Publications

PURPOSE: To briefly summarize existing data on effects of aging on auditory processing and cognition.

METHOD: A narrative review summarized previously reported data on age-related changes in auditory processing and in cognitive processes with a focus on spoken language comprehension and memory. In addition, recent data on effects of lifestyle engagement on cognitive processes are reviewed.

RESULTS: There is substantial evidence for age-related declines in both auditory processes and cognitive abilities. Accumulating evidence supports the idea that the perceptual burden associated with hearing loss impacts the processing resources available for good comprehension and memory for spoken language, particularly in older adults with limited resources. However, many language abilities are well preserved in old age, and there is considerable variability among individuals in cognitive performance across the life span. The authors discuss how lifestyle factors and socioemotional engagement can help to offset declining abilities.

CONCLUSIONS: It is clear that spoken language processing in adulthood and old age is affected by changes in perceptual, cognitive, and socioemotional processes as well as by interactions among these changes. Recommendations for further research include studying speech comprehension in complex conditions, including meaningful-connection spoken language, and tailoring clinical interventions based on patients' auditory processing and cognitive abilities along with their individual socioemotional demands.

BACKGROUND: Patients with single-sided deafness (SSD), where one ear has an unaidable hearing loss and the other ear has normal or aidable hearing, often complain of difficulties understanding speech and localizing sound sources, and report a higher self-perceived hearing disability. Patients with SSD may benefit from using contralateral routing of signal (CROS) or bilateral contralateral routing of the signal (BiCROS) amplification. Dissatisfaction of previously available (Bi)CROS devices has been reported, such as, interfering transmissions, low-fidelity sound quality, poor "user-friendly" set-up, and a bulky and cosmetically cumbersome appearance.

PURPOSE: Recent advances in hearing aid technology have improved (Bi)CROS hearing aids; however, these devices have not been experimentally evaluated. We hypothesized that newer technology with reports of improved digital signal processing, wireless transmission, and physical design would be as good, or better than, our participants' previous-generation BiCROS systems.

RESEARCH DESIGN: A within-subjects, pretest-posttest design was executed.

STUDY SAMPLE: Thirty-nine veterans (one female, 38 males; mean age = 74 yr, range = 49-85 yr) from the Audiology Section of the Bay Pines Veterans Affair Healthcare System participated. All participants were previously experienced BiCROS hearing aid users with varying degrees of sensorinerual hearing impairment in their better ear.

INTERVENTION: Participants were provided at least 4 wk of consistent use with the new BiCROS. DATA COLLECTION AND ANALYSES: Participants completed three research visits. At Visit 1, with their previous BiCROS, and at Visit 3, with their new BiCROS, the following objective and subjective measures were obtained: (1) soundfield speech-in-noise testing using the Words-In-Noise (WIN) test; (2) speech, spatial, and qualities of the hearing scale (SSQ) questionnaire; (3) selected questions from the MarkeTrak questionnaire; and, (4) three open-ended questions. Data were analyzed using parametric and nonparametric statistics.

RESULTS: Overall, the objective (WIN) and subjective (SSQ, MarkeTrak, and open-ended questions) measures indicated that the new BiCROS provided better outcomes than the previous BiCROS system. In addition, an overlap of favorable results was seen across measures.

CONCLUSIONS: Of the 39 participants, 95% reported improvements with the new BiCROS and chose to utilize the device regularly. The favorable objective and subjective outcomes indicate that the new BiCROS system is as good, or better than, what was previously utilized by our sample of veterans.

BACKGROUND: The most common complaint of adults with hearing loss is understanding speech in noise. One class of masker that may be particularly useful in the assessment of speech-in-noise abilities is interrupted noise. Interrupted noise usually is a continuous noise that has been multiplied by a square wave that produces alternating intervals of noise and silence. Wilson and Carhart found that spondaic word thresholds for listeners with normal hearing were 28 dB lower in an interrupted noise than in a continuous noise, whereas listeners with hearing loss experienced only an 11 dB difference.

PURPOSE: The purpose of this series of experiments was to determine if a speech-in-interrupted-noise paradigm differentiates better (1) between listeners with normal hearing and listeners with hearing loss and (2) among listeners with hearing loss than do traditional speech-in-continuous-noise tasks.

RESEARCH DESIGN: Four descriptive/quasi-experimental studies were conducted.

STUDY SAMPLE: Sixty young adults with normal hearing and 144 older adults with pure-tone hearing losses participated.

DATA COLLECTION AND ANALYSIS: A 4.3 sec sample of speech-spectrum noise was constructed digitally to form the 0 interruptions per second (ips; continuous) noise and the 5, 10, and 20 ips noises with 50% duty cycles. The noise samples were mixed digitally with the Northwestern University Auditory Test No. 6 words at selected signal-to-noise ratios and recorded on CD. The materials were presented through an earphone, and the responses were recorded and analyzed at the word level. Similar techniques were used for the stimuli in the remaining experiments.

RESULTS: In Experiment 1, using 0 ips as the reference condition, the listeners with normal hearing achieved 34.0, 30.2, and 28.4 dB escape from masking for 5, 10, and 20 ips, respectively. In contrast, the listeners with hearing loss only achieved 2.1 to 2.4 dB escape from masking. Experiment 2 studied the 0 and 5 ips conditions on 72 older listeners with hearing loss, who were on average 13 yr younger and more varied in their hearing loss than the listeners in Experiment 1. The mean escape from masking in Experiment 2 was 7dB, which is 20-25 dB less than the escape achieved by listeners with normal hearing. Experiment 3 examined the effects that duty cycle (0-100% in 10% steps) had on recognition performance in the 5 and 10 ips conditions. On the 12 young listeners with normal hearing, (1) the 50% correct point increased almost linearly between the 0 and 60% duty cycles (slope = 4.2 dB per 10% increase in duty cycle), (2) the slope of the function was steeper between 60 and 80% duty cycles, and (3) about the same masking was achieved for the 80-100% duty cycles. The data from the listeners with hearing loss were inconclusive. Experiment 4 varied the interburst ratios (0, -6, -12, -24, -48, and -infinity dB) of 5 ips noise and evaluated recognition performance by 24 young adults. The 50% points were described by a linear regression (R2 = 0.98) with a slope of 0.55 dB/dB.

CONCLUSION: The current data indicate that interrupted noise does provide a better differentiation both between listeners with normal hearing and listeners with hearing loss and among listeners with hearing loss than is provided by continuous noise.

OBJECTIVES: Comparing the effects of different disorders and interventions on health-related quality of life (HRQoL) is important for healthcare policy and accountability. There are two basic approaches to measure HRQoL: questionnaires derived from psychometrics and preference-based measures or utilities derived from econometrics. While disease-specific HRQoL questionnaires, such as the Dizziness Handicap Inventory (DHI), are important because they focus on the impact of a specific problem and its treatments (i.e., vestibular disorders), economic comparisons of the impacts of diseases/disorders and their treatments are typically based on utility assessment. The utility measures for audiology application (UMAA) were developed to measure utilities for various audiologic conditions using a standard computer. The purpose of this study was to determine if the UMAA provides stable, valid, and sensitive utility measures of the effects of benign paroxysmal positional vertigo (BPPV) and its treatment on HRQoL. It was hypothesized that utilities, as measured by the UMAA, would indicate improvement in HRQoL post-treatment for BPPV comparable to a disease-specific health status measure (DHI).

DESIGN: The UMAA incorporates three techniques to measure utility: rating scale, standard gamble, and time tradeoff. A utility is a cardinal measure of strength of preference and is measured on a continuum basis from 0.0 (incapacitating dizziness) to 1.0 (no dizziness). Fifty-two adults with BPPV of the posterior semicircular canal completed the UMAA and DHI before treatment and again post-treatment. A subgroup of 15 participants completed the UMAA on two occasions before treatment to assess test-retest stability and to establish critical difference values.

RESULTS: Results from this investigation demonstrate that utilities as measured through the UMAA are stable, valid, and comparable to the DHI. Post-treatment utilities were also significantly higher than pretreatment utilities, indicating that the utilities, as measured through the UMAA, are sensitive to improvement in HRQoL after BPPV treatment.

CONCLUSIONS: Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.

OBJECTIVE: Cochlear implant (CI) users typically report that speech recognition becomes substantially more difficult in the presence of background noise. This perception is consistent with objective measures of speech recognition showing that CI users require more favorable signal-to-noise ratios than normal-hearing (NH) listeners to achieve equivalent speech recognition. However, recent research in hearing aid users suggests that noise tolerance or the "willingness to listen in noise" may also influence perceived communication ability. Therefore, the purpose of this study was to evaluate the extent to which speech recognition in noise and noise tolerance predict perceived communication ability among adult CI users.

DESIGN: Twenty adult CI users were evaluated on an objective test of speech recognition in noise (Bamford-Kowal-Bench Sentences in Noise [BKB-SIN] test) and a measure of noise tolerance (Acceptable Noise Level [ANL] test) and completed a self-report measure of communication difficulty (Abbreviated Profile of Hearing Aid Benefit [APHAB]). Relationships between BKB-SIN scores, ANL scores, and aided APHAB scores for the ease of communication, background noise, reverberation, and Global scales were assessed. In addition, BKB-SIN scores and ANL scores for the CI users were compared with scores for a control group of 23 NH listeners.

RESULTS: CI users demonstrated substantially poorer BKB-SIN scores than NH listeners, as expected; however, their ANL scores were similar to those for NH listeners. BKB-SIN scores and ANL scores were not systematically related to one another. Each measure accounted for more than one third of the variance in CI users' aided APHAB Global scores; together, the two measures accounted for 72% of that variance.

CONCLUSIONS: Both speech recognition in noise and noise tolerance are strongly associated with CI users' self-perceived communication ability. The two measures seem to reflect different factors that influence an individual's communication experience; thus, both may provide useful clinical information. The establishment of formal criteria for BKB-SIN scores and ANL scores that are predictive of excessive communication difficulty may help to identify CI users who could benefit from additional audiologic rehabilitation.

Pregnancy during graduate medical training became a pertinent issue in the United States during the 10-year interval between 1992 and 2002 as the number of female residents trended steadily upward to over 25 per cent. Surgical training programs characteristically present unique challenges and stressors for all trainees, and pregnancy introduces additional physical, professional, and emotional demands for the pregnant woman and her coworkers. A qualitative study was performed using in-person interviews of female otolaryngology residents who had given birth within the previous 12 months. Items addressed included the pregnancy course and its complications, specific stressors during and after pregnancy, and solutions implemented by the resident and her program director. Reactions and level of support from coworkers were also discussed. Five pregnancies were reported among three residents interviewed. One resident experienced preterm delivery, which necessitated a week-long stay in the neonatal intensive care unit for her infant. Another had chorioamnionitis during delivery of two infants. One child had low birth weight. The third resident had a miscarriage during the first trimester of her first pregnancy and sustained a minor head injury after fainting in the operating room during her second pregnancy. Overall, long hours, unpredictable work demands, and guilt over colleagues' increased workloads and altered schedules were noted as significant sources of stress among these residents; the women also described high expectations of themselves, along with misgivings over their ability to balance pregnancy and parenthood with career demands. The most significant postpartum stress indicator was the matter of child care, especially as it related to finding adequate coverage for on-call periods ranging from 3 to 14 days per month. Maintaining breastfeeding was an additional concern in the postpartum period. Pregnancy during surgical residency is a significant source of conflict for the pregnant resident and her colleagues. Our study illustrates how program directors can pre-emptively address challenges this event presents. When policies on maternity leave, call issues during pregnancy, and flexible rotation schedules are in place before pregnancy occurs, the process may be smoother and more rewarding for all involved.

PURPOSE: To use the International Outcome Inventory for Hearing Aids (IOI-HA) with patients having advanced hearing aid technology to assess their satisfaction and benefit focusing on gender and experience effects, compare to norms, and use the IOI-HA and a practice-specific questionnaire to monitor the quality of the services provided by a dispensing practice.

RESEARCH DESIGN: A study of 160 potential participants who had worn their newly purchased multichannel digital hearing aids having directional microphones for at least three months, completed a trial period, and should have had time to acclimatize to them. English-speaking, private or insurance paying, competent, adult patients from a private practice were mailed a 12-item practice-specific questionnaire and the seven-item IOI-HA.

RESULTS: Of the 160 questionnaires mailed, 73 were returned for a 46% return rate. Of those, 64 were useable. Participants included male (34) and female (30), new (30) and previous (34) hearing aid users, who self-selected their participation by returning the questionnaires. The practice-specific questionnaire assessed patients' demographics and the quality of services received. The IOI-HA was analyzed according to an overall score and on two different factor scores. A power analysis revealed that 19 respondents per group were needed for the IOI-HA results to have a statistical power of .80 and probability of a Type II error of .20 for detecting a significant difference at the p < 0.05 level. Similar to earlier studies, no significant differences were observed either for any of the main effects or interactions for gender or user experience for the two IOI-HA factors and overall scores. A significant, but weak, positive correlation (r = .34; df = 63; p < .05) was observed between patients' overall satisfaction as indicated from the IOI-HA and the practice-specific quality assurance satisfaction question. T-tests on IOI-HA items 4 (satisfaction) and 7 (quality of life) revealed that the present participants' responses were significantly higher than for those in the normative study.

CONCLUSIONS: Gender and hearing aid experience did not influence these patients' responses on the IOI-HA, and all respondents were satisfied with their hearing aids and the practice that dispensed them. No major differences were found between these patients' IOI-HA results and normative data suggesting that both sets of respondents were satisfied with their hearing aids. However, limited statistical comparisons for the satisfaction and quality of life items revealed significant differences in favor of these participants' scores over those in the normative study. This suggested that the advanced hearing aid technology used here had a positive effect on patients' ratings and that the IOI-HA norms should be updated periodically to reflect changes in technology.

Simply asking elderly patients whether they have trouble hearing is an effective start to screening for hearing loss. Refer elderly patients with suspected hearing impairment for audiologic diagnosis and nonmedical rehabilitation treatment, including hearing aids. To assess a patient's risk of falling, review gait, balance disorders, weakness, environmental hazards, and medications.

Hearing and balance problems are prevalent among the elderly. Primary care physicians (PCPs) are important pivotal points of entry for ensuring that patients receive needed audiology services. New Medicare beneficiaries are entitled to one-time preventative examinations including hearing/balance screenings. A 35-item questionnaire was developed to assess physicians' participation in, knowledge about, and attitudes toward hearing/balance screenings and referrals for the elderly. The survey was mailed to 710 PCPs (19 undeliverable; 95 returned; response rate = 13.7%) in major metropolitan areas in the United States. Generally, these PCPs were not conducting hearing/balance screenings, aware of patient self-report screening questionnaires, or likely to screen in the future. They referred to audiologists and otolaryngologists mainly when patients complained of having hearing/balance difficulties, and they stated that these problems were important in the elderly and that the Medicare program was worthy of funding but that they had little time and were not reimbursed appropriately for screening. Therefore, PCPs could benefit from informational outreach campaigns on the prevalence of, negative HRQoL (health-related quality of life) effects from, and screening procedures for hearing/balance disorders in the elderly.