater with AC stimulation than BC stimulation at both positions. The binaural benefit for BC stimulation at the mastoid and BCHA position is approximately half in terms of decibels compared with AC stimulation in the speech based tests (spatial release from masking and binaural intelligibility level difference). For binaural masking level difference, the binaural benefit for the two BC positions with chirp signal phase inversion is approximately twice the benefit with inverted phase of the noise. The precedence effect results with BC stimulation at the mastoid and BCHA position are similar for low frequency noise stimulation but differ with high-frequency noise stimulation.

    CONCLUSIONS: The results confirm that binaural hearing processing with bilateral BC stimulation at the mastoid position is also present at the BCHA implant position. This indicates the ability for binaural hearing in patients with good cochlear function when using bilateral BCHAs.

  • 47.
    Zekveld, Adriana
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Rudner, Mary
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Johnsrude, Ingrid
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Festen, Joost M.
    VU University Medical Center Amsterdam, The Netherlands.
    Van Beek, Johannes H M
    VU University Medical Center Amsterdam, The Netherlands.
    Rönnberg, Jerker
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    The influence of semanically related and unrelated text cues on the intelligibility of sentences in noice2011In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 32, no 6, p. 16-25Article in journal (Refereed)
    Abstract [en]

    Objectives: In two experiments with different subject groups, we explored the relationship between semantic context and intelligibility by examining the influence of visually presented, semantically related, and unrelated three-word text cues on perception of spoken sentences in stationary noise across a range of speech-to-noise ratios (SNRs). In addition, in Experiment (Exp) 2, we explored the relationship between individual differences in cognitive factors and the effect of the cues on speech intelligibility.

    Design: In Exp 1, cues had been generated by participants themselves in a previous test session (own) or by someone else (alien). These cues were either appropriate for that sentence (match) or for a different sentence (mismatch). A condition with nonword cues, generated by the experimenter, served as a control. Experimental sentences were presented at three SNRs (dB SNR) corresponding to the entirely correct repetition of 29%, 50%, or 71% of sentences (speech reception thresholds; SRTs). In Exp 2, semantically matching or mismatching cues and nonword cues were presented before sentences at SNRs corresponding to SRTs of 16% and 29%. The participants in Exp 2 also performed tests of verbal working memory capacity and the ability to read partially masked text.

    Results: In Exp 1, matching cues improved perception relative to the nonword and mismatching cues, with largest benefits at the SNR corresponding to 29% performance in the SRT task. Mismatching cues did not impair speech perception relative to the nonword cue condition, and no difference in the effect of own and alien matching cues was observed. In Exp 2, matching cues improved speech perception as measured using both the percentage of correctly reported words and the percentage of entirely correctly reported sentences. Mismatching cues reduced the percentage of repeated words (but not the sentence-based scores) compared with the nonword cue condition. Working memory capacity and ability to read partly masked sentences were positively associated with the number of sentences repeated entirely correctly in the mismatch condition at the 29% SNR.

    Conclusions: In difficult listening conditions, both relevant and irrelevant semantic context can influence speech perception in noise. High working memory capacity and good linguistic skills are associated with a greater ability to inhibit irrelevant context when uncued sentence intelligibility is around 29% correct.

  • 48.
    Zekveld, Adriana
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Rudner, Mary
    Linköping University, Department of Behavioural Sciences and Learning, Cognition, Development and Disability. Linköping University, Faculty of Arts and Sciences.
    Johnsrude, Ingrid
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Festen, Joost M
    Vrije University of Amsterdam Medical Centre.
    van Beek, Johannes H M
    Vrije University of Amsterdam Medical Centre.
    Rönnberg, Jerker
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    The Influence of Semantically Related and Unrelated Text Cues on the Intelligibility of Sentences in Noise2011In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, ISSN 0196-0202, Vol. 32, no 6, p. E16-E25Article in journal (Refereed)
    Abstract [en]

    Objectives: In two experiments with different subject groups, we explored the relationship between semantic context and intelligibility by examining the influence of visually presented, semantically related, and unrelated three-word text cues on perception of spoken sentences in stationary noise across a range of speech-to-noise ratios (SNRs). In addition, in Experiment (Exp) 2, we explored the relationship between individual differences in cognitive factors and the effect of the cues on speech intelligibility. less thanbrgreater than less thanbrgreater thanDesign: In Exp 1, cues had been generated by participants themselves in a previous test session (own) or by someone else (alien). These cues were either appropriate for that sentence (match) or for a different sentence (mismatch). A condition with nonword cues, generated by the experimenter, served as a control. Experimental sentences were presented at three SNRs (dB SNR) corresponding to the entirely correct repetition of 29%, 50%, or 71% of sentences (speech reception thresholds; SRTs). In Exp 2, semantically matching or mismatching cues and nonword cues were presented before sentences at SNRs corresponding to SRTs of 16% and 29%. The participants in Exp 2 also performed tests of verbal working memory capacity and the ability to read partially masked text. less thanbrgreater than less thanbrgreater thanResults: In Exp 1, matching cues improved perception relative to the nonword and mismatching cues, with largest benefits at the SNR corresponding to 29% performance in the SRT task. Mismatching cues did not impair speech perception relative to the nonword cue condition, and no difference in the effect of own and alien matching cues was observed. In Exp 2, matching cues improved speech perception as measured using both the percentage of correctly reported words and the percentage of entirely correctly reported sentences. Mismatching cues reduced the percentage of repeated words (but not the sentence-based scores) compared with the nonword cue condition. Working memory capacity and ability to read partly masked sentences were positively associated with the number of sentences repeated entirely correctly in the mismatch condition at the 29% SNR. less thanbrgreater than less thanbrgreater thanConclusions: In difficult listening conditions, both relevant and irrelevant semantic context can influence speech perception in noise. High working memory capacity and good linguistic skills are associated with a greater ability to inhibit irrelevant context when uncued sentence intelligibility is around 29% correct.

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