Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Related Articles

Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Int J Audiol. 2017 Dec 07;:1-9

Authors: Sayler SK, Rabinowitz PM, Cantley LF, Galusha D, Neitzel RL

Abstract
OBJECTIVE: This study characterised overall and specific costs associated with hearing conservation programmes (HCPs) at US metal manufacturing sites, and examined the association between these costs and several noise-induced hearing loss (NIHL) outcomes.
DESIGN: We interviewed personnel and reviewed records at participating facilities. We also measured noise for comparison to the ten-year average of measurements made by each facility. NIHL outcomes assessed included rates of standard threshold shifts (STS) and high-frequency hearing loss, as well as prevalence of hearing impairment, for each participating facility. We used linear regression to identify per-person HCP costs that best predicted the NIHL outcomes.
STUDY SAMPLE: We evaluated 14 US metal manufacturing facilities operated by a single company.
RESULTS: Annual HCP costs ranged from roughly $67,000 to $397,000 (average $308 ± 80 per worker). Our full-shift noise measurements (mean 83.1 dBA) showed good agreement with the facilities' measurements (mean 82.6 dBA). Hearing impairment prevalence was about 15% overall. Higher expenditures for training and hearing protector fit-testing were significantly associated with reduced STS prevalence. Higher training expenditures were also related to lower hearing impairment prevalence and high-frequency hearing loss rates.
CONCLUSIONS: HCP costs were substantial and variable. Increased workplace spending on training and fit-testing may help minimise NIHL.

PMID: 29216778 [PubMed - as supplied by publisher]

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Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Related Articles

Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Int J Audiol. 2017 Dec 07;:1-9

Authors: Sayler SK, Rabinowitz PM, Cantley LF, Galusha D, Neitzel RL

Abstract
OBJECTIVE: This study characterised overall and specific costs associated with hearing conservation programmes (HCPs) at US metal manufacturing sites, and examined the association between these costs and several noise-induced hearing loss (NIHL) outcomes.
DESIGN: We interviewed personnel and reviewed records at participating facilities. We also measured noise for comparison to the ten-year average of measurements made by each facility. NIHL outcomes assessed included rates of standard threshold shifts (STS) and high-frequency hearing loss, as well as prevalence of hearing impairment, for each participating facility. We used linear regression to identify per-person HCP costs that best predicted the NIHL outcomes.
STUDY SAMPLE: We evaluated 14 US metal manufacturing facilities operated by a single company.
RESULTS: Annual HCP costs ranged from roughly $67,000 to $397,000 (average $308 ± 80 per worker). Our full-shift noise measurements (mean 83.1 dBA) showed good agreement with the facilities' measurements (mean 82.6 dBA). Hearing impairment prevalence was about 15% overall. Higher expenditures for training and hearing protector fit-testing were significantly associated with reduced STS prevalence. Higher training expenditures were also related to lower hearing impairment prevalence and high-frequency hearing loss rates.
CONCLUSIONS: HCP costs were substantial and variable. Increased workplace spending on training and fit-testing may help minimise NIHL.

PMID: 29216778 [PubMed - as supplied by publisher]

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Clinical, molecular, and computational analysis in two cases with mitochondrial encephalomyopathy associated with SUCLG1 mutation in a consanguineous family.

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Clinical, molecular, and computational analysis in two cases with mitochondrial encephalomyopathy associated with SUCLG1 mutation in a consanguineous family.

Biochem Biophys Res Commun. 2017 Dec 04;:

Authors: Maalej M, Tej A, Bouguila J, Tilouche S, Majdoub S, Khabou B, Tabbebi M, Felhi R, Ammar M, Mkaouar-Rebai E, Keskes L, Boughamoura L, Fakhfakh F

Abstract
Deficiency of the mitochondrial enzyme succinyl COA ligase (SUCL) is associated with encephalomyopathic mtDNA depletion syndrome and methylmalonic aciduria. This disorder is caused by mutations in both SUCL subunits genes: SUCLG1 (α subnit) and SUCLA2 (β subnit). We report here, two Tunisian patients belonging to a consanguineous family with mitochondrial encephalomyopathy, hearing loss, lactic acidosis, hypotonia, psychomotor retardation and methylmalonic aciduria. Mutational analysis of SUCLG1 gene showed, for the first time, the presence of c.41T > C in the exon 1 at homozygous state. In-silico analysis revealed that this mutation substitutes a conserved methionine residue to a threonine at position 14 (p.M14T) located at the SUCLG1 protein mitochondrial targeting sequence. Moreover, these analysis predicted that this mutation alter stability structure and mitochondrial translocation of the protein. In Addition, a decrease in mtDNA copy number was revealed by real time PCR in the peripheral blood leukocytes in the two patients compared with controls.

PMID: 29217198 [PubMed - as supplied by publisher]

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Lipid bilayer mediates ion-channel cooperativity in a model of hair-cell mechanotransduction.

Related Articles

Lipid bilayer mediates ion-channel cooperativity in a model of hair-cell mechanotransduction.

Proc Natl Acad Sci U S A. 2017 Dec 07;:

Authors: Gianoli F, Risler T, Kozlov AS

Abstract
Mechanoelectrical transduction in the inner ear is a biophysical process underlying the senses of hearing and balance. The key players involved in this process are mechanosensitive ion channels. They are located in the stereocilia of hair cells and opened by the tension in specialized molecular springs, the tip links, connecting adjacent stereocilia. When channels open, the tip links relax, reducing the hair-bundle stiffness. This gating compliance makes hair cells especially sensitive to small stimuli. The classical explanation for the gating compliance is that the conformational rearrangement of a single channel directly shortens the tip link. However, to reconcile theoretical models based on this mechanism with experimental data, an unrealistically large structural change of the channel is required. Experimental evidence indicates that each tip link is a dimeric molecule, associated on average with two channels at its lower end. It also indicates that the lipid bilayer modulates channel gating, although it is not clear how. Here, we design and analyze a model of mechanotransduction where each tip link attaches to two channels, mobile within the membrane. Their states and positions are coupled by membrane-mediated elastic forces arising from the interaction between the channels' hydrophobic cores and that of the lipid bilayer. This coupling induces cooperative opening and closing of the channels. The model reproduces the main properties of hair-cell mechanotransduction using only realistic parameters constrained by experimental evidence. This work provides an insight into the fundamental role that membrane-mediated ion-channel cooperativity can play in sensory physiology.

PMID: 29217640 [PubMed - as supplied by publisher]

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Lipid bilayer mediates ion-channel cooperativity in a model of hair-cell mechanotransduction.

Related Articles

Lipid bilayer mediates ion-channel cooperativity in a model of hair-cell mechanotransduction.

Proc Natl Acad Sci U S A. 2017 Dec 07;:

Authors: Gianoli F, Risler T, Kozlov AS

Abstract
Mechanoelectrical transduction in the inner ear is a biophysical process underlying the senses of hearing and balance. The key players involved in this process are mechanosensitive ion channels. They are located in the stereocilia of hair cells and opened by the tension in specialized molecular springs, the tip links, connecting adjacent stereocilia. When channels open, the tip links relax, reducing the hair-bundle stiffness. This gating compliance makes hair cells especially sensitive to small stimuli. The classical explanation for the gating compliance is that the conformational rearrangement of a single channel directly shortens the tip link. However, to reconcile theoretical models based on this mechanism with experimental data, an unrealistically large structural change of the channel is required. Experimental evidence indicates that each tip link is a dimeric molecule, associated on average with two channels at its lower end. It also indicates that the lipid bilayer modulates channel gating, although it is not clear how. Here, we design and analyze a model of mechanotransduction where each tip link attaches to two channels, mobile within the membrane. Their states and positions are coupled by membrane-mediated elastic forces arising from the interaction between the channels' hydrophobic cores and that of the lipid bilayer. This coupling induces cooperative opening and closing of the channels. The model reproduces the main properties of hair-cell mechanotransduction using only realistic parameters constrained by experimental evidence. This work provides an insight into the fundamental role that membrane-mediated ion-channel cooperativity can play in sensory physiology.

PMID: 29217640 [PubMed - as supplied by publisher]

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Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Related Articles

Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Int J Audiol. 2017 Dec 07;:1-9

Authors: Sayler SK, Rabinowitz PM, Cantley LF, Galusha D, Neitzel RL

Abstract
OBJECTIVE: This study characterised overall and specific costs associated with hearing conservation programmes (HCPs) at US metal manufacturing sites, and examined the association between these costs and several noise-induced hearing loss (NIHL) outcomes.
DESIGN: We interviewed personnel and reviewed records at participating facilities. We also measured noise for comparison to the ten-year average of measurements made by each facility. NIHL outcomes assessed included rates of standard threshold shifts (STS) and high-frequency hearing loss, as well as prevalence of hearing impairment, for each participating facility. We used linear regression to identify per-person HCP costs that best predicted the NIHL outcomes.
STUDY SAMPLE: We evaluated 14 US metal manufacturing facilities operated by a single company.
RESULTS: Annual HCP costs ranged from roughly $67,000 to $397,000 (average $308 ± 80 per worker). Our full-shift noise measurements (mean 83.1 dBA) showed good agreement with the facilities' measurements (mean 82.6 dBA). Hearing impairment prevalence was about 15% overall. Higher expenditures for training and hearing protector fit-testing were significantly associated with reduced STS prevalence. Higher training expenditures were also related to lower hearing impairment prevalence and high-frequency hearing loss rates.
CONCLUSIONS: HCP costs were substantial and variable. Increased workplace spending on training and fit-testing may help minimise NIHL.

PMID: 29216778 [PubMed - as supplied by publisher]

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via IFTTT

Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Related Articles

Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

Int J Audiol. 2017 Dec 07;:1-9

Authors: Sayler SK, Rabinowitz PM, Cantley LF, Galusha D, Neitzel RL

Abstract
OBJECTIVE: This study characterised overall and specific costs associated with hearing conservation programmes (HCPs) at US metal manufacturing sites, and examined the association between these costs and several noise-induced hearing loss (NIHL) outcomes.
DESIGN: We interviewed personnel and reviewed records at participating facilities. We also measured noise for comparison to the ten-year average of measurements made by each facility. NIHL outcomes assessed included rates of standard threshold shifts (STS) and high-frequency hearing loss, as well as prevalence of hearing impairment, for each participating facility. We used linear regression to identify per-person HCP costs that best predicted the NIHL outcomes.
STUDY SAMPLE: We evaluated 14 US metal manufacturing facilities operated by a single company.
RESULTS: Annual HCP costs ranged from roughly $67,000 to $397,000 (average $308 ± 80 per worker). Our full-shift noise measurements (mean 83.1 dBA) showed good agreement with the facilities' measurements (mean 82.6 dBA). Hearing impairment prevalence was about 15% overall. Higher expenditures for training and hearing protector fit-testing were significantly associated with reduced STS prevalence. Higher training expenditures were also related to lower hearing impairment prevalence and high-frequency hearing loss rates.
CONCLUSIONS: HCP costs were substantial and variable. Increased workplace spending on training and fit-testing may help minimise NIHL.

PMID: 29216778 [PubMed - as supplied by publisher]

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Stimulus Characteristics of Single-Word Tests of Children's Speech Sound Production

Purpose

This clinical focus article provides readers with a description of the stimulus characteristics of 12 popular tests of speech sound production.

Method

Using significance testing and descriptive analyses, stimulus items were compared in terms of the number of opportunities for production of all consonant singletons, clusters, and rhotic and nonrhotic vowels of Standard American English; phonetic/phonological and structural complexity; and the presence of bound morphemes.

Results

The tests varied widely in terms of the number of opportunities for production of consonant singletons, clusters, and rhotic and nonrhotic vowels. Most of the tests included only 1 opportunity, scored or unscored, to produce a majority of the consonant singletons in each word position. Only 3 of the tests included stimulus items with 3-element clusters. The majority contained limited opportunities to produce 3- or 4-syllable stimulus items. The tests provided sufficient opportunities for production of most vowels, although most did not score vowels. The tests differed significantly in the complexity of their stimulus items. Most, however, contained a negligible number of items that, with the addition of a bound morpheme, resulted in a word-final cluster.

Conclusion

Most of the tests elicit an inadequate sample with which to conduct a comprehensive phonological analysis.

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Developmental Stuttering in Children Who Are Hard of Hearing

Purpose

A number of studies with large sample sizes have reported lower prevalence of stuttering in children with significant hearing loss compared to children without hearing loss. This study used a parent questionnaire to investigate the characteristics of stuttering (e.g., incidence, prevalence, and age of onset) in children who are hard of hearing (CHH).

Method

Three hundred three parents of CHH who participated in the Outcomes of Children With Hearing Loss study (Moeller & Tomblin, 2015) were sent questionnaires asking about their child's history of stuttering.

Results

One hundred ninety-four parents of CHH responded to the survey. Thirty-three CHH were reported to have stuttered at one point in time (an incidence of 17.01%), and 10 children were still stuttering at the time of survey submission (a prevalence of 5.15%). Compared to estimates in the general population, this sample displayed a significantly higher incidence and prevalence. The age of onset, recovery rate, and other characteristics were similar to hearing children.

Conclusions

Based on this sample, mild to moderately severe hearing loss does not appear to be a protective factor for stuttering in the preschool years. In fact, the incidence and prevalence of stuttering may be higher in this population compared to the general population. Despite the significant speech and language needs that children with mild to moderately severe hearing loss may have, speech-language pathologists should appropriately prioritize stuttering treatment as they would in the hearing population.

Supplemental Material

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Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys

Purpose

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population.

Method

We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation.

Results

Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%–56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%–22% experiencing food insecurity, compared to 11%–14% of their peers without any indications of speech-language difficulties).

Conclusions

We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

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Emergent Literacy Skills in Preschool Children With Hearing Loss Who Use Spoken Language: Initial Findings From the Early Language and Literacy Acquisition (ELLA) Study

Purpose

The purpose of this study was to compare change in emergent literacy skills of preschool children with and without hearing loss over a 6-month period.

Method

Participants included 19 children with hearing loss and 14 children with normal hearing. Children with hearing loss used amplification and spoken language. Participants completed measures of oral language, phonological processing, and print knowledge twice at a 6-month interval. A series of repeated-measures analyses of variance were used to compare change across groups.

Results

Main effects of time were observed for all variables except phonological recoding. Main effects of group were observed for vocabulary, morphosyntax, phonological memory, and concepts of print. Interaction effects were observed for phonological awareness and concepts of print.

Conclusions

Children with hearing loss performed more poorly than children with normal hearing on measures of oral language, phonological memory, and conceptual print knowledge. Two interaction effects were present. For phonological awareness and concepts of print, children with hearing loss demonstrated less positive change than children with normal hearing. Although children with hearing loss generally demonstrated a positive growth in emergent literacy skills, their initial performance was lower than that of children with normal hearing, and rates of change were not sufficient to catch up to the peers over time.

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How African American English-Speaking First Graders Segment and Rhyme Words and Nonwords With Final Consonant Clusters

Purpose

This study explored how typically developing 1st grade African American English (AAE) speakers differ from mainstream American English (MAE) speakers in the completion of 2 common phonological awareness tasks (rhyming and phoneme segmentation) when the stimulus items were consonant–vowel–consonant–consonant (CVCC) words and nonwords.

Method

Forty-nine 1st graders met criteria for 2 dialect groups: AAE and MAE. Three conditions were tested in each rhyme and segmentation task: Real Words No Model, Real Words With a Model, and Nonwords With a Model.

Results

The AAE group had significantly more responses that rhymed CVCC words with consonant–vowel–consonant words and segmented CVCC words as consonant–vowel–consonant than the MAE group across all experimental conditions. In the rhyming task, the presence of a model in the real word condition elicited more reduced final cluster responses for both groups. In the segmentation task, the MAE group was at ceiling, so only the AAE group changed across the different stimulus presentations and reduced the final cluster less often when given a model.

Conclusion

Rhyming and phoneme segmentation performance can be influenced by a child's dialect when CVCC words are used.

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The Oral Narrative Comprehension and Production Abilities of Verbal Preschoolers on the Autism Spectrum

Purpose

This study described the oral narrative comprehension and production skills of verbal preschool-age children on the autism spectrum and investigated correlations between oral narrative ability and norm-referenced language test performance.

Method

Twenty-nine preschool-age children (aged 4;0–5;9 years;months) with autism, who obtained an age-equivalent score of at least 36 months on the expressive communication subscale of the Vineland Adaptive Behavior Scales–Second Edition (Sparrow, Cicchetti, & Balla, 2005), participated. Children listened to an unfamiliar fictional narrative and answered comprehension questions afterward. After listening to the narrative a second time, children were asked to retell the narrative without picture support. Narratives were transcribed and analyzed for length, semantic diversity, grammatical complexity and accuracy, intelligibility, inclusion of critical events, and narrative stage.

Results

All children participated in the comprehension task, and 19 children produced an analyzable narrative retell. Compared with published data on typically developing children, significant difficulties were observed in narrative comprehension, intelligibility, and grammatical accuracy. Most of the children told descriptive or action sequences, with only 1 child producing an abbreviated episode. Significant positive correlations were found (a) between performance on the Peabody Picture Vocabulary Test–Fourth Edition (Dunn & Dunn, 2007) and semantic diversity and narrative comprehension and (b) between parent-reported receptive communication competence (Vineland Adaptive Behavior Scales–Second Edition) and narrative comprehension.

Conclusions

This study provides preliminary evidence of specific difficulties in oral narrative comprehension and production skills in verbal preschoolers on the autism spectrum.

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Masthead

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Introduction: Hearing Across the Lifespan (HEAL) 2016

Purpose

This introduction overviews this special issue on the Hearing Across the Lifespan (HEAL) conference, which was held in Cernobbio, Italy, June 2–4, 2016.

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Field Monitoring of Otoacoustic Emissions During Noise Exposure: Pilot Study in Controlled Environment

Purpose

In spite of all the efforts to implement workplace hearing conservation programs, noise-induced hearing loss remains the leading cause of disability for North American workers. Nonetheless, an individual's susceptibility to noise-induced hearing loss can be estimated by monitoring changes in hearing status in relation to the level of ambient noise exposure. The purpose of this study was to validate an approach that could improve workplace hearing conservation practices. The approach was developed using a portable and robust system designed for noisy environments and consisted of taking continuous measurements with high temporal resolution of the health status of the inner ear using otoacoustic emissions (OAEs).

Method

A pilot study was conducted in a laboratory, exposing human subjects to industrial noise recordings at realistic levels. In parallel, OAEs were measured periodically using the designed OAE system as well as with a commercially available OAE system, used as a reference.

Results

Variations in OAE levels were analyzed and discussed along with the limitations of the reference and designed systems.

Conclusions

This study demonstrates that the monitoring of an individual's OAEs could be useful in monitoring temporary changes in hearing status induced by exposure to ambient noise and could be considered as a new tool for effective hearing conservation programs in the workplace.

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Findings From EuroTrak Surveys From 2009 to 2015: Hearing Loss Prevalence, Hearing Aid Adoption, and Benefits of Hearing Aid Use

Purpose

The purpose of this study was to analyze data from the EuroTrak surveys performed from 2009 to 2015 in Germany, France, and the United Kingdom to identify factors that could account for the growth in hearing aid sales over that period.

Method

Data of 132,028 people—approximately 15,000 for each of the 3 countries at 3-year intervals—were collected using a questionnaire. The sample in each country was weighted using the respective country age–gender populations to get balanced results. Furthermore, 11,867 persons with self-reported hearing impairment filled in a comprehensive questionnaire on hearing status and related matters; 4,631 were hearing aid owners. Data were pooled over the 3 countries for each of the years 2009, 2012, and 2015 and analyzed for developments over the 6-year period. In certain cases, data were pooled across countries and years. The analysis focused on hearing loss prevalence, hearing aid adoption rates, satisfaction with hearing aids, and benefits of hearing aid use.

Results

Hearing loss prevalence was stable over the period around 10%—slightly higher for men than for women. Hearing aid adoption overall increased from 33% to 37%, and bilateral use increased from 55% to 69%. Intervals between hearing aid renewals decreased. These factors contribute to increased hearing aid sales. Bilateral users are more satisfied with the hearing aid product features (76%) and performance (72%) and use their hearing aids 9.1 hr per day, compared with unilateral users where the corresponding numbers are 71%, 67%, and 7.8 hr, respectively. Satisfaction with hearing aid product features and performance in general is slightly increasing; hearing aid users are 14.5% less exhausted at the end of the day compared with nonusers with similar hearing loss and exhibit less depressive and forgetfulness symptoms.

Conclusions

The prevalence of self-reported hearing loss is 10.6% and stable, and hearing aid adoption has increased, particularly of bilateral fittings that are more satisfactory and exhibit higher daily use patterns. Higher uptake of hearing aids contributes to growing hearing aid sales.

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Diagnosing and Screening in a Minority Language: A Validation Study

Purpose

The Turkish Digit Triplet Test for hearing self-screening purposes and the Turkish Matrix Test (TURMatrix) for follow-up hearing diagnostics offer an automated closed-set response format where patients respond by choosing from response alternatives. Their applicability for testing Turkish-speaking patients in their native language by German audiologists with different Turkish language skills was investigated.

Method

Tests were composed of spoken numbers (Turkish Digit Triplet Test) or sentences (TURMatrix). For 49 participants differing in hearing ability, speech reception thresholds (SRTs) in noise and quiet were obtained, for the TURMatrix with either the open- or closed-set response format, by audiologists with and without Turkish language skills, respectively.

Results

SRTs of both tests correlate closely with each other as well as with hearing ability, but not as closely as individual SRTs in quiet with hearing ability. SRTs in noise of listeners with normal hearing were about 0.7 dB lower for the closed-set than for the open-set response format.

Conclusions

The 2 tests yield comparable results and are applicable to professionals without suitable language skills. For the closed-set response format of the TURMatrix, literacy is crucial and supplemental (visual) cues improve performance. Speech audiometry in noise should assess suprathreshold processing deficits independently from language proficiency in the majority language.

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Ecological Momentary Assessment: Feasibility, Construct Validity, and Future Applications

Purpose

This research assessed the feasibility and construct validity of ecological momentary assessment in capturing the hearing experiences of adults with mild hearing impairment in natural environments.

Method

Twenty-nine adults between the ages of 55 and 79 years (M = 69 years) answered multiple surveys on a smartphone app over a 2-week trial. Participants also wore 1 environmental classifier and a streamer allowing bidirectional communication between smartphone and classifier. Surveys were triggered based on defined criteria, or by the participants. A paper-based self-report questionnaire was administered before and after the trial.

Results

Feasibility was indicated by high compliance rates, with a total of 1,128 surveys completed. Of these, 72% were completed during a listening event, 26% within 1 hr, and only 2% of the surveys more than 1 hr after the listening event. The mean survey completion time was 1 min 40 s. Mean pre- and post-trial self-report scores were not significantly different, indicating no reactivity. Construct validity was indicated by the close agreement between subjective ratings of listening situations and objective data from the hearing aid classifier.

Conclusions

Ecological momentary assessment is a feasible and valid research methodology for older adults with mild hearing impairment. The methodology has potential as a clinical counseling and outcome tool.

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Autonomic Nervous System Responses to Hearing-Related Demand and Evaluative Threat

Purpose

This paper consists of 2 parts. The purpose of Part 1 was to review the potential influence of internal (person-related) factors on listening effort. The purpose of Part 2 was to present, in support of Part 1, preliminary data illustrating the interactive effects of an external factor (task demand) and an internal factor (evaluative threat) on autonomic nervous system measures.

Method

For Part 1, we provided a brief narrative review of motivation and stress as modulators of listening effort. For Part 2, we described preliminary data from a study using a repeated-measures (2 × 2) design involving manipulations of task demand (high, low) and evaluative threat (high, low). The low-demand task consisted of repetition of sentences from a narrative. The high-demand task consisted of answering questions about the narrative, requiring both comprehension and recall. During the high evaluative threat condition, participants were filmed and told that their video recordings would be evaluated by a panel of experts. During the low evaluative threat condition, no filming occurred; participants were instructed to “do your best.” Skin conductance (sympathetic nervous system activity) and heart rate variability (HRV, parasympathetic activity) were measured during the listening tasks. The HRV measure was the root mean square of successive differences of adjacent interbeat intervals. Twelve adults with hearing loss participated.

Results

Skin conductance increased and HRV decreased relative to baseline (no task) for all listening conditions. Skin conductance increased significantly with an increase in evaluative threat, but only for the more demanding task. There was no significant change in HRV in response to increasing evaluative threat or task demand.

Conclusions

Listening effort may be influenced by factors other than task difficulty, as reviewed in Part 1. This idea is supported by the preliminary data indicating that the sympathetic nervous system response to task demand is modulated by social evaluative threat. More work is needed to determine the relative contributions of motivation and emotional stress on physiological responses during listening tasks.

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Reflections on Lake Como Conferences (2000–2016)

Purpose

We present an overview of the conceptualization and development of the Newborn Hearing Screening and Hearing Across the Lifespan (Lake Como) conferences from 2000 to 2016.

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Relation Between Listening Effort and Speech Intelligibility in Noise

Purpose

Subjective ratings of listening effort might be applicable to estimate hearing difficulties at positive signal-to-noise ratios (SNRs) at which speech intelligibility scores are near 100%. Hence, ratings of listening effort were compared with speech intelligibility scores at different SNRs, and the benefit of hearing aids was evaluated.

Method

Two groups of listeners, 1 with normal hearing and 1 with hearing impairment, performed adaptive speech intelligibility and adaptive listening effort tests (Adaptive Categorical Listening Effort Scaling; Krueger, Schulte, Brand, & Holube, 2017) with sentences of the Oldenburg Sentence Test (Wagener, Brand, & Kollmeier, 1999a, 1999b; Wagener, Kühnel, & Kollmeier, 1999) in 4 different maskers. Model functions were fitted to the data to estimate the speech reception threshold and listening effort ratings for extreme effort and no effort.

Results

Listeners with hearing impairment showed higher rated listening effort compared with listeners with normal hearing. For listeners with hearing impairment, the rating extreme effort, which corresponds to negative SNRs, was more correlated to the speech reception threshold than the rating no effort, which corresponds to positive SNRs. A benefit of hearing aids on speech intelligibility was only verifiable at negative SNRs, whereas the effect on listening effort showed high individual differences mainly at positive SNRs.

Conclusion

The adaptive procedure for rating subjective listening effort yields information beyond using speech intelligibility to estimate hearing difficulties and to evaluate hearing aids.

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A “Goldilocks” Approach to Hearing-Aid Self-Fitting: User Interactions

Purpose

The purpose of the current study was to evaluate user reactions to custom software designed for self-adjustment of amplification.

Method

“Goldilocks” software was developed to allow user exploration and selection of preferred levels of overall output, low-frequency cut, and high-frequency boost while listening to preprocessed speech. Thirteen hearing-aid users and 13 nonusers self-adjusted before and after taking a speech perception test incorporated into the software.

Results

All 26 participants were able to complete the 2 adjustments and the intervening test in an average of 6.5 min—20 of them from on-screen instructions without experimenter help. Relative to a generic starting condition, the average participant opted to increase overall output, reduce low-frequency cut, and increase high-frequency boost. The first and second self-selected values were highly correlated, but there was evidence of further increases of overall volume and high-frequency boost after speech perception testing with the initial adjustment. There was no evidence that prior hearing-aid experience affected the ability to understand or complete the self-fitting process.

Conclusions

This approach to hearing-aid self-fitting can be a speedy, reliable, and feasible alternative to, or supplement to, conventional fitting procedures, but many questions remain to be answered.

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Subjective Fatigue in Children With Hearing Loss Assessed Using Self- and Parent-Proxy Report

Purpose

The primary purposes of this study were to examine the effects of hearing loss and respondent type (self- vs. parent-proxy report) on subjective fatigue in children. We also examined associations between child-specific factors and fatigue ratings.

Method

Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS; Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). We compared self- and parent-proxy ratings from 60 children with hearing loss (CHL) and 43 children with normal hearing (CNH). The children ranged in age from 6 to 12 years.

Results

School-age CHL experienced more overall and cognitive fatigue than CNH, although the differences were smaller than previously reported. Parent-proxy report was not strongly associated with child self-report, and parents tended to underestimate their child's fatigue, particularly sleep/rest fatigue. Language ability was also associated with subjective fatigue. For CHL and CNH, as language abilities increased, cognitive fatigue decreased.

Conclusions

School-age CHL experience more subjective fatigue than CNH. The poor association between parent-proxy and child reports suggests that the parent-proxy version of the PedsQL-MFS should not be used in isolation when assessing fatigue in school-age children. Future research should examine how language abilities may modulate fatigue and its potential academic consequences in CHL.

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International Outcome Inventory for Hearing Aids: Data From a Large Swedish Quality Register Database

Purpose

The purpose of this study was to analyze a database of completed International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires obtained from over 100,000 clients fitted with new hearing aids in Sweden during the period of 2012–2016. Mean IOI-HA total scores were correlated with degree of hearing loss, unilateral versus bilateral fitting, first-time versus return clients, gender, and variation among dispensing clinics. The correlations with expectations, service quality, and technical functioning of the hearing aids were also analyzed.

Method

Questionnaires containing the 7 IOI-HA items as well as questions concerning some additional issues were mailed to clients 3–6 months after fitting of new hearing aids. The questionnaires were returned to and analyzed by an independent research institute.

Results

More than 100 dispensing clinics nationwide take part in this project. A response rate of 52.6% resulted in 106,631 data sets after excluding incomplete questionnaires. Forty-six percent of the responders were women, and 54% were men. The largest difference in mean score (0.66) was found for the IOI-HA item “use” between return clients and first-time users. Women reported significantly higher (better) scores for the item “impact on others” compared with men. The bilaterally fitted subgroup reported significantly higher scores for all 7 items compared with the unilaterally fitted subgroup. Experienced users produced higher scores on benefit and satisfaction items, whereas first-time users gave higher scores for residual problems. No correlation was found between mean IOI-HA total score and average hearing threshold level (pure-tone average [PTA]). Mean IOI-HA total scores were found to correlate significantly with perceived service quality of the dispensing center and with the technical functionality of the hearing aids.

Conclusions

When comparing mean IOI-HA total scores from different studies or between groups, differences with regard to hearing aid experience, gender, and unilateral versus bilateral fitting have to be considered. No correlation was found between mean IOI-HA total score and degree of hearing loss in terms of PTA. Thus, PTA is not a reliable predictor of benefit and satisfaction of hearing aid provision as represented by the IOI-HA items. Identification of a specific lower fence in PTA for hearing aid candidacy is therefore to be avoided. Large differences were found in mean IOI-HA total scores related to different dispensing centers.

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The ALFA4Hearing Model (At-a-Glance Labeling for Features of Apps for Hearing Health Care) to Characterize Mobile Apps for Hearing Health Care

Purpose

The aim of the study was to analyze, by using the ALFA4Hearing model (At-a-Glance Labeling for Features of Apps for Hearing Health Care), a sample of apps over a wide range of services in the hearing health care (HHC) domain in order to take a first picture of the current scenario of apps for HHC.

Method

We tested 120 apps, and we characterized them by using the ALFA4Hearing model, which includes 29 features in 5 components (Promoters, Services, Implementation, Users, and Descriptive Information). We analyzed (a) the distribution of the 29 features in the sample, (b) the relationship between the Implementation features and the Services provided by the apps, and (c) the distribution of the 29 features in apps for professional use.

Results

The analysis of our sample of apps by means of the ALFA4Hearing model highlighted interesting trends and emerging challenges. Also, results suggested many potential opportunities for research and clinical practice, such as greater involvement of stakeholders, improved evidence base, higher technical quality, and usability.

Conclusions

The ALFA4Hearing model is able to represent, at a glance, a large amount of information about apps for HHC, highlighting trends and challenges. It might be useful to HHC professionals as a basis for app characterization and informed decision making.

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Do Older Listeners With Hearing Loss Benefit From Dynamic Pitch for Speech Recognition in Noise?

Purpose

Dynamic pitch, the variation in the fundamental frequency of speech, aids older listeners' speech perception in noise. It is unclear, however, whether some older listeners with hearing loss benefit from strengthened dynamic pitch cues for recognizing speech in certain noise scenarios and how this relative benefit may be associated with individual factors. We first examined older individuals' relative benefit between natural and strong dynamic pitches for better speech recognition in noise. Further, we reported the individual factors of the 2 groups of listeners who benefit differently from natural and strong dynamic pitches.

Method

Speech reception thresholds of 13 older listeners with mild–moderate hearing loss were measured using target speech with 3 levels of dynamic pitch strength. Individuals' ability to benefit from dynamic pitch was defined as the speech reception threshold difference between speeches with and without dynamic pitch cues.

Results

The relative benefit of natural versus strong dynamic pitch varied across individuals. However, this relative benefit remained consistent for the same individuals across those background noises with temporal modulation. Those listeners who benefited more from strong dynamic pitch reported better subjective speech perception abilities.

Conclusion

Strong dynamic pitch may be more beneficial than natural dynamic pitch for some older listeners to recognize speech better in noise, particularly when the noise has temporal modulation.

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Stimulus Characteristics of Single-Word Tests of Children's Speech Sound Production

Purpose

This clinical focus article provides readers with a description of the stimulus characteristics of 12 popular tests of speech sound production.

Method

Using significance testing and descriptive analyses, stimulus items were compared in terms of the number of opportunities for production of all consonant singletons, clusters, and rhotic and nonrhotic vowels of Standard American English; phonetic/phonological and structural complexity; and the presence of bound morphemes.

Results

The tests varied widely in terms of the number of opportunities for production of consonant singletons, clusters, and rhotic and nonrhotic vowels. Most of the tests included only 1 opportunity, scored or unscored, to produce a majority of the consonant singletons in each word position. Only 3 of the tests included stimulus items with 3-element clusters. The majority contained limited opportunities to produce 3- or 4-syllable stimulus items. The tests provided sufficient opportunities for production of most vowels, although most did not score vowels. The tests differed significantly in the complexity of their stimulus items. Most, however, contained a negligible number of items that, with the addition of a bound morpheme, resulted in a word-final cluster.

Conclusion

Most of the tests elicit an inadequate sample with which to conduct a comprehensive phonological analysis.

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Developmental Stuttering in Children Who Are Hard of Hearing

Purpose

A number of studies with large sample sizes have reported lower prevalence of stuttering in children with significant hearing loss compared to children without hearing loss. This study used a parent questionnaire to investigate the characteristics of stuttering (e.g., incidence, prevalence, and age of onset) in children who are hard of hearing (CHH).

Method

Three hundred three parents of CHH who participated in the Outcomes of Children With Hearing Loss study (Moeller & Tomblin, 2015) were sent questionnaires asking about their child's history of stuttering.

Results

One hundred ninety-four parents of CHH responded to the survey. Thirty-three CHH were reported to have stuttered at one point in time (an incidence of 17.01%), and 10 children were still stuttering at the time of survey submission (a prevalence of 5.15%). Compared to estimates in the general population, this sample displayed a significantly higher incidence and prevalence. The age of onset, recovery rate, and other characteristics were similar to hearing children.

Conclusions

Based on this sample, mild to moderately severe hearing loss does not appear to be a protective factor for stuttering in the preschool years. In fact, the incidence and prevalence of stuttering may be higher in this population compared to the general population. Despite the significant speech and language needs that children with mild to moderately severe hearing loss may have, speech-language pathologists should appropriately prioritize stuttering treatment as they would in the hearing population.

Supplemental Material

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Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys

Purpose

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population.

Method

We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation.

Results

Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%–56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%–22% experiencing food insecurity, compared to 11%–14% of their peers without any indications of speech-language difficulties).

Conclusions

We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

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Emergent Literacy Skills in Preschool Children With Hearing Loss Who Use Spoken Language: Initial Findings From the Early Language and Literacy Acquisition (ELLA) Study

Purpose

The purpose of this study was to compare change in emergent literacy skills of preschool children with and without hearing loss over a 6-month period.

Method

Participants included 19 children with hearing loss and 14 children with normal hearing. Children with hearing loss used amplification and spoken language. Participants completed measures of oral language, phonological processing, and print knowledge twice at a 6-month interval. A series of repeated-measures analyses of variance were used to compare change across groups.

Results

Main effects of time were observed for all variables except phonological recoding. Main effects of group were observed for vocabulary, morphosyntax, phonological memory, and concepts of print. Interaction effects were observed for phonological awareness and concepts of print.

Conclusions

Children with hearing loss performed more poorly than children with normal hearing on measures of oral language, phonological memory, and conceptual print knowledge. Two interaction effects were present. For phonological awareness and concepts of print, children with hearing loss demonstrated less positive change than children with normal hearing. Although children with hearing loss generally demonstrated a positive growth in emergent literacy skills, their initial performance was lower than that of children with normal hearing, and rates of change were not sufficient to catch up to the peers over time.

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How African American English-Speaking First Graders Segment and Rhyme Words and Nonwords With Final Consonant Clusters

Purpose

This study explored how typically developing 1st grade African American English (AAE) speakers differ from mainstream American English (MAE) speakers in the completion of 2 common phonological awareness tasks (rhyming and phoneme segmentation) when the stimulus items were consonant–vowel–consonant–consonant (CVCC) words and nonwords.

Method

Forty-nine 1st graders met criteria for 2 dialect groups: AAE and MAE. Three conditions were tested in each rhyme and segmentation task: Real Words No Model, Real Words With a Model, and Nonwords With a Model.

Results

The AAE group had significantly more responses that rhymed CVCC words with consonant–vowel–consonant words and segmented CVCC words as consonant–vowel–consonant than the MAE group across all experimental conditions. In the rhyming task, the presence of a model in the real word condition elicited more reduced final cluster responses for both groups. In the segmentation task, the MAE group was at ceiling, so only the AAE group changed across the different stimulus presentations and reduced the final cluster less often when given a model.

Conclusion

Rhyming and phoneme segmentation performance can be influenced by a child's dialect when CVCC words are used.

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The Oral Narrative Comprehension and Production Abilities of Verbal Preschoolers on the Autism Spectrum

Purpose

This study described the oral narrative comprehension and production skills of verbal preschool-age children on the autism spectrum and investigated correlations between oral narrative ability and norm-referenced language test performance.

Method

Twenty-nine preschool-age children (aged 4;0–5;9 years;months) with autism, who obtained an age-equivalent score of at least 36 months on the expressive communication subscale of the Vineland Adaptive Behavior Scales–Second Edition (Sparrow, Cicchetti, & Balla, 2005), participated. Children listened to an unfamiliar fictional narrative and answered comprehension questions afterward. After listening to the narrative a second time, children were asked to retell the narrative without picture support. Narratives were transcribed and analyzed for length, semantic diversity, grammatical complexity and accuracy, intelligibility, inclusion of critical events, and narrative stage.

Results

All children participated in the comprehension task, and 19 children produced an analyzable narrative retell. Compared with published data on typically developing children, significant difficulties were observed in narrative comprehension, intelligibility, and grammatical accuracy. Most of the children told descriptive or action sequences, with only 1 child producing an abbreviated episode. Significant positive correlations were found (a) between performance on the Peabody Picture Vocabulary Test–Fourth Edition (Dunn & Dunn, 2007) and semantic diversity and narrative comprehension and (b) between parent-reported receptive communication competence (Vineland Adaptive Behavior Scales–Second Edition) and narrative comprehension.

Conclusions

This study provides preliminary evidence of specific difficulties in oral narrative comprehension and production skills in verbal preschoolers on the autism spectrum.

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Masthead

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Introduction: Hearing Across the Lifespan (HEAL) 2016

Purpose

This introduction overviews this special issue on the Hearing Across the Lifespan (HEAL) conference, which was held in Cernobbio, Italy, June 2–4, 2016.

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Field Monitoring of Otoacoustic Emissions During Noise Exposure: Pilot Study in Controlled Environment

Purpose

In spite of all the efforts to implement workplace hearing conservation programs, noise-induced hearing loss remains the leading cause of disability for North American workers. Nonetheless, an individual's susceptibility to noise-induced hearing loss can be estimated by monitoring changes in hearing status in relation to the level of ambient noise exposure. The purpose of this study was to validate an approach that could improve workplace hearing conservation practices. The approach was developed using a portable and robust system designed for noisy environments and consisted of taking continuous measurements with high temporal resolution of the health status of the inner ear using otoacoustic emissions (OAEs).

Method

A pilot study was conducted in a laboratory, exposing human subjects to industrial noise recordings at realistic levels. In parallel, OAEs were measured periodically using the designed OAE system as well as with a commercially available OAE system, used as a reference.

Results

Variations in OAE levels were analyzed and discussed along with the limitations of the reference and designed systems.

Conclusions

This study demonstrates that the monitoring of an individual's OAEs could be useful in monitoring temporary changes in hearing status induced by exposure to ambient noise and could be considered as a new tool for effective hearing conservation programs in the workplace.

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Findings From EuroTrak Surveys From 2009 to 2015: Hearing Loss Prevalence, Hearing Aid Adoption, and Benefits of Hearing Aid Use

Purpose

The purpose of this study was to analyze data from the EuroTrak surveys performed from 2009 to 2015 in Germany, France, and the United Kingdom to identify factors that could account for the growth in hearing aid sales over that period.

Method

Data of 132,028 people—approximately 15,000 for each of the 3 countries at 3-year intervals—were collected using a questionnaire. The sample in each country was weighted using the respective country age–gender populations to get balanced results. Furthermore, 11,867 persons with self-reported hearing impairment filled in a comprehensive questionnaire on hearing status and related matters; 4,631 were hearing aid owners. Data were pooled over the 3 countries for each of the years 2009, 2012, and 2015 and analyzed for developments over the 6-year period. In certain cases, data were pooled across countries and years. The analysis focused on hearing loss prevalence, hearing aid adoption rates, satisfaction with hearing aids, and benefits of hearing aid use.

Results

Hearing loss prevalence was stable over the period around 10%—slightly higher for men than for women. Hearing aid adoption overall increased from 33% to 37%, and bilateral use increased from 55% to 69%. Intervals between hearing aid renewals decreased. These factors contribute to increased hearing aid sales. Bilateral users are more satisfied with the hearing aid product features (76%) and performance (72%) and use their hearing aids 9.1 hr per day, compared with unilateral users where the corresponding numbers are 71%, 67%, and 7.8 hr, respectively. Satisfaction with hearing aid product features and performance in general is slightly increasing; hearing aid users are 14.5% less exhausted at the end of the day compared with nonusers with similar hearing loss and exhibit less depressive and forgetfulness symptoms.

Conclusions

The prevalence of self-reported hearing loss is 10.6% and stable, and hearing aid adoption has increased, particularly of bilateral fittings that are more satisfactory and exhibit higher daily use patterns. Higher uptake of hearing aids contributes to growing hearing aid sales.

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Diagnosing and Screening in a Minority Language: A Validation Study

Purpose

The Turkish Digit Triplet Test for hearing self-screening purposes and the Turkish Matrix Test (TURMatrix) for follow-up hearing diagnostics offer an automated closed-set response format where patients respond by choosing from response alternatives. Their applicability for testing Turkish-speaking patients in their native language by German audiologists with different Turkish language skills was investigated.

Method

Tests were composed of spoken numbers (Turkish Digit Triplet Test) or sentences (TURMatrix). For 49 participants differing in hearing ability, speech reception thresholds (SRTs) in noise and quiet were obtained, for the TURMatrix with either the open- or closed-set response format, by audiologists with and without Turkish language skills, respectively.

Results

SRTs of both tests correlate closely with each other as well as with hearing ability, but not as closely as individual SRTs in quiet with hearing ability. SRTs in noise of listeners with normal hearing were about 0.7 dB lower for the closed-set than for the open-set response format.

Conclusions

The 2 tests yield comparable results and are applicable to professionals without suitable language skills. For the closed-set response format of the TURMatrix, literacy is crucial and supplemental (visual) cues improve performance. Speech audiometry in noise should assess suprathreshold processing deficits independently from language proficiency in the majority language.

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Ecological Momentary Assessment: Feasibility, Construct Validity, and Future Applications

Purpose

This research assessed the feasibility and construct validity of ecological momentary assessment in capturing the hearing experiences of adults with mild hearing impairment in natural environments.

Method

Twenty-nine adults between the ages of 55 and 79 years (M = 69 years) answered multiple surveys on a smartphone app over a 2-week trial. Participants also wore 1 environmental classifier and a streamer allowing bidirectional communication between smartphone and classifier. Surveys were triggered based on defined criteria, or by the participants. A paper-based self-report questionnaire was administered before and after the trial.

Results

Feasibility was indicated by high compliance rates, with a total of 1,128 surveys completed. Of these, 72% were completed during a listening event, 26% within 1 hr, and only 2% of the surveys more than 1 hr after the listening event. The mean survey completion time was 1 min 40 s. Mean pre- and post-trial self-report scores were not significantly different, indicating no reactivity. Construct validity was indicated by the close agreement between subjective ratings of listening situations and objective data from the hearing aid classifier.

Conclusions

Ecological momentary assessment is a feasible and valid research methodology for older adults with mild hearing impairment. The methodology has potential as a clinical counseling and outcome tool.

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Autonomic Nervous System Responses to Hearing-Related Demand and Evaluative Threat

Purpose

This paper consists of 2 parts. The purpose of Part 1 was to review the potential influence of internal (person-related) factors on listening effort. The purpose of Part 2 was to present, in support of Part 1, preliminary data illustrating the interactive effects of an external factor (task demand) and an internal factor (evaluative threat) on autonomic nervous system measures.

Method

For Part 1, we provided a brief narrative review of motivation and stress as modulators of listening effort. For Part 2, we described preliminary data from a study using a repeated-measures (2 × 2) design involving manipulations of task demand (high, low) and evaluative threat (high, low). The low-demand task consisted of repetition of sentences from a narrative. The high-demand task consisted of answering questions about the narrative, requiring both comprehension and recall. During the high evaluative threat condition, participants were filmed and told that their video recordings would be evaluated by a panel of experts. During the low evaluative threat condition, no filming occurred; participants were instructed to “do your best.” Skin conductance (sympathetic nervous system activity) and heart rate variability (HRV, parasympathetic activity) were measured during the listening tasks. The HRV measure was the root mean square of successive differences of adjacent interbeat intervals. Twelve adults with hearing loss participated.

Results

Skin conductance increased and HRV decreased relative to baseline (no task) for all listening conditions. Skin conductance increased significantly with an increase in evaluative threat, but only for the more demanding task. There was no significant change in HRV in response to increasing evaluative threat or task demand.

Conclusions

Listening effort may be influenced by factors other than task difficulty, as reviewed in Part 1. This idea is supported by the preliminary data indicating that the sympathetic nervous system response to task demand is modulated by social evaluative threat. More work is needed to determine the relative contributions of motivation and emotional stress on physiological responses during listening tasks.

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Reflections on Lake Como Conferences (2000–2016)

Purpose

We present an overview of the conceptualization and development of the Newborn Hearing Screening and Hearing Across the Lifespan (Lake Como) conferences from 2000 to 2016.

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Relation Between Listening Effort and Speech Intelligibility in Noise

Purpose

Subjective ratings of listening effort might be applicable to estimate hearing difficulties at positive signal-to-noise ratios (SNRs) at which speech intelligibility scores are near 100%. Hence, ratings of listening effort were compared with speech intelligibility scores at different SNRs, and the benefit of hearing aids was evaluated.

Method

Two groups of listeners, 1 with normal hearing and 1 with hearing impairment, performed adaptive speech intelligibility and adaptive listening effort tests (Adaptive Categorical Listening Effort Scaling; Krueger, Schulte, Brand, & Holube, 2017) with sentences of the Oldenburg Sentence Test (Wagener, Brand, & Kollmeier, 1999a, 1999b; Wagener, Kühnel, & Kollmeier, 1999) in 4 different maskers. Model functions were fitted to the data to estimate the speech reception threshold and listening effort ratings for extreme effort and no effort.

Results

Listeners with hearing impairment showed higher rated listening effort compared with listeners with normal hearing. For listeners with hearing impairment, the rating extreme effort, which corresponds to negative SNRs, was more correlated to the speech reception threshold than the rating no effort, which corresponds to positive SNRs. A benefit of hearing aids on speech intelligibility was only verifiable at negative SNRs, whereas the effect on listening effort showed high individual differences mainly at positive SNRs.

Conclusion

The adaptive procedure for rating subjective listening effort yields information beyond using speech intelligibility to estimate hearing difficulties and to evaluate hearing aids.

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A “Goldilocks” Approach to Hearing-Aid Self-Fitting: User Interactions

Purpose

The purpose of the current study was to evaluate user reactions to custom software designed for self-adjustment of amplification.

Method

“Goldilocks” software was developed to allow user exploration and selection of preferred levels of overall output, low-frequency cut, and high-frequency boost while listening to preprocessed speech. Thirteen hearing-aid users and 13 nonusers self-adjusted before and after taking a speech perception test incorporated into the software.

Results

All 26 participants were able to complete the 2 adjustments and the intervening test in an average of 6.5 min—20 of them from on-screen instructions without experimenter help. Relative to a generic starting condition, the average participant opted to increase overall output, reduce low-frequency cut, and increase high-frequency boost. The first and second self-selected values were highly correlated, but there was evidence of further increases of overall volume and high-frequency boost after speech perception testing with the initial adjustment. There was no evidence that prior hearing-aid experience affected the ability to understand or complete the self-fitting process.

Conclusions

This approach to hearing-aid self-fitting can be a speedy, reliable, and feasible alternative to, or supplement to, conventional fitting procedures, but many questions remain to be answered.

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Subjective Fatigue in Children With Hearing Loss Assessed Using Self- and Parent-Proxy Report

Purpose

The primary purposes of this study were to examine the effects of hearing loss and respondent type (self- vs. parent-proxy report) on subjective fatigue in children. We also examined associations between child-specific factors and fatigue ratings.

Method

Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS; Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). We compared self- and parent-proxy ratings from 60 children with hearing loss (CHL) and 43 children with normal hearing (CNH). The children ranged in age from 6 to 12 years.

Results

School-age CHL experienced more overall and cognitive fatigue than CNH, although the differences were smaller than previously reported. Parent-proxy report was not strongly associated with child self-report, and parents tended to underestimate their child's fatigue, particularly sleep/rest fatigue. Language ability was also associated with subjective fatigue. For CHL and CNH, as language abilities increased, cognitive fatigue decreased.

Conclusions

School-age CHL experience more subjective fatigue than CNH. The poor association between parent-proxy and child reports suggests that the parent-proxy version of the PedsQL-MFS should not be used in isolation when assessing fatigue in school-age children. Future research should examine how language abilities may modulate fatigue and its potential academic consequences in CHL.

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International Outcome Inventory for Hearing Aids: Data From a Large Swedish Quality Register Database

Purpose

The purpose of this study was to analyze a database of completed International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires obtained from over 100,000 clients fitted with new hearing aids in Sweden during the period of 2012–2016. Mean IOI-HA total scores were correlated with degree of hearing loss, unilateral versus bilateral fitting, first-time versus return clients, gender, and variation among dispensing clinics. The correlations with expectations, service quality, and technical functioning of the hearing aids were also analyzed.

Method

Questionnaires containing the 7 IOI-HA items as well as questions concerning some additional issues were mailed to clients 3–6 months after fitting of new hearing aids. The questionnaires were returned to and analyzed by an independent research institute.

Results

More than 100 dispensing clinics nationwide take part in this project. A response rate of 52.6% resulted in 106,631 data sets after excluding incomplete questionnaires. Forty-six percent of the responders were women, and 54% were men. The largest difference in mean score (0.66) was found for the IOI-HA item “use” between return clients and first-time users. Women reported significantly higher (better) scores for the item “impact on others” compared with men. The bilaterally fitted subgroup reported significantly higher scores for all 7 items compared with the unilaterally fitted subgroup. Experienced users produced higher scores on benefit and satisfaction items, whereas first-time users gave higher scores for residual problems. No correlation was found between mean IOI-HA total score and average hearing threshold level (pure-tone average [PTA]). Mean IOI-HA total scores were found to correlate significantly with perceived service quality of the dispensing center and with the technical functionality of the hearing aids.

Conclusions

When comparing mean IOI-HA total scores from different studies or between groups, differences with regard to hearing aid experience, gender, and unilateral versus bilateral fitting have to be considered. No correlation was found between mean IOI-HA total score and degree of hearing loss in terms of PTA. Thus, PTA is not a reliable predictor of benefit and satisfaction of hearing aid provision as represented by the IOI-HA items. Identification of a specific lower fence in PTA for hearing aid candidacy is therefore to be avoided. Large differences were found in mean IOI-HA total scores related to different dispensing centers.

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The ALFA4Hearing Model (At-a-Glance Labeling for Features of Apps for Hearing Health Care) to Characterize Mobile Apps for Hearing Health Care

Purpose

The aim of the study was to analyze, by using the ALFA4Hearing model (At-a-Glance Labeling for Features of Apps for Hearing Health Care), a sample of apps over a wide range of services in the hearing health care (HHC) domain in order to take a first picture of the current scenario of apps for HHC.

Method

We tested 120 apps, and we characterized them by using the ALFA4Hearing model, which includes 29 features in 5 components (Promoters, Services, Implementation, Users, and Descriptive Information). We analyzed (a) the distribution of the 29 features in the sample, (b) the relationship between the Implementation features and the Services provided by the apps, and (c) the distribution of the 29 features in apps for professional use.

Results

The analysis of our sample of apps by means of the ALFA4Hearing model highlighted interesting trends and emerging challenges. Also, results suggested many potential opportunities for research and clinical practice, such as greater involvement of stakeholders, improved evidence base, higher technical quality, and usability.

Conclusions

The ALFA4Hearing model is able to represent, at a glance, a large amount of information about apps for HHC, highlighting trends and challenges. It might be useful to HHC professionals as a basis for app characterization and informed decision making.

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Do Older Listeners With Hearing Loss Benefit From Dynamic Pitch for Speech Recognition in Noise?

Purpose

Dynamic pitch, the variation in the fundamental frequency of speech, aids older listeners' speech perception in noise. It is unclear, however, whether some older listeners with hearing loss benefit from strengthened dynamic pitch cues for recognizing speech in certain noise scenarios and how this relative benefit may be associated with individual factors. We first examined older individuals' relative benefit between natural and strong dynamic pitches for better speech recognition in noise. Further, we reported the individual factors of the 2 groups of listeners who benefit differently from natural and strong dynamic pitches.

Method

Speech reception thresholds of 13 older listeners with mild–moderate hearing loss were measured using target speech with 3 levels of dynamic pitch strength. Individuals' ability to benefit from dynamic pitch was defined as the speech reception threshold difference between speeches with and without dynamic pitch cues.

Results

The relative benefit of natural versus strong dynamic pitch varied across individuals. However, this relative benefit remained consistent for the same individuals across those background noises with temporal modulation. Those listeners who benefited more from strong dynamic pitch reported better subjective speech perception abilities.

Conclusion

Strong dynamic pitch may be more beneficial than natural dynamic pitch for some older listeners to recognize speech better in noise, particularly when the noise has temporal modulation.

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Stimulus Characteristics of Single-Word Tests of Children's Speech Sound Production

Purpose

This clinical focus article provides readers with a description of the stimulus characteristics of 12 popular tests of speech sound production.

Method

Using significance testing and descriptive analyses, stimulus items were compared in terms of the number of opportunities for production of all consonant singletons, clusters, and rhotic and nonrhotic vowels of Standard American English; phonetic/phonological and structural complexity; and the presence of bound morphemes.

Results

The tests varied widely in terms of the number of opportunities for production of consonant singletons, clusters, and rhotic and nonrhotic vowels. Most of the tests included only 1 opportunity, scored or unscored, to produce a majority of the consonant singletons in each word position. Only 3 of the tests included stimulus items with 3-element clusters. The majority contained limited opportunities to produce 3- or 4-syllable stimulus items. The tests provided sufficient opportunities for production of most vowels, although most did not score vowels. The tests differed significantly in the complexity of their stimulus items. Most, however, contained a negligible number of items that, with the addition of a bound morpheme, resulted in a word-final cluster.

Conclusion

Most of the tests elicit an inadequate sample with which to conduct a comprehensive phonological analysis.

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Developmental Stuttering in Children Who Are Hard of Hearing

Purpose

A number of studies with large sample sizes have reported lower prevalence of stuttering in children with significant hearing loss compared to children without hearing loss. This study used a parent questionnaire to investigate the characteristics of stuttering (e.g., incidence, prevalence, and age of onset) in children who are hard of hearing (CHH).

Method

Three hundred three parents of CHH who participated in the Outcomes of Children With Hearing Loss study (Moeller & Tomblin, 2015) were sent questionnaires asking about their child's history of stuttering.

Results

One hundred ninety-four parents of CHH responded to the survey. Thirty-three CHH were reported to have stuttered at one point in time (an incidence of 17.01%), and 10 children were still stuttering at the time of survey submission (a prevalence of 5.15%). Compared to estimates in the general population, this sample displayed a significantly higher incidence and prevalence. The age of onset, recovery rate, and other characteristics were similar to hearing children.

Conclusions

Based on this sample, mild to moderately severe hearing loss does not appear to be a protective factor for stuttering in the preschool years. In fact, the incidence and prevalence of stuttering may be higher in this population compared to the general population. Despite the significant speech and language needs that children with mild to moderately severe hearing loss may have, speech-language pathologists should appropriately prioritize stuttering treatment as they would in the hearing population.

Supplemental Material

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Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys

Purpose

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population.

Method

We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation.

Results

Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%–56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%–22% experiencing food insecurity, compared to 11%–14% of their peers without any indications of speech-language difficulties).

Conclusions

We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

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Emergent Literacy Skills in Preschool Children With Hearing Loss Who Use Spoken Language: Initial Findings From the Early Language and Literacy Acquisition (ELLA) Study

Purpose

The purpose of this study was to compare change in emergent literacy skills of preschool children with and without hearing loss over a 6-month period.

Method

Participants included 19 children with hearing loss and 14 children with normal hearing. Children with hearing loss used amplification and spoken language. Participants completed measures of oral language, phonological processing, and print knowledge twice at a 6-month interval. A series of repeated-measures analyses of variance were used to compare change across groups.

Results

Main effects of time were observed for all variables except phonological recoding. Main effects of group were observed for vocabulary, morphosyntax, phonological memory, and concepts of print. Interaction effects were observed for phonological awareness and concepts of print.

Conclusions

Children with hearing loss performed more poorly than children with normal hearing on measures of oral language, phonological memory, and conceptual print knowledge. Two interaction effects were present. For phonological awareness and concepts of print, children with hearing loss demonstrated less positive change than children with normal hearing. Although children with hearing loss generally demonstrated a positive growth in emergent literacy skills, their initial performance was lower than that of children with normal hearing, and rates of change were not sufficient to catch up to the peers over time.

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How African American English-Speaking First Graders Segment and Rhyme Words and Nonwords With Final Consonant Clusters

Purpose

This study explored how typically developing 1st grade African American English (AAE) speakers differ from mainstream American English (MAE) speakers in the completion of 2 common phonological awareness tasks (rhyming and phoneme segmentation) when the stimulus items were consonant–vowel–consonant–consonant (CVCC) words and nonwords.

Method

Forty-nine 1st graders met criteria for 2 dialect groups: AAE and MAE. Three conditions were tested in each rhyme and segmentation task: Real Words No Model, Real Words With a Model, and Nonwords With a Model.

Results

The AAE group had significantly more responses that rhymed CVCC words with consonant–vowel–consonant words and segmented CVCC words as consonant–vowel–consonant than the MAE group across all experimental conditions. In the rhyming task, the presence of a model in the real word condition elicited more reduced final cluster responses for both groups. In the segmentation task, the MAE group was at ceiling, so only the AAE group changed across the different stimulus presentations and reduced the final cluster less often when given a model.

Conclusion

Rhyming and phoneme segmentation performance can be influenced by a child's dialect when CVCC words are used.

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The Oral Narrative Comprehension and Production Abilities of Verbal Preschoolers on the Autism Spectrum

Purpose

This study described the oral narrative comprehension and production skills of verbal preschool-age children on the autism spectrum and investigated correlations between oral narrative ability and norm-referenced language test performance.

Method

Twenty-nine preschool-age children (aged 4;0–5;9 years;months) with autism, who obtained an age-equivalent score of at least 36 months on the expressive communication subscale of the Vineland Adaptive Behavior Scales–Second Edition (Sparrow, Cicchetti, & Balla, 2005), participated. Children listened to an unfamiliar fictional narrative and answered comprehension questions afterward. After listening to the narrative a second time, children were asked to retell the narrative without picture support. Narratives were transcribed and analyzed for length, semantic diversity, grammatical complexity and accuracy, intelligibility, inclusion of critical events, and narrative stage.

Results

All children participated in the comprehension task, and 19 children produced an analyzable narrative retell. Compared with published data on typically developing children, significant difficulties were observed in narrative comprehension, intelligibility, and grammatical accuracy. Most of the children told descriptive or action sequences, with only 1 child producing an abbreviated episode. Significant positive correlations were found (a) between performance on the Peabody Picture Vocabulary Test–Fourth Edition (Dunn & Dunn, 2007) and semantic diversity and narrative comprehension and (b) between parent-reported receptive communication competence (Vineland Adaptive Behavior Scales–Second Edition) and narrative comprehension.

Conclusions

This study provides preliminary evidence of specific difficulties in oral narrative comprehension and production skills in verbal preschoolers on the autism spectrum.

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Masthead

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Introduction: Hearing Across the Lifespan (HEAL) 2016

Purpose

This introduction overviews this special issue on the Hearing Across the Lifespan (HEAL) conference, which was held in Cernobbio, Italy, June 2–4, 2016.

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Field Monitoring of Otoacoustic Emissions During Noise Exposure: Pilot Study in Controlled Environment

Purpose

In spite of all the efforts to implement workplace hearing conservation programs, noise-induced hearing loss remains the leading cause of disability for North American workers. Nonetheless, an individual's susceptibility to noise-induced hearing loss can be estimated by monitoring changes in hearing status in relation to the level of ambient noise exposure. The purpose of this study was to validate an approach that could improve workplace hearing conservation practices. The approach was developed using a portable and robust system designed for noisy environments and consisted of taking continuous measurements with high temporal resolution of the health status of the inner ear using otoacoustic emissions (OAEs).

Method

A pilot study was conducted in a laboratory, exposing human subjects to industrial noise recordings at realistic levels. In parallel, OAEs were measured periodically using the designed OAE system as well as with a commercially available OAE system, used as a reference.

Results

Variations in OAE levels were analyzed and discussed along with the limitations of the reference and designed systems.

Conclusions

This study demonstrates that the monitoring of an individual's OAEs could be useful in monitoring temporary changes in hearing status induced by exposure to ambient noise and could be considered as a new tool for effective hearing conservation programs in the workplace.

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Findings From EuroTrak Surveys From 2009 to 2015: Hearing Loss Prevalence, Hearing Aid Adoption, and Benefits of Hearing Aid Use

Purpose

The purpose of this study was to analyze data from the EuroTrak surveys performed from 2009 to 2015 in Germany, France, and the United Kingdom to identify factors that could account for the growth in hearing aid sales over that period.

Method

Data of 132,028 people—approximately 15,000 for each of the 3 countries at 3-year intervals—were collected using a questionnaire. The sample in each country was weighted using the respective country age–gender populations to get balanced results. Furthermore, 11,867 persons with self-reported hearing impairment filled in a comprehensive questionnaire on hearing status and related matters; 4,631 were hearing aid owners. Data were pooled over the 3 countries for each of the years 2009, 2012, and 2015 and analyzed for developments over the 6-year period. In certain cases, data were pooled across countries and years. The analysis focused on hearing loss prevalence, hearing aid adoption rates, satisfaction with hearing aids, and benefits of hearing aid use.

Results

Hearing loss prevalence was stable over the period around 10%—slightly higher for men than for women. Hearing aid adoption overall increased from 33% to 37%, and bilateral use increased from 55% to 69%. Intervals between hearing aid renewals decreased. These factors contribute to increased hearing aid sales. Bilateral users are more satisfied with the hearing aid product features (76%) and performance (72%) and use their hearing aids 9.1 hr per day, compared with unilateral users where the corresponding numbers are 71%, 67%, and 7.8 hr, respectively. Satisfaction with hearing aid product features and performance in general is slightly increasing; hearing aid users are 14.5% less exhausted at the end of the day compared with nonusers with similar hearing loss and exhibit less depressive and forgetfulness symptoms.

Conclusions

The prevalence of self-reported hearing loss is 10.6% and stable, and hearing aid adoption has increased, particularly of bilateral fittings that are more satisfactory and exhibit higher daily use patterns. Higher uptake of hearing aids contributes to growing hearing aid sales.

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Diagnosing and Screening in a Minority Language: A Validation Study

Purpose

The Turkish Digit Triplet Test for hearing self-screening purposes and the Turkish Matrix Test (TURMatrix) for follow-up hearing diagnostics offer an automated closed-set response format where patients respond by choosing from response alternatives. Their applicability for testing Turkish-speaking patients in their native language by German audiologists with different Turkish language skills was investigated.

Method

Tests were composed of spoken numbers (Turkish Digit Triplet Test) or sentences (TURMatrix). For 49 participants differing in hearing ability, speech reception thresholds (SRTs) in noise and quiet were obtained, for the TURMatrix with either the open- or closed-set response format, by audiologists with and without Turkish language skills, respectively.

Results

SRTs of both tests correlate closely with each other as well as with hearing ability, but not as closely as individual SRTs in quiet with hearing ability. SRTs in noise of listeners with normal hearing were about 0.7 dB lower for the closed-set than for the open-set response format.

Conclusions

The 2 tests yield comparable results and are applicable to professionals without suitable language skills. For the closed-set response format of the TURMatrix, literacy is crucial and supplemental (visual) cues improve performance. Speech audiometry in noise should assess suprathreshold processing deficits independently from language proficiency in the majority language.

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Ecological Momentary Assessment: Feasibility, Construct Validity, and Future Applications

Purpose

This research assessed the feasibility and construct validity of ecological momentary assessment in capturing the hearing experiences of adults with mild hearing impairment in natural environments.

Method

Twenty-nine adults between the ages of 55 and 79 years (M = 69 years) answered multiple surveys on a smartphone app over a 2-week trial. Participants also wore 1 environmental classifier and a streamer allowing bidirectional communication between smartphone and classifier. Surveys were triggered based on defined criteria, or by the participants. A paper-based self-report questionnaire was administered before and after the trial.

Results

Feasibility was indicated by high compliance rates, with a total of 1,128 surveys completed. Of these, 72% were completed during a listening event, 26% within 1 hr, and only 2% of the surveys more than 1 hr after the listening event. The mean survey completion time was 1 min 40 s. Mean pre- and post-trial self-report scores were not significantly different, indicating no reactivity. Construct validity was indicated by the close agreement between subjective ratings of listening situations and objective data from the hearing aid classifier.

Conclusions

Ecological momentary assessment is a feasible and valid research methodology for older adults with mild hearing impairment. The methodology has potential as a clinical counseling and outcome tool.

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Autonomic Nervous System Responses to Hearing-Related Demand and Evaluative Threat

Purpose

This paper consists of 2 parts. The purpose of Part 1 was to review the potential influence of internal (person-related) factors on listening effort. The purpose of Part 2 was to present, in support of Part 1, preliminary data illustrating the interactive effects of an external factor (task demand) and an internal factor (evaluative threat) on autonomic nervous system measures.

Method

For Part 1, we provided a brief narrative review of motivation and stress as modulators of listening effort. For Part 2, we described preliminary data from a study using a repeated-measures (2 × 2) design involving manipulations of task demand (high, low) and evaluative threat (high, low). The low-demand task consisted of repetition of sentences from a narrative. The high-demand task consisted of answering questions about the narrative, requiring both comprehension and recall. During the high evaluative threat condition, participants were filmed and told that their video recordings would be evaluated by a panel of experts. During the low evaluative threat condition, no filming occurred; participants were instructed to “do your best.” Skin conductance (sympathetic nervous system activity) and heart rate variability (HRV, parasympathetic activity) were measured during the listening tasks. The HRV measure was the root mean square of successive differences of adjacent interbeat intervals. Twelve adults with hearing loss participated.

Results

Skin conductance increased and HRV decreased relative to baseline (no task) for all listening conditions. Skin conductance increased significantly with an increase in evaluative threat, but only for the more demanding task. There was no significant change in HRV in response to increasing evaluative threat or task demand.

Conclusions

Listening effort may be influenced by factors other than task difficulty, as reviewed in Part 1. This idea is supported by the preliminary data indicating that the sympathetic nervous system response to task demand is modulated by social evaluative threat. More work is needed to determine the relative contributions of motivation and emotional stress on physiological responses during listening tasks.

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Reflections on Lake Como Conferences (2000–2016)

Purpose

We present an overview of the conceptualization and development of the Newborn Hearing Screening and Hearing Across the Lifespan (Lake Como) conferences from 2000 to 2016.

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Relation Between Listening Effort and Speech Intelligibility in Noise

Purpose

Subjective ratings of listening effort might be applicable to estimate hearing difficulties at positive signal-to-noise ratios (SNRs) at which speech intelligibility scores are near 100%. Hence, ratings of listening effort were compared with speech intelligibility scores at different SNRs, and the benefit of hearing aids was evaluated.

Method

Two groups of listeners, 1 with normal hearing and 1 with hearing impairment, performed adaptive speech intelligibility and adaptive listening effort tests (Adaptive Categorical Listening Effort Scaling; Krueger, Schulte, Brand, & Holube, 2017) with sentences of the Oldenburg Sentence Test (Wagener, Brand, & Kollmeier, 1999a, 1999b; Wagener, Kühnel, & Kollmeier, 1999) in 4 different maskers. Model functions were fitted to the data to estimate the speech reception threshold and listening effort ratings for extreme effort and no effort.

Results

Listeners with hearing impairment showed higher rated listening effort compared with listeners with normal hearing. For listeners with hearing impairment, the rating extreme effort, which corresponds to negative SNRs, was more correlated to the speech reception threshold than the rating no effort, which corresponds to positive SNRs. A benefit of hearing aids on speech intelligibility was only verifiable at negative SNRs, whereas the effect on listening effort showed high individual differences mainly at positive SNRs.

Conclusion

The adaptive procedure for rating subjective listening effort yields information beyond using speech intelligibility to estimate hearing difficulties and to evaluate hearing aids.

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