Publications by Type: Journal Article

Both clinical and research findings support the effectiveness of frequency-modulated (FM) technology among individuals who continue to encounter significant communication problems despite the use of conventional hearing instruments. The use rate of FM devices throughout the nation, however, remains disappointingly low. The authors present a case of a longtime hearing aid user whose hearing aids provided decreasing benefit as his hearing impairment increased to the extent that cochlear implantation was considered. Through the establishment of patient-specific treatment goals, the provision of appropriate FM technology as verified through real-ear measurements, and careful and deliberate counseling and follow-up, this patient was able to realize significant communication benefits as reported through several self-assessment measures. The cost-benefit implications of FM technology versus cochlear implantation are discussed.

The World Health Organization's (WHO) Disability Assessment Scale II (WHO-DAS II) is a generic health-status instrument firmly grounded in the WHO's International Classification of Functioning, Disability and Health (WHO-ICF). As such, it assesses functioning for six domains: communication, mobility, self-care, interpersonal, life activities, and participation. Domain scores aggregate to a total score. Because the WHO-DAS II contains questions relevant to hearing and communication, it has good face validity for use as an outcome measure for audiologic intervention. The purpose of the present study was to determine the psychometric properties of the WHO-DAS II on a sample of individuals with adult-onset hearing loss, including convergent validity, internal consistency, and test-retest stability. Convergent validity was established by examining correlations between the WHO-DAS II (domain and total scores) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Hearing Aid Handicap for the Elderly (HHIE), two disease-specific measures, as well as with the Short Form-36 for veterans (SF-36V), a second generic measure. Data on all four measures were collected from 380 older individuals with adult-onset hearing loss who were not hearing aid users. The results of the convergent validity analysis revealed that the WHODAS II communication domain score was moderately and significantly correlated with scores on the APHAB and the HHIE. WHO-DAS II interpersonal and participation domain scores and the total scores were also moderately and significantly correlated with HHIE scores. These findings support the validity of using the WHO-DAS II for assessing activity limitations and participation restrictions of adult-onset hearing loss. Several WHO-DAS II domain scores and the total score were also significantly and moderately-markedly correlated with scores from the SF-36V. These findings support the validity of the WHO-DAS II as a generic health-status instrument. Internal consistency reliability for all the domain scores was adequate for all but the interpersonal domain. Test-retest stability for all the domain scores was adequate. Critical difference values were calculated for use in clinical application of the WHO-DAS II. From these findings, we concluded that the WHO-DAS II communication, participation, and total scores can be used to examine the effects of adult-onset hearing loss on functional health status. Further work examining the utility of the WHO-DAS II as an outcome measure for hearing aid intervention is warranted.

The World Health Organization's Disability Assessment Scale II (WHO-DAS II) is a generic health-status instrument that provides six domain scores and a total, aggregate score. Two of the domain scores, communication and participation, and the total score, have good validity, internal-consistency reliability, and test-retest stability in individuals with adult-onset hearing loss. As such, these two domain scores and the total WHO-DAS II score may be useful as generic outcome measures to assess the effectiveness of hearing aid intervention for this population. Before the use of the WHO-DAS II in hearing aid clinical trials, however, the responsiveness of the instrument and the short- and long-term outcomes to hearing aid intervention had to be determined. Responsiveness and outcomes were assessed in 380 veterans (approximately half received hearing aids and half served as controls) by examining group differences, effect-size estimates, and individual differences as a function of hearing aid intervention. For comparison, data also were obtained on two disease-specific measures, the APHAB and the HHIE. The WHO-DAS II communication domain and total scores were sufficiently responsive to hearing aid intervention for use in future studies in which group differences are to be detected. The WHO-DAS II participation domain was not sufficiently responsive to hearing aid intervention. The APHAB and HHIE, both disease-specific measures, were more sensitive to hearing aid intervention than the generic measure. The short- and long-term outcomes of hearing aid intervention were also examined in the present study. Group outcomes for hearing aid intervention can be expected to be stable for at least 6 months when measured by WHO-DAS II total score and for at least 12 months when measured by the WHO-DAS II communication domain scores. Effect-size estimates and examination of the number of individuals exhibiting change scores exceeding 90% critical differences for true changes in scores indicate that for clinical applications, disease-specific instruments are more useful than the WHO-DAS II. The findings of this study support the use of the WHO-DAS II as a generic measure in hearing aid trials research so as to allow for comparisons of health-status outcomes across different diseases or disorders.

Health-related quality-of-life (HRQoL) instruments measure the impact of a disorder and treatment on several attributes that are thought to constitute the self-perceived health status of an individual. This tutorial reviews the conceptual framework of HRQoL, including the challenges associated with defining and measuring HRQoL, specifically as it applies to audiologic care. A relatively new instrument, the World Health Organization-Disability Assessment Schedule II, will be discussed as a potentially valuable instrument to measure the impact of hearing loss and hearing aid intervention on self-perceived HRQoL.

This article describes the doctor of audiology (AuD) program at the University of South Florida (USF). The USF AuD program has been operational since the fall of 1999 and, to date, 47 students have graduated from either the postbaccalaureate track or the post-master's track. The faculty consists of 9 full-time and 8 part-time adjunct members who provide a curriculum that covers the audiology scope of practice. Being located in a major metropolitan area allows for diverse clinical practicum experiences that result in students being prepared to become autonomous professional practitioners.

OBJECTIVE: To examine short- and long-term subjective benefits of providing a counseling-oriented audiological rehabilitation (AR) program as an adjunct to hearing aid intervention for individuals with adult-onset hearing loss.

DESIGN: One hundred six veterans (68 men and 38 women), fit binaurally with digitally programmable analog hearing aids, participated. The Communication Profile for the Hearing Impaired (CPHI; ) was administered to all participants before hearing aid fitting. Half the patients were randomly assigned to receive hearing aids alone (i.e., control); the other patients were assigned to participate in a 4-wk group AR program in conjunction with receiving hearing aids (i.e., HA + AR). At the end of the AR program, the CPHI was again administered to all participants to assess short-term benefit and at 6 mo and 1 yr after hearing aid fitting to assess long-term benefit.

RESULTS: A separate repeated-measures version of the general linear model was used to examine short- and long-term benefits for the CPHI factor scores (communication importance, communication performance, adjustment, interaction, and reaction) and for individual importance ratings and scale scores. Hearing aid use improved both short- and long-term self-perception of communication performance, with no additional benefits from participation in the AR program. Consistent with the goals of a counseling-oriented AR program, differential short-term treatment effects were found for communication strategy usage, which led to differential short-term benefits for the interaction and reaction factors. Although failing to reach strict criteria for statistical significance, there was an observable difference in short-term outcomes between the two groups for the adjustment factor, with greater improvements occurring for the HA + AR group. Over the course of the year, benefits measured for the HA + AR group remained stable, whereas scores for the control group continued to increase, resulting in no differences in factor scores between groups at 1 yr after intervention.

CONCLUSIONS: The finding of a short-term differential treatment benefit for AR in terms of interaction and reaction, and possibly for adjustment, was important, as better outcomes in these areas may be important in the decision to keep hearing aids. If this is the case, then the data support the inclusion of a counseling-oriented AR program. Differential treatment effects in interaction and reaction appeared to result from communication strategy use, indicating that the AR program is meeting many of its goals in this area. The lack of long-term differential effects appeared as the result of continued changes in adjustment, interaction, and reaction with continued hearing aid experience.

Over the last century, research in the area of age-related hearing loss has provided a vast amount of knowledge regarding age-related effects on the anatomy and physiology of the auditory system. As we enter the new millennium, researchers are beginning to shift their attention towards developing methods of modulating the effects of age-related hearing loss and the development of efficacious intervention strategies to meet all of an individual's hearing-related rehabilitative needs. The purpose of this review is to provide a framework for considering how the biological aspects of the aging auditory system interact with the most common current therapeutic intervention for age-related hearing loss–the use of amplification–and also how the biological aspects point to other potential intervention strategies.

BACKGROUND: The present study explored factors that influenced older individuals' subjective perception of hearing problems. In addition to objectively screened hearing ability, nonauditory factors such as stressful life conditions (visual impairment, chronic disease, disability, and recent stressful life events), neuroticism, and social resources were hypothesized to be predictors of self-perceived hearing problems.

METHODS: These hypotheses were tested with a hierarchical regression model using a stratified sample of 425 community-dwelling older individuals (mean age = 72.2).

RESULTS: Individuals with more recent stressful life events, higher levels of neuroticism, and less emotional support reported greater hearing problems after controlling for objectively screened hearing. In addition to the main effects, a significant interaction was observed between neuroticism and screened hearing, indicating that the combination of poor hearing and high neuroticism increased the level of self-perceived hearing problems.

CONCLUSIONS: The findings suggest that the effects of nonauditory factors should be taken into account in the application of self-assessed measures of hearing problems.